OBJ 2

Week 2 Nursing Objectives

Please answer the following questions and then upload into the site labeled Week 2 Learning Objectives

1. The Profession of Nursing (week 2)

1. Nursing Education and Accreditation

1. Identify the roles of major nursing organizations that have an impact on nursing education.

1. Describe the differences between the ANA, ANCC, CCNE, NLN, and STTI

1. Describe the nursing education accreditation process and its importance.

1. Describe the types of nursing programs and degrees.

1. Explain the purpose of the Doctor of Nursing Practice (DNP) degree.

1. The History of Nursing

1. Identify several key figures and events in nursing history.

1. Describe the past image of nursing and critical related issues

1. What is a Profession?

1. Compare and contrast a profession with an occupation.

1. Describe what powers a profession has in our society.

1. Describe autonomy and self-regulation within a profession.

1. What is Nursing?

1. Discuss the ANA definition of nursing.

1. Explain the meaning of caring to nursing.

1. Compare and contrast the art of nursing with the science of nursing.

1. Compare and contrast the major nursing roles.

1. Nursing as a Profession

1. Explain how a nurse enters the profession.

1. Describe the current ethnic/gender characteristics of the nursing profession.

1. Explain the relevance of standards to the nursing profession.

1. Compare and contrast Nurse Practice Act and Nursing Standards of Care.

1. Discuss the development and roles of nursing associations.

1. Define certification and credentialing.

If you are taking information from the power point slides, you do not have to provide an APA reference. This part is more about what you gained from class lecture and discussion this week.

1. Name 3 events or key figures that you believe have impacted nursing. What was the impact and was it positive or negative?

2. Is nursing a profession? Explain the reason for your answer.

3. You have been tasked to write a new definition of nursing-what would it say?

4. List 3 examples of the “art” of nursing

5. List 3 examples of the “science” of nursing

Introduction to the Profession of Nursing
Let’s take a quick look at what & where nursing has been,
how it has traveled along the way,
and let’s speculate about where nursing
will go from here!

History of nursing

Religious orders, female relatives

Pest houses in colonial America

Who would the ‘new nurse’ be?

Florence Nightingale

https://www.biography.com/people/florence-nightingale-9423539
*

‘Angel of the Battlefield’
Clara Barton

*

New Training Schools

Minority nurses

Lillian Wald

*

Expanding the reach of nurses

War and nursing

Influenza: the Spanish Flu*

On the frontlines

Nursing more respectable

Nursing students as hospital workforce*

What image?

Increased respect

Professional Organization*

Heroic image

Greater inclusion*

Mobile Army Surgical Hospitals/Korea

Nursing- starched and white

Does image limit role?

‘[nurses] think nothing of wearing clothing adorned with cartoon characters. What other professions that serve the public have cartoon characters on their uniform? Police officers, hospital staff, judges, fifefighters, others would not be seen with Snoopy, Sponge Bob, or animal characters covering their uniform…No wonder you have no authority’
Does the uniform matter?

Advances in education

Are you being ‘trained’ or ‘educated’?

Medical technology

State Boards and Licensure

Nurse Theorists

Nursing research

What is the profession of nursing like after 10 years?

Nurses at top

Nursing shortage

Wars

Aging population

Shortage of nursing faculty

Nursing infomatics

Health insurance changes/ ‘Obamacare’

Effects of limited access to care

Advanced Practice nursing: Filling a void in primary care

Image- who’s who?

Magnet status

Where do nurses work besides hospitals nowadays?
Practice Settings

Long-term Care

Hospice

MD’s office/Clinic

School Nursing

Occupational (Industrial) Nursing

Community Nursing

Cruise ships, summer camp

Military Nursing

Academia

Laboratory/Research

Administration

Government

Business/Sales

Nurse Attorney

Nurse Anesthetist

Primary Care/Nurse Practitioner

Where do you see yourself?

Definition of Nursing

ANA Definition of Nursing
….the protection, promotion, and optimization of health and abilities, the prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.
From American Nurses Association website

Knowledge Base for Nursing Practice

Regulation of Nursing Practice

What is

A Profession?

