Running head: POSTION PAPER

Position Paper
Clayton Jensen
Professor Kristen Espinoza
NURS*409*01

Running head: POSTION PAPER

Society very often underestimates the value of a nurse. So much so that even those in the
profession refer to themselves and their job as just being a nurse. This thought process isn't
exactly anyone's fault. Nursing has come a long way from where it started. Look back at where
nursing started in history. In England during the protestant reformation (1517 - 1648), the care of
the sick was provided by common women, often those of the lower classes who were too old or
too ill to find any other type of work. That definition sounds a lot like what a Walmart greeter's
would be. They were also seen as people prone to fighting, foul language, petty theft, and
extortion of money from patients (Pavey 1953). So in all reality they were worse than a Walmart
greeter's definition. They were the scum of society.
Due to the advancement of a nurse's skill-set, nursing education has blossomed to
something of a prestigious undertaking amongst the medical community. As one who is currently
in this educational endeavor of becoming a nurse, I will say that the safety of those patients in my
nursing future will be extremely grateful for the high nursing education standards that are
required of any nursing student through their educational process.
Acquiring a nursing degree means that you have learned and understand the mechanisms
of the body and the many pathophysiologies that come with it, learned the language of the
medical profession, and how to take care of a patient with any severity of injury from a textbook
point of view. This includes administering medications. There is a lot missing still from a nursing
education that is required to be a great nurse. The main thing missing is simply experience, which
no schooling program can truly provide. This being said, you can't acquire that experience
before acquiring the tools needed for its acquisition. For this purpose nursing school is important
to the preparation of a future nurse and the quality of care of their patients. You can't play the

Running head: POSTION PAPER

game without learning first how the game is played.

As a nurse progresses and develops in their field it is hard not to notice the things in the
health-care and societal system that need modifying. This brings up the power, authority, and true
influence on the organizational and legal systems, that govern our society, that a nurse possesses.
Often times nurses do not see this important influence for good which they have. Nurses often
ask how can I make a difference. The response to this question lies in the many different
powers a nursing professional has. There are six main sources of power that a nurse has and
should use to not only better care for those they serve but to be a better advocate for those who
cannot. These six powers are: The Potential Power of Numbers, Expert Power, Legitimate Power,
Referent Power, Reward Power, and Coercive Power.
The potential power of numbers is exactly what it says it is. Nurses sometimes forget that
as the largest group of health care providers, they could generate enough power to successfully
reform the health care system based on numbers alone. According to the 2004 National Sample
Survey of Registered Nurses, there are 2.9 million registered nurses who are dispersed in every
voting district in the nation (U.S. Department of Health and Human Services, n.d.).
Expert power is related to possessing the knowledge and skill that someone else needs
(Cohen, 1992)..
Legitimate power is that bestowed by the particular status or the role of an individual
(Cohen et al., 1998). Every nurse possesses this source of power whether they know it or not.
They receive this power through the license they are required to have in order to practice by their
State Board of Nursing.
Referent power is a source of power available to nurse policy advocates. It is gained by
having other peoples admiration and respect (Cohen et al., 1998). Nursing is often defined as a

Running head: POSTION PAPER

the protection, promotion, and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and populations (LeMone, 2013). The
Gallup Organizations 2006 annual poll on professional honesty and ethical standards ranked
nurses as number one in terms of public respect (Saad, 2006).
Lastly there is Reward and Coercive power. A nurse has the ability to practice both and
obtain power from either. Although the power that will be retained the longest would be through
Reward power. We often times see those of high legitimate power utilize Coercive power to
manipulate those around them. This always ends badly. The power acquired through reward
power would have granted them more influence in the end. A nurse is better off utilizing reward
power when he or she can, which is almost all situations.
Legal authority as described by Eleanor J. Sullivan states that legal authority is defined by
the Nurse Practice Act whereas organizational authority is defined by the companys job
description. In other words, legal authority includes all registered nurses regardless of their
employment. This legal authority of a nurse includes obtaining a license through the state in
order to verify the competence of the individual. It is compiled of a series of steps that require
proof of graduation from an accredited nursing school, sufficient clinical hours, completing the
application process for licensure and background check, and passing the National Council
Licensure Examination (Utah Department of Administrative, 2015).
Organizational authority is more individualized. For example, when applying for a
nursing position with an organization such as the American Fork Hospital, the position posting
will describe the hierarchical status, such as management or staff, and the responsibilities
expected while in that specific position.

Running head: POSTION PAPER

The roles of a professional nurse are endless. Nurses have a role as a leader, medication
administrator, supporter, collaborator, motivator, teacher and many more. Based on my individual
practice, I have found the most significant roles to me include being an advocate for clients, a
teacher, a confidence builder and a safety specialist. As I begin putting myself in a nursing role, I
anticipate starting my career by focusing on the safety of my clients, and addressing their most
basic needs to create a sound basis for care. Furthermore, being an advocate for clients is
essential to provide and build a firm foundation for care. As I become more experienced, I see
myself developing more advanced roles such as a delegator and even a leader.
It is important to understand the nurses scope of practice is defined in two ways:
by the state boards of nursing, and by the hospital job description. Additionally Each state has the
legal authority to define the role that the RN has. If ever needed I can refer to the Nurse Practice
Act for guidance before jumping into a task for which I could be held legally accountable for.
The Nurse Practice Act, which defines a nurses scope of practice for each state, will be my
ultimate guide when determining my scope of practice.
Delegation is defined according to each state, and therefore, I will also refer back to the
Nurse Practice Act of my state for the appropriate delegation to LPNs, UAPs, and CNAs
(LaCharity, Kumagai, & Bartz, 2013). By learning how to delegate tasks such as ADLs to others
in your team, patients needs will be met sooner than if a nurse was working alone. It is important
to remember delegation comes with a price, those who you delegate are operating under the
nurse's license and good judgment. The nurse is accountable for the delegatee's actions.
To be accountable is defined as upholding obligations or taking ownership for decisions
and results (Sullivan, 2012, p. 132). Breaking down accountability you would find that it consists

