Running head: NURSING

Nursing Lindsey Koch Ferris State University

NURSING Abstract Nursing is more than just taking care of patients. Nursing involves the continual acquisition of new knowledge, a positive attitude, and skills. This paper will outline the knowledge, skills, and attitudes in my current practice. Next I will outline my philosophy using the four metaparadigm concepts of person, health, and environment and cover nursing theory. Then I will cover my transition of my knowledge, skills, and attitudes into my BSN role. Lastly, I will conclude the paper with my reflection.

NURSING Nursing During my associate degree in nursing (ADN) program at Mid-Michigan Community

College, I was exposed to several types of nursing theories that worked to help make us students more experienced nurses in our scope of practice. In my ADN program, we focused on all three concepts of nursing: person, environment, and health to make ourselves better registered nurses (RN). By being better nurses, we were able to provide better care to our patients. I believe that using different types of nursing theories together makes nurses better-rounded than if they just focus on using one theory of nursing. For example, not all patients can be affected the same way so nurses may have to try different theories to help promote health in an individual patient. Many plans of care need to be personalized by using various or certain types of theories. This is why I am adding to my current scope of practice to transition into a bachelor of science in nursing (BSN) nurse. By becoming a BSN, I will become a better nurse from the way that I incorporate nursing theories into my scope of practice to provide more well-rounded care for my patients. The purpose of this paper is to identify my current practice, describe my current philosophy of nursing, and my transition into a BSN role. Current Practice As a new nurse, my current practice is very limited. I recently graduated with my ADN from Mid- Michigan Community College. I graduated in May, 2013, and I finished my preceptorship at Mid-Michigan Medical Center-Midland at the beginning of June. Throughout the nursing program, I received experience at Mid-Michigan Medical Center-Midland, St. Marys of Michigan-Saginaw, and Stratford Village-Midland. Most of my experience was at

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Mid-Michigan Medical Center-Midland with their medical-surgical floors, obstetrics/gynecology floor, and mental health floor. After receiving a job at a nursing home a couple weeks ago, I am now doing on the floor training at their facility. Even with a broad area of practice, I do not believe that experience is enough until the nurse gets to where they are going to work and learn that facilitys system. As cited in Black (2014), the American nursing association (ANA) outlines the expectations of the professional role within which all RNs must practice and delineates the standards of care and associated competencies for professional nursing (p. 59). The national council licensure examination (NCLEX) determines if a nurses knowledge level is appropriate. I feel that my knowledge level is appropriate, but ANA outlines standard 8 to encourage life-long learning (White & OSullivan, 2012). I feel that I am obtaining the level of knowledge that I want by working on a nursing unit with the nursing skills I have acquired over the years. Starting out at my first nursing job, I felt completely unprepared, but by thinking with a positive attitude, I was able to learn more details of my job. When starting out as a new nurse, I believe that nurses can expect to feel that they dont obtain the level knowledge and skills that are needed to work out on the floor, but with a positive attitude, they can quickly get to that level. The following sections will outline the knowledge, skills and attitude needed in my current position. Knowledge Starting out as a RN, a nurse needs to know the basic knowledge that is taught to them in nursing school. After getting hired at a new job, the facility will teach the nurse the knowledge that they need to perform successfully at that facility. New nurses need to learn what their scope of practice is to successfully perform their job. Starting out, a new graduate needs to know the

NURSING basic knowledge involved in their basic scope and standards of practice for starting out, but as they work, they will learn more specific rules to follow according to their specific job. For

example, that is why nurses take the national council licensure examination (NCLEX) to test that the nurse is competent enough to be working on the floor and that they have the basic knowledge to work out on the floor. When a nurse passes the NCLEX, the nurse is proving that they have the basic knowledge to be able to work competently as a registered nurse. From that point on, the nurse expands their knowledge through continuing education and experience from working at their new hired facility. Skills In my opinion, most nursing schools now put a significant focus on clinical skills. With skills labs and clinical rotations, nurses are able to graduate with more than basic skills. Additional skills training are also available at most facilities. For example, I recently signed up for a class to expand my knowledge of wound vac dressings. I want to expand my skills past the basic knowledge that I graduated with. Also, with the use of technology, online information is available with directions on how to use most skills. Another example is that some hospitals have their policies and procedures on private websites for their employees. I believe that this can greatly help a new nurse that wasnt 100% sure about a step in a certain procedure or at least help the nurse to navigate through their questions. I believe that, as a nurse, the best way to develop skills is to practice. Nurses are not expected to know every skill, but thats where they use their knowledge on where to find instructions on certain skills. They need to know where to find their resources and how to use them. This intertwines with their knowledge because both are needed to critically think and get their work done. With a positive attitude, nurses are able to work through most situations.