Let’s start with definitions

Position-group of tasks assigned to one individual

Job-a group of positions similar in nature and level of skill

Occupation-a group of jobs similar in type of work

Profession-a type of occupation that requires prolonged preparation and formal qualifications and meets higher level criteria that raise it above that of an occupation

Process Approach
All occupations are at different points of development from position to profession
Position —————————– Profession
Based on public perception of where each fit on the continuum
Lacks objective criteria
Do you think the public views nursing as a profession?

Power Approach
Two criteria
How much independence of practice does this occupation have?
How much power does this occupation control?
Political power
Earning power
Medicine, law, and politics clearly considered professions according to these criteria
What about nursing? Does nursing have the political power and earning potential to meet the criteria?

Salaries
Membership in professional organizations
Political power
4

Trait Approach
Common characteristics
High intellectual level
High level of individual responsibility & accountability
Specialized body of knowledge
Knowledge learned in institutions of higher education
Public service and altruism

Traits continued
Public service over financial gain
Relatively high degree of autonomy & independent practice
Well-organized and strong organization to control quality of practice
Code of ethics
Strong professional identity
Demonstration of professional competency & legally recognized license

Where does nursing stand?
High intellectual level
In today’s high tech environment, nurses must function at high intellectual level
High level of individual responsibility & accountability
Unlike the past, nurses now held accountable for errors
Can no longer state, “Did what doctor ordered”

Nursing Traits
Specialized body of knowledge
Theory, research, nursing science to direct practice in place of “tradition”
Evidence-based practice instead of “we have always done it this way.”
Use of research-supported nursing practice
Public service & altruism
Continue to be seen as selfless, placing others above own safety
Today-on call, 12 hour shifts
Is this still universal? What are “refrigerator nurses?”

More traits to consider?
Well-organized and strong representation
ANA, NLN, specialty organizations
What is the degree of nursing membership in comparison to other “professional organizations?”
Code of ethics
Competency and professional licensure
NCLEX
Individual state nurse practice acts

Any negatives?
Education is still quite diverse
What are current recommendations?
What interferes?
Autonomy & individual practice
Despite advances, nursing remains interdependent and independent
States regulate the amount of independent practice-who else cares?

Handmaiden image-how is this impacted by amount of education?
10

Health Care Teams
Nurses must work with a diverse group of providers-each bringing special skills to healthcare
Nurses have a wide range of opportunities
Require varied backgrounds, experiences, credentials
Move from acute to chronic care settings
Advanced practice nurses
Nurse practitioners
Clinical nurse specialist
Case managers

Lack of acute care jobs, but increasing need for chronic care and community
NP-diagnose and treat; some states allow 3rd party reimbursement
CNS-work with acute and chronic-educators and physician collaborators,
Case managers can have a wide variety of education-SW, physicians, nurses, laypeople-are nurses the best to fill this role?
11

Nursing Power
Despite much responsibility-little control
Do “helpers” feel comfortable wielding power?
How can nurses move from subservient to using their influence?
What is empowerment?
Referent power-what is gained with nurse-patient, nurse-co-worker relationships?
Expert power-helps build respect with other health care team members
Power of rewards-behavior modification
Coercive power-not considered therapeutic
Legitimate power-legal power related to licensure
Collective power-power in numbers

Referent power-based in relationship
Often do something for someone that you would not do otherwise because you have a relationship with the person
Tolerate long hours, do difficult tasks, patients take meds or get out of bed because of the nurse-patient relationship; doctor return your call promptly; CNA help you without asking, etc
Expert power-increased knowledge and understanding commands more respect
12

Increasing Power
Professional unity-encourage membership and involvement in professional organizations
Political activity-need to be involved with those who have effect on our power & practice
Accountability & professionalism-govern ourselves with high standards
Networking-present united front

13

What’s ahead?
Although called a “nursing profession,” it is probably more appropriate to say nursing is moving from occupation to true profession
Stand firm in the process
Avoid quick fixes
Addressing pending nursing shortage
Lifelong commitment to nursing

What is Nursing?

Beginnings to today

Is this it?