Running head: POSTION PAPER

of two main aspects, answerability and responsibility. Responsibility is the process of carrying
out an action while answerability is the ability to say "yes" to an action one performs.
The Nurse Practice Act of Utah states a registered nurse is accountable for operating
within their scope of practice. (Utah Department of administrative code: Nurse practice rule,
2015). A registered nurse is accountable for their own actions in regards to direct patient care, as
well as their communication to other healthcare providers. accountability can be applied to nurses
within both organizations and the professional field. Nurses are accountable within the
professional organization when they consistently work to improve patient care, and promote
safety. Accountability applies to the professional field when a nurse implements evidenced based
practice or complies and is involved in governance issues that influence nursing practice, and
continuing education (Battie, 2014).
Accountability not only relates to the scope of practice the nurse performs personally but
also to those the nurse delegates a task to and their personal performance. By delegating a task to
another LPN, CNA, or UAP you are saying that person has your trust to perform a task for you in
their scope of practice. They are operating now under the nurses license as well as Their own.
The same applies to managers and charge nurses who have more authority and therefore can
delegate down the chain of command, but they are also responsible for the deferred tasks.
Education, authority, nursing roles, and accountability are extremely important however I
feel ethics is the most important. You cannot exercise any of these principles without ethics. It is
important that as a member of the health care team I know what my own personal ethics are so as
to not pass personal bias as much as possible.
The health care profession is one that often places ethical dilemmas in the hands of the
professional working in the field. Knowing my own ethical principles allows me to know my

Running head: POSTION PAPER

own potential bias in a situation.

Professionally a nurse's ethics were defined by the nine provisions stated by the ANA in
2015 Code of Ethics for Nurses. Provision one states that the nurse, in all professional
relationships, practices with compassion and the recognition of human dignity and worth which
is present in every individual. Provision two states that the primary commitment of the nurse is to
the patient, whether the patient is defined as an individual, group, or community. Provision three
states that the nurse seeks to protect the health, safety, and rights of the patient. Provision four
states that that the nurse has accountability, authority and responsibility, for nursing practice.
Provision five states that the nurse has a duty to self to maintain competence and to continue
professional growth. Provision six states that the nurse facilitates improvement of the healthcare
environment. Provision seven states that the nurse assists in advancement of the profession
through contributions to practice, education, administration, and knowledge development.
Provision eight states that the nurse collaborates with the public and other health professionals in
promoting community, national and international efforts to meet health needs. Lastly, provision
nine states that the profession of nursing collectively must strive to articulate nursing values,
maintain the integrity of the nursing profession, and integrate social justice.
In conclusion there is a lot to being a nurse. A student right out of school is not expected
to know what all those aspects are. Nurses are continually learning and growing in numbers of
powerful and influential people. As Florence Nightingale put it, "Nursing is an art: and if it is to
be made an art, it requires an exclusive devotion as hard a preparation as any painter's or
sculptor's work; for what is the having to do with dead canvas or dead marble, compared with
having to do with the living body, the temple of God's spirit? It is one of the Fine Arts: I had
almost said, the finest of Fine Arts." Essentially nursing is not only structured but also

Running head: POSTION PAPER

individualized. If there were the same art in every home or museum it wouldn't be considered art
but rather normal. Nursing is using the structure built by those before us while making it our
own. All that truly matters is that you are ready to help people and are open to change. With that
any nurse can and will become a great nurse.

Running head: POSTION PAPER

Citations
Baitte, R. & Steelman, V.M. (2014). Accountability in nursing practice: Why it is important for
patient safety. AORN Journal 100(5). p. 537-541.
Cohen, S.S., Leavitt, J.K., Leonhardt, M.A, & Mason, D.J. (1998). Political analysis and Strategy.
In D. Mason & J. K. Leavitt (Eds.), Policy and politics in nursing and health care(3rd ed.).
(pp. 139-159). Philadelphia, PA: W.B. Saunders Company.
LaCharity, L.A., Kumagai, C.K., & Bartz, B. (2013). Prioritization, Delegation Assignment:
Practice exercises for medical-surgical nursing. (3rd ed.) St. Louis, MO: Mosby.
LeMone, P. (2013). Medical-surgical nursing: critical thinking in patient care. (5th ed., Pearson
new international ed.). Upper Saddle River, N.J.: Pearson.
Pavey, A.E. (1953). the story of the growth or nursing as an art, a vocation, and a profession (4th
ed.). Philadelphia: J.B. Lippincott.
Saad, L. (2006). Nursing tops the list of most honest and ethical professions. The Gallup Poll.
Retrieved on December 22, 2006 from www.galluppoll.com/content/?ci=25888&pg=1
Sullivan, E. J. (2012). Effective Leadership and Management in Nursing (8th ed.). Boston, MA:
Prentice Hall.
U.S. Department of Health and Human Services. HRSA. (n.d.). Preliminary findings: 2004
National sample survey of registered nurses. Retrieved January 20, 2007
fromhttp://bhpr.hrsa.gov/healthworkforce/reports/rnpopulation/preliminaryfindings.htm
Utah Department of Administrative services Division of Administrative Rules. (2015). Utah
Administrative Code: Nurse Practice Rule. Retrieved from