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Traveling Nurse, an Exciting Career

Written by kimmel52 on November 12, 2008 – 12:13 am

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Today is an exciting time for nurses. The job market is plentiful with positions including the demand for traveling nurses. To be a travel nurse takes a special person. The individual who is a travel nurse is one who likes to see new places and meet new people, face challenges with confidence and work as a team member. Being a travel nurse is not for everyone. Nurses who have family responsibilities may choose to work near their home. However, for those who like to travel and are very outgoing, being a travel nurse is a rewarding experience.
As an experienced nursing professional, you are in a truly unique position. Read more »


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Therapeutic Communication in Nursing

Written by kimmel52 on November 12, 2008 – 12:11 am

Nursing is a caring profession. It is also a profession that is more and more evidenced based in practice. In as much as the scientific aspects of nursing is increasing due to the complex technological advancement of medicine and the machinery that is used at the patients bedside, the fact remains that the nurse is the first person that the client usually comes in contact with in any emergency or hospital setting. Having said this, the term, “caring” is an essential emotion that all nurses, for that matter, all individuals in the health profession must possess. With caring comes the trained ability of the nurse to facilitate therapeutic communication. One might ask, what is therapeutic communication?

To better answer this question, the term communication should first be defined. Communication can be defined as “The Process of transmitting messages and interpreting meaning.” (Wilson and others, 1995) With therapeutic communication, the sender, or nurse seeks to illicit a response from the receiver, the patient that is beneficial to the patient’s mental and physical health. Just as stress has been proven to adversely affect the health of individuals, the therapeutic approach to communication can actually help. In any given situation everyone uses communication. Everyone has seen the individual that looks like they are either angry, stressed, feeling ill or maybe sad. Read more »


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Nursing Professionalism

Written by kimmel52 on November 12, 2008 – 12:09 am

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

All professions have as their cornerstone and creed a code of ethics and or professional performance standards. The nursing profession is no different. As the field of nursing grows and changes in defining the role of a nurse, the central theme will always be that of caring. It can be said that, all other duties and responsibilities of nurses have centered around, “caring”. Caring has been described by many nursing theorist as the innate nature of a human being to be able to give unconditional help in the form of doing for, therapeutic communication, therapeutic touch, compassion, a gentleness of spirit and humbleness of knowing ones self.
The nurse provides services with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.

· The nurse safeguards the client’s right to privacy by judiciously protecting information of a confidential nature.

· The nurse acts to safeguard the client and the public when health care and safety are affected by the incompetent, unethical or illegal practice of any person.

· The nurse assumes responsibility and accountability for individual nursing judgements and actions.

· The nurse maintains competence in nursing.

· The nurse exercises informed judgement and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities to others.

· The nurse participates in activities that contribute to the ongoing development of the profession’s body of knowledge.

· The nurse participates in the profession’s efforts to implement and improve standards of nursing.

· The nurse participates in the profession’s effort to establish and maintain conditions of employment conducive to high quality nursing care.

· The nurse participates in the profession’s effort to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing.

· The nurse collaborates with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public.
Jean Watson, a Ph.D. in Educational Psychology and Counseling developed a theory of caring first published in 1979. She believed that caring was central to the profession of nursing as well as being the unifying principle of practice. The two major assumptions that she made are as follows:
1. Care and love constitute the primal and universal psychic energy.
2. Care and love are requisite for our survival and the nourishment of humanity.

Madeleine Leininger, a nurse and anthropologist proposed a theory of caring based on culture. She was able to see that how one society defines caring is not always the same as another society. For instance, in Asia, looking directly into another’s eyes is not a sign of respect but a sign of disrespect. Therefore a western nurse unaware of the Asian culture of caring would be seen as an uncaring and disrespectful person. Leininger termed this knowledge of cultural caring as, “transcultural nursing”. “Her beliefs are that culture is the broadest and the most holistic way to conceptualize, understand, and be effective with people.” With the emergence of the, “caring”, theorists also came the emergence of “Standards of Profession Performance”. The two terms are entwined in their definitions. There cannot be one without the other. The American Nursing Association set forth the following requisites for standards of professional performance. It is within these standards that can be seen the unifying theme of caring.