How to define it
By what nurses do? Nursing is more than a list of tasks!
What drives nursing to do what they do?
How can we define nursing & highlight the value of nursing?
How can we direct nursing research without a definition?
How can we answer the question, “What is a nurse?”

Virginia Henderson
The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death), that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.

ANA Definition of Nursing
….the protection, promotion, and optimization of health and abilities, the prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.
From American Nurses Association website

Huh?
Common elements include nursing as
Caring
Art
Science
Holistic
Adaptive
Concerned with health promotion, health maintenance, and health restoration
A helping profession

The Art
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.
Florence Nightingale

The Science
The most important practical lesson that can be given to nurse is to teach them to observe.
Florence Nightingale

Together, not one or the other!
Synthesize the following to provide high quality care
Empirical knowledge-facts that can be verified
The science
Aesthetics
Good practice of nursing skills
Ethical knowledge
What should be done?
Personal knowledge
Know, reflect, empathize

Can be empirically verified
Knowledge organized into general theories explaining phenomena to nursing
Seeking and generating explanations
Controlled factual evidence
Theory and research developments
Aesthetics
Being a good nurse
Manual skills
Empathy and compassion
Good clinical judgment
Appreciation of art and beauty
Personal is basis for use of therapeutic relationship in nursing
9

Beginnings
Nurse (nutricius)- nourishing
Done since the beginning of time and often considered a woman’s role
Early was focused on banishing evil spirits and little science
Church involved in caring for the poor, eventually handed over to women in church
Virgins and widows
Treatment remained mixture of magic and some science

Continuing Development
Male “nurses” followed soldiers to battle-status and respect
Religious upheaval resulted in shortages of nurses and facilities
Alcoholics and former prostitutes served in hospitals rather than prison
Industrial revolutions allowed more sharing of information, increasing experimentation

Enter Flo
Hospitals still not places of healing and war mortality remained high
Florence Nightingale rejected affluent lifestyle & studied nursing
She used observations to improve health care and lives were saved during the Crimean War
Established training for nurses and brought new respect and dignity to nursing

Early America
Colonial times-little training
By civil war, increase in formal training for nurses improved outcomes
Improved sanitation
Environmental improvements
Good nutrition
Increased interest in improving and protecting health concerns

Victorian Era
Uh-oh
Wives cared for family and husbands provided and ruled the household
Now, nurses single and expected to submit in harmony to the doctor’s authority
Illness rewarded, little incentive to be healthy
Fortunately a time of reformers! Began to establish nursing standards, require licensure to protect the public

20th Century
Nursing impacted by
Wars
Influenza
The great depression
HIV/AIDS
Rapid technological advances

Military Nurse Corps
Red Cross
Nursing Education evolving
Public Health Nursing
Funding for nursing education
Standardized licensing tests
17

The Present
Computers!
Financial crises
Dramatic events
Attacks on World Trade Centers
Natural disasters
The Affordable Care Act

Nursing Pins

Nursing

Education

Accreditation

Regulation

Roles

The Original “Sim” Lab

Intent on Studies

Diploma Program
Oldest form of preparation in the US
Dominated nursing education until mid-1960’s
Emphasized skills needed to provide acute care for patients
Granted “diploma” / not academic degree
Only 67 accredited diploma programs in 2014

Associate Degree Nursing
Developed based on planned research and experimentation
Open program based in the community college
Initially intended to provide bedside (technical) nurses with more knowledge than LPN, but narrower role than professional
Started in 1951, currently produces most nursing graduates over any other program (1092 programs in 2014)

Terminal degree to provide nurses for immediate employment
“nurse technician”
5

Baccalaureate in Nursing
Began as 5 year program-combining 3 year diploma program with additional 2 years of liberal arts
710 programs in 2014
Now a wide variety of options for BSN nursing education
Accelerated
LPN to BSN
RN to BSN

Demographics have changed!

Graduate Nursing Education
Needed advanced preparation in education and clinical nursing skills
Master’s degree considered terminal degree for nurses until the 1960’s
Emphasis has varied based on need
Management
Education
Clinical specialists
Nurse practitioners

Nurses as “Doctors”
Doctor of Nursing Practice (DNP)
Clinical practice-oriented leadership training
Doctor of Nursing Philosophy (PhD)
Scholarly research and inquiry

Picture the differences

From top to bottom

Questions
What nursing program currently produces the most registered nurses?
What program is the oldest?
What educational program is preferred for entry into professional nursing?
Which kind of program are you in and what will that education prepare you to do?

ADN
Diploma
BSN
Enter into the nursing profession as a generalist nurse able to work at “entry level” in nursing.
12

Accreditation & Regulation
What is nursing’s relationship with society?
Both nursing and nursing education are highly regulated
Why are they regulated?
Who is in control of the regulations?

Nurse Practice Acts
Receiving health care is inherently risky to patients
There is no federal authority to regulate nursing
To protect patients, states provide education and practice standards
Additionally, these standards legitimize nursing in the eyes of the public
Raise quality of professional nurses & improve educational standards

State Nurse Practice Acts
Each state and territory enacts a Nurse Practice Act (NPA) and it is passed by the state legislature
Each NPA establishes a state board of nursing
State board of nursing establishes administrative rules and regulations consistent with the NPA
Each state’s NPA determines requirement for licensure

What’s included?
Vary from state to state
Definitions
Authority, power & composition of Board of Nursing
Educational program standards
Standards and scope of nursing practice
Types of titles and licenses
Protection of titles
Requirements for licensure
Grounds for disciplinary action

Virginia Board of Nursing
Virginia State Board of Nursing (VSBON)- (https://www.dhp.virginia.gov/nursing
/)
This is your guidance for what and how you practice nursing in Virginia
Nurses need to be familiar with the NPA and the BON in their state of practice
Go to the site and search for the NPA for Virginia

Nursing Program Standards
Schools of Nursing must first be approved by their state board of nursing
This approval is to ensure graduates are successful on the national licensure exam (NCLEX)
Often contingent on the program’s NCLEX pass rates
Why does this matter to you?

Accreditation
Is it required?
Technically…well, no
But, can impact
Financial aid
Tuition reimbursement
Transfer of credits
Job prospects?
So, do you care about accreditation?

AACN
American Association of Colleges of Nursing (AACN)
National voice for baccalaureate and graduate nursing education
Programs include
Curriculum standards (Essentials Document)
Health policy advocacy
Research and data services
Conferences and webinars
Accreditation through the CCNE
Clinical nurse leader certification

CCNE
Commission on Collegiate Nursing Education (CCNE)
Autonomous accrediting agency (AACN)
Ensures quality and integrity of baccalaureate, graduate, and residency programs in nursing
Non-governmental peer review process
Fosters trust in the public and continuing improvement in nursing education and professional practice

NLN
National League for Nursing (NLN)
“The voice of Nursing Education”
Founded in 1893 (American Society of Superintendents of Training Schools for Nurses)- first nursing organization in US
Dedicated to excellence in nursing
Professional development
Networking opportunities
Testing services
Nursing research grants
Public policy initiatives

CNEA
NLN Commission for Nursing Education Accreditation (NLN CNEA)-established 2013
NLN accreditation was formerly known as NLN Accrediting Commission (NLNAC) & became a separate entity, the Accreditation Commission for Education in Nursing (ACEN) which continues to accredit nursing programs
Accredits all types of nursing education programs, including practical, diploma, associate, bachelor, and graduate programs

Nursing Roles
Generalist nurse
Advanced practice nurse
Nurse educator
Nurse administrator
Nurse researcher
Nurse policy analyst
Nurse practitioners
Certified Registered Nurse Anesthetists
Certified nurse-midwives
Clinical nurse specialists

Nursing Roles

Where can you work?

Very Useful Sites!
AACN- American Association of Colleges of Nursing (http
://
www.aacn.nche.edu/about-aacn)
ACEN-Accreditation Commission for Education in Nursing (http://www.acenursing.org/)
ANA- American Nurses Association (http://www.nursingworld.org
/)
NLN- National League for Nursing (http://www.nln.org
/)
NCSBN- National Council of State Boards of Nursing (https://
www.ncsbn.org/index.htm)