NURSING Attitude A positive attitude is needed to survive as a new nurse. A new nurse will not know

everything or know how to do everything, but they need to possess a positive attitude so that they can find out the answer or be able to find procedures. For example, according to Colleen Owens (2007), a writer for the advance healthcare network for nurses states, Often, the biggest challenge new nurse face is the reality shock that hits once they enter full-time practice new nurses may feel they are not prepared to meet the needs of their patients (p. 73). This can cause those new nurses to have a bad attitude and be very disappointed in their schooling. This happened to me when I first started at Tendercare. Being responsible for many patients or residents can take a toll on a nurses attitude. Not all nurses are prepared to realize that they have more to learn, and that they need to keep a positive attitude. In my experience, if you ask a nurse that has been practicing for twenty years or even a newer nurse, they will all tell you that they learn new things every day. Each nurse needs to realize that they will be continuing their education and learning for the rest of their career. Keep a positive attitude because these new experiences will make each nurse a better nurse for their patients. Knowledge, skills, and attitude are very unique to nursing. Nursing is always changing. Nurses must always keep a positive attitude to be able to take the greatest care of their patients. With being a lifelong learner, knowledge will continue to grow throughout the years. The skills that have been learned could change to improved techniques and with that, a nurses knowledge and skills will grow. Dont be frustrated because being a nurse is a unique experience that will keep you growing throughout your whole profession.

NURSING Philosophy Black (2014) states, Philosophy is defined as the study of the principles underlying conduct, thought, and the nature of the universe (p. 261). To me, philosophy means diggings deeper into the meaning of why something works the way it does. It is important because nurses use philosophy to try to understand many things in life like their patients or fellow nurses. Why do they do what they do? Black also states that, Philosophy begins when someone contemplates, or wonders about, something (p. 261). This can apply to many aspects of life. I believe that each person can view a philosophy differently because I do not believe that any two

people think exactly alike. I believe philosophy is important because it is a fundamental part of a nurses core that drives us to wonder why and critically think. Do different philosophies affect the way nurses care for their patients? I believe that each philosophy affects how nurses care for their patients. Nursing care is made up of three nursing concepts: person, health, and environment. Over the next few paragraphs, I will outline the details of my understanding of each nursing concept with a unique philosophy. Person Person is one of the most important nursing concepts. To me, person, as a nursing concept, means that each patient is their own person who has their own individualized needs that you will need to adjust your care plans to. One example in Black (2014) is Orems model which focuses on the patients self-care capacities and the process of designing nursing actions to meet the patients self-care needs (p. 273). Individuals are treated by their own individualized needs to help them grow during their health needs. Person is such an important concept because

NURSING nursing care will not be the same for every patient. For example, patients needs are different according to their individualized personality, level of health, and even environment. Health Another nursing concept is health. To me, health as a nursing concept is the level at which an individual is functioning at and helping that individual heal. I believe that it is an

important concept because individuals need different care according to their health and whatever stress or illness they may be going through. For example, an eighty-year old patient with metastasized end stage cancer would probably get different nursing care than a twenty-five year old patient with stage one cancer. In my experience, nursing care could be provided to the eighty year old by providing comfort care while the twenty-five year old patient would most likely get aggressive treatment to fight the cancer. Health can play a big role in how to give care to a patient. Black (2014) states, the patients baseline ability to provide adequate self-care is assessed by the nurse to determine the extent to which the patient is limited in providing his or her own effective care (p. 273). Nurses work with the patient to see where they are at in their health to be able to provide effective nursing to them. They need to work with the patient to see if the patient needs certain care because of their level of health or because of another reason such as environment. Environment The final concept that I am going to touch on is environment. To me, environment is the support system and area from which a person comes from. This can greatly affect nursing care because some individuals need to be nursed differently due to their environments. Environment can affect a patients ability to take care of their own self. Nurses may expect the patient to do

NURSING more for themself than they are expected to do at home. The patient may be surrounded by family who takes care of all of their needs. Black (2014) states that factors such as age, gender, and developmental status, as well as sociocultural and environmental factors (p. 273). This provides nurses with a background of the patient to help better their care. What are they used to and how can we improve our nursing to fit their needs? Nursing Theory Nursing theory is an important influence in a nurses career. Starting out in an ADN program, nurses are taught nursing theory to help guide their practice. Black (2014) states, Nursing as a profession has a distinct theoretical orientation to practice. This means that the

practice of nursing is based on a specific body of knowledge that is built on theory. This body of knowledge shapes and is shaped by how nurses see the world (p. 266). With a knowledge based on theory, nurses are able to reason and critically think better. Nursing theory helps guide a nurses practice from the beginning of their profession through when they transition to an advanced level of nursing. Transition To successfully transition into a BSN role, nurses need to continue to use the scope and standards of practice of knowledge, skills, and attitude that they start out with. Through education and resource utilization, the nurses knowledge prospers. As they utilize evidencedbased practice and research, professional practice evaluation, and quality of practice, the nurses skills grow. Finally, through ethics, leadership, collaboration, and environmental health, the nurses attitude continues to be positive to allow the nurse to grow into their BSN role.

NURSING Knowledge A major difference of knowledge in the BSN role compared to the ADN role is the amount of education and resource utilization. A BSN requires advanced knowledge related to continuing education. White & OSullivan (2012) explain ANA standard 8, Education is requisite for acquisition of the knowledge, skills, and abilities needed to maintain current, safe, and effective clinical practice (p. 123). The nurse advances their education and increases their

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practice role with opportunities that were not available at earlier scopes of practices. As the nurse advances their education, not only are new resources available from studying, but the importance of resource utilization is confirmed. Regarding nurses and utilizing resources, White & OSullivan outline ANA standard 15, They [nurses] need to be a part of designing and evaluating the solutions to create safer, higher quality, and more efficient systems (p. 196) By utilizing resources, nurses will not only be able to expand their knowledge to an advanced level, but they will also be able to better provide for their patients. The increased knowledge is different than my current practice role of ADN because I am obtaining advanced levels of knowledge that were not available to a nurse at the ADN level. Through my continuing education and increase of knowledge from it, the BSN role will give me advanced opportunities in my nursing career and help me better care for my patients. I will be able to better care for my patients with my acquired skills through my increased knowledge. Skills The skills that are obtained by transitioning to a BSN are greatly increased through evidenced-based practice and research. Regarding evidence-based practice, White & OSullivan (2012) outline ANA standard 9, The standard holds all registered nurses accountable to use

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evidence and research findings to guide their practice and to evaluate new evidence and research for practice changes (p. 138). Skills are able to grow as nurses evaluate the patient outcomes. For example, a nurse may decide that their current routine isnt as successful as they would like, but they have been observing another nurses preferred routine, they would use their evidencedbased practice to adapt techniques to make their routine more successful. Not only was the nurse using evidenced-based practice and research, but they were also using professional practice evaluation of their skills. White & OSullivan outline ANA standard 14 professional evaluation, While engaging in periodic and systematic self-evaluation of professional performance, the RN compares personal knowledge, skills, and abilities to established criteria (p. 187). By selfevaluation and the professional practice evaluation of co-workers through evidenced-based practice, the nurse will improve their quality of practice. By improving their quality of practice, not only are they bettering themselves, but they are also providing better care for their patients. White & OSullivan outline ANA standard 10, Quality is everyones responsibility in health care; however, Standard 10 identifies the nurses responsibility in ensuring quality of carenurses have individual responsibility and accountability for quality care (p. 146). With increased skills and knowledge through transitioning to a BSN role, the quality of care for the patients increases. I have found from my current practice role of ADN to transitioning to a BSN role, I am more prepared for providing quality care for my patients. Not only has my knowledge increased through my transition, but I have also developed skills to provide better care for my patients. My critical thinking has improved, and I have been able to manage all of my duties more efficiently. This has helped my attitude become more positive to additionally provide better quality of care.

NURSING Attitude I believe that attitude is initially built from an individuals personal ethics. This grows

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throughout the years as the individual has experiences that test their ethics. This helps the person grow into the person, or in this case nurse, that they will be. Positive ethics are linked with a positive attitude. White & OSullivan (2012) outline ANA standard 7: The Code of Ethics for Nurses, which has evolved over time, is a dynamic document that is revised periodically to remain current with the advances in the profession and in the healthcare environment. The Code reflects the professions central and enduring values, which include service to and duties toward those for whom we care, as well as to ourselves (p. 113). Along with a nurses personal ethics on how they treat individuals, they need to remember to communicate effectively with their patients and coworkers to provide excellent care. When combined with a negative attitude, communication can be greatly impaired. However, with a positive attitude, effective communication will be more likely to occur. White & OSullivan Outline ANA standard 14 communication, Research has shown that effective communication is essential to safe, quality patient care and to healthy work environments that lead to nurse satisfaction and staff retention (p. 159). Effective communication must be used along with the nurses ethics to provide quality care for patients with better environmental health. A healthy environment helps add to an overall positive workplace by making the employees and patients happier. White & OSullivan outline ANA standard 16 environmental health, Nurses have an immense capacity to affect environmental conditions for their patients, themselves, and their communities Nurses can improve the publics health by promoting positive workplace and

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community environments (p. 203). With a positive attitude showing through communicating at the work place and treating each individual with the nurses own personal ethics, a healthy environment is possible for each workplace. Each workplace needs a leader with a healthy and positive attitude to help collaborate the staff to work together. I find that nursing leaders are individuals with strong ethics and strong communication skills. The leader must be able to have a positive attitude and know that they are able to make changes in the work place. White & OSullivan outline ANA standard 12 leadership as, The fundamental nature of leadership can be described as the ability to influence others toward accomplishing common goals (p. 163). Every nurse can be a leader, but they must know that they need to be able to positively join together their employees to a common goal. To do this, they must collaborate with other coworkers. A good leader always communicates with their group members. White & OSullivan outline ANA standard 13 collaboration as, The ongoing challenge to achieve positive outcomes through collaboration rests with the co part of collaboration, in working together effectively toward a mutual goal (p. 173). With a good leader and nurses working together toward a mutual goal, the goal with be reached with a positive attitude. I feel that attitude starting out as a new nurse is not always positive. New nurses may have expectations that may fail them. Through growing through their new BSN role, the nurse may have a different attitude. The roles provided for a BSN require a different attitude and set of goals. A BSN is more of a leader and needs to have the positive attitude of a leader working with their co-workers towards a common goal. I feel that my leadership role has greatly increased and helped me become a better nurse by embracing my BSN role.

NURSING Reflection I find it hard to reflect on my current practice because I have only been a working, registered nurse for a couple months. I have so far gone through trials to test my strengths as a

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nurse. I have been tested by patients and also felt overwhelmed. However, with a team working at my side, I was always able to get through my struggles and triumph. I am currently getting my schedule figured out so I can be the best nurse that I can be. I have already improved as a confident and competent registered nurse in my short time at Tendercare. My current practice, to me, however feels an open opportunity to learn and advance my skills and knowledge. I truly believe that being a nurse makes me as a lifelong learner. Throughout the beginning of my profession, I have been faced with new techniques, and I realized that I will always be learning. I may end up being fonder of the new techniques, or maybe I will stay fonder of my old techniques, but I will stay up to the nursing standards that are expected of current nurses. By doing what is expected of nurses, I will keep up with my current scope of practice to continue being a competent nurse at every job that I work on. Being a nurse is a never ending learning experience, but with the right positive attitude, it can be the profession of a lifetime. Nursing care can vary greatly if nurses use their nursing concepts. With each nursing concept used, nursing care can vary even more if a specified nursing philosophy is used or even a personal philosophy is used. I personally use my nursing concepts tweaked to my ethics and morals to provide the best care for my patients. I treat them how I would like to be treated individualized to my own needs. Without using the main concept of person, I do not believe that nurses will be able to provide the best nursing care because each person is individualized. Treat each patient as their own person, not as another person in a room that needs to be taken care of.

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By remembering this and using the nursing standards of professional performance, I am able to transition smoothly into my BSN role.

NURSING References Black, B. P. (2014). Professional nursing: Concepts and challenges. St. Louis, Missouri: Elsevier Saunders.

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Owens, C. (2007, September 1). Reality Shock: Your First Year As a Nurse. Nurse Grad, 73. Retrieved October 15, 2013, from http://nursing.advanceweb.com/Article/Reality-Shock-Your-First-YearAs-a-Nurse.aspx White, K. M., & OSullivan, A. (Ed.) (2012). The essential guide to nursing practice. Washington, D.C.: American Nurses Association [ANA].