Standard 1. Quality of Care.
The nurse systematically evaluates and effectiveness of nursing practice. The nurse does this by participating in peer review committees and in consistently evaluating his/her own performance and how her performance has enhanced the clients health and emotional wellness.

Standard II. Performance Appraisal
The nurse evaluates his/her own nursing practice in relation to the national and state statues set forth defining the role of nurse.

Standard III. Education
The nurse acquires and maintains current knowledge in nursing practice. Many states now require continuing educational credits to be earned by a nurse. The number of credits vary from state to state. However, a nurse cannot renew their license without proof of these continuing educational credits. These credits help to keep the nurse current with new medica/nursingl advancements related to patient care.

Standard IV. Collegiality
The nurse interacts with and contributes to the nursing profession by meeting with other professionals in the medical field, such as Physicians, Physical Therapist, Respiratory Therapists, and Home Care Coordinators, to exchange ideas and gain a mutual respect while stimulating a leaning environment that all will benefit.

Standard V. Ethics
The nurse’s decisions and actions in helping and caring for individuals are based on principles of ethics and institutional guidelines.

Standard VI. Collaboration
The nurse collaborates with other medical professionals in creating an environment for the clients that facilitate an increasing continuum of mental and physical wellness.

Standard VII. Research
The nurse will not cease to expand his/her educational horizons, and continue to seek out and explore new areas of research and statistics.

Standard VIII. Resource Utilization
The nurse will participate in committees within the organization to evaluate and increase the effectiveness of safety, costs in planning and delivering patient care.

It can be seen that within the guidelines of professional performance the center theme is the caring for the client from every aspect. It is within these guidelines that the nurse can better define his/her role as a the one individual who has the ability to enhance the clients mental and physical wellness by coordinating, educating, and working with others to promote a caring and supportive environment.

Reference: Blais, Kathleen Koenig, Hayes, Janice S., Kozier, Barbara, Erb, Glenora, Professional Nursing Practice concepts and Perspectives, co. 2002, 4th ed. Prentice Hall, New Jersey


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Reality Shock For New Nurses

Written by kimmel52 on November 12, 2008 – 12:07 am

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

So now you are close to graduating from nursing school or you have graduated recently. Whichever the case, you will be in for a reality shock when you begin your career as a Registered Nurse. What do we mean by the term, “reality shock”? Well, like the term says, it is the reality that shocks us. For second-career nurses, the transition from nursing school to working with real patients can range from somewhat uncomfortable to highly shocking. These rookies often have given up secure, well-established careers, only to discover on-the-job demands never mentioned in the textbooks.

However, the right attitude can help you weather your first few months on the nursing unit. For those who overcome the challenges of transitioning to nursing, the rewards outweigh the costs of starting over. Education of nurses is thought to lack reality orientation, which is reflected in the difficulty graduate nurses experience in their transition from an educational to a work situation. The phenomenon of “reality shock” is defined by Kramer (1974) as this lack of reality orientation. On graduation, “neophyte” nurses are confronted with conflicting roles of professional (from education) and bureaucratic (from work environment). Adopting a particular role is part of the socialisation process graduates undergo. Methods of adjusting and improving the experience of “reality shock” have been suggested by Kramer (1974) and developed using a theoretical model, by Neuman (1982). The quality of care provided by graduate nurses needs to be examined as this is the ultimate role of the nurse. (1)The question you may ask is, “so there is a difference in the reality of being a student or graduate nurse”? The answer is an emphatic, YES! First of all, as a student nurse you were given assignments that were not beyond the scope of your practice or ability. In addition to that, you were working under your instructor’s license and whether or not you were aware, they kept a very close watch on you. Therefore, there was a safety net that always hovered beneath you in case you were to fall.

This is not the case as you take on the title, Registered Nurse. There is no safety net. You are out there by yourself, free to make decisions and make mistakes. With those decisions and mistakes you are also, FULLY ACCOUNTABLE. Now imagine yourself with eight or more patients. You may be asking yourself, “What do you mean eight or MORE patients?” Most student nurses never have more than six or seven patients and that is only at the very end of the program. Even then, the student nurses can delegate tasks to assistive personnel thereby lessening their work load. However, there will be time that you will be on a floor, without any assistive personnel, with more than eight patients and no one to rely on except yourself. To compound this scenario, there may be patients that have very critical care pathways that you must follow, incoming calls from patient’s families, doctor’s, operating room staff, and other collaborative care departments requesting information. Now, let’s stop this scenario in its tracks. You probably feel the stress building by just reading the previous passage. If so, don’t worry, it is a perfectly normal reaction. So, relax, and know that there are ways to ease this inevitable right of passage. Let’s take a look at some of the ways to help ease and deal with reality shock.

1. First of all, it is important to understand that, “reality shock” does indeed exist and you will come face to face with it. Knowing what you will face is most of the battle. The task at hand then becomes, knowing what steps to take and resources to use, and how to use them.

2. Learn as much as you can during your in-service training program, which usually lasts up to eight weeks or more. This means familiarizing yourself with every inch of your floor. Know where everything is located, from safety pins to I.V. tubing. You may never know when you may need it, NOW, and the worst thing that can happen is that you spend precious time looking for something as small as a safety pin.

3. Know, who the assisted personnel are, and know them by name and face. Find out who will be the ones that you will be working with during your shift. What usually happens during in-service training is that graduate nurses train on the main shift, which is most frequently days, before transferring to the shift that they have been hired to work. Therefore it is very important to know who you will be working with during your shift. Try also to develop a working relationship with the assistive personnel. Remember, it is not a popularity game, you are not out to make best friends. Your goal is quality patient care, and the patient comes first. Let your intentions be known that your number one goal is to give the best patient care that you have respect for the care team assistive personnel and are a willing and helpful body to them as well. In doing this, you will have disabled the invisible wall that exists between nurses and assistive personnel. That wall is the one entitled, I am a NURSE and you are ONLY an aide. One thing that you must strive for is to use an even tone of voice, and fairness when delegating. You must also remember the rights of delegation, which are as follows, a. the right task, b. the right person, c. the right communication, (must be clear and concise), d. the right feedback, (the person who is delegated the task must comprehend what it is that is asked of them and let the nurse know that they comprehend). By doing this you are ensuring that patient care will not suffer do to a personality glitch, which could have been avoided.

4. Know, know and KNOW where the Policy and Procedure manual is located on the floor. Part of your hospital in-service will include the introduction of the Policy and Procedure Manual. This is the manual that you will have to refer to many times for protocol from everything from changing out a Foley Catheter to transporting a patient to another floor. The final analysis will be in any investigation, “did the nurse use and follow the Policy and Procedure Manual?” You want to always be sure that you follow the rules and protocols contained in your institutions manual. Therefore, you should know where it is located and be familiar with how to look up various procedures and policies, particularly

5. The policy regarding medication errors. Most everyone makes them and it is crucial that you know what paperwork is required to be filled out. It will come in handy. You cannot just, “wing it”, when making a decision, you have to follow protocol.

6. Use assertive communication when interacting with doctors’. Assertive communication indicates that you are aware of yourself and your limitations as well as your liability to the patients that you care for. Using this form of communication with over assertive medical personnel will help you function to your maximum capability and earn respect as an independent care professional. {For more information on the uses and strategies concerning assertive communication, please refer to the text entitled, Nursing Today, Transition and Trends, by JoAnn Zerwekh, Jo Carol Claborn, 5th edition, Co. 2006, Saunders, Philadelphia.}

7. Ask questions. You will have time during your in-service training to ask questions and get answers. It is your right to do so. Remember, not knowing is not an excuse, and you do not want to be in a situation where there will be no-one to ask. This is not to say that you will know everything, but a least you are giving yourself a head start and a good solid foundation by knowing what you can. So don’t be afraid to ask. Also, know who your resources are, for questions that you may have on the shift that you will be working.

8. Find a mentor with whom you can relate. Try to find someone not only on the shift during training, but also on the shift that you will be working. It is nice to find someone who has the experience and understanding as well as someone that you can get along. There might be a time that you will want to call them in the middle of the night and vent your concerns, or just to have them give you positive input in your performance. Mentors are essential to the growth of a new nurse.

9. Lastly, Know, Know and Know, what your State Nurse Practice Act states. This Act, is your guideline for most all that you do as a Registered Nurse. Know it well.

Hopefully these tips will help to ease the reality shock that you will face during your transition from student nurse to full time graduate nurse. Remember, you can’t do it all. You are a welcome asset to your employer, but first and foremost an embodiment of all that Florence Nightingale stood for. Best wishes on your journey.
References:
Mirella Pancia


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Information on Your Nursing State Boards

Written by kimmel52 on November 12, 2008 – 12:03 am

Nursing Education – Summary of Information from Pass Rate Reports

In reports submitted by nursing education programs with NCLEX pass rates ten percentage points or more below the national average, the following commonalities were noted: Read more »


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Nurse Salaries For Different Nursing Fields

Written by kimmel52 on November 12, 2008 – 12:00 am

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Many new graduate nurses are readily offered jobs prior to graduation. The positions that they are offered are usually those with the title graduate nurse or GN. For the most part, new graduates are looking for employment near their home. Since the general nursing student is now in their early to late thirties, they have already established a secure family base. While jobs for graduate nurses are plentiful it helps to have some idea of how many jobs are actually offered throughout the United States. The wonderful fact of being a nurse is that they can work just about anywhere.

The following information should be helpful in getting some idea of the pay for different nursing fields. Hospital Nurse Recruiters will inform the new graduate nurse that obtaining a bachelor degree in nursing is favored. Many hospitals will offer some form of tuition reimbursement for those nurses who seek to obtain a BSN degree. Tuition reimbursement can go as high as one hundred percent to fifty percent. For nurses who work in hospitals, there is a world of opportunity to move into many different nursing specialties. As the nurse gains more experience in their field, their salary will also increase. The salaries listed below are not all inclusive, but merely present to the reader a general idea of the salary range that exists. The reader should keep in mind that each hospital will be unique in what type of salary is offered depending on the nurses qualifications and prior work experience.

Just as you might think, large cities like New York, Los Angeles, and Chicago hold the top spots for the number of nursing jobs available. The larger cities also have higher salaries and better benefits for their nurses. The tradeoff is longer hours and more stress in large city nursing jobs versus the small community jobs where hours are usually better and the number of patients to serve is lower.

The median expected salary for a typical Staff Nurse – RN in *Detroit**, MI*, is *$65,817*. This basic market pricing report was prepared using our Certified Compensation Professionals’ analysis of survey data collected from thousands of HR departments at employers of all sizes, industries and geographies.

Job Description

Staff Nurse – RN:

Evaluates, plans, implements, and documents nursing care for an assigned patient population. Assists physician during examinations and procedures. Performs various patient tests and administers medications within the scope of practice of the registered nurse. Promotes patient’s independence by establishing patient care goals and teaching patient and family to understand condition, medications, and self-care skills. Requires an associate’s degree and is certified as a registered nurse. Familiar with standard concepts, practices, and procedures within a particular field. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. A wide degree of creativity and latitude is expected. Typically reports to a manager or head of a unit/department.
he current potential for advancement in the nursing industry is very promising for a registered nurse. Nursing is the largest single profession in the health care industry today. The saturation of nurses, however, has not had a negative effect on the demand in recent years.
This provides many nurses with an incentive to differentiate themselves from their colleagues to advance within the nursing industry.
Registered Nurse Salaries

Staff RNs working in the United States average a median base salary of $41,642. Half of all US RN’s are expected to earn between $38,792 and $44,869. Nearly 67% of nurses are employed in hospital inpatient and outpatient settings. 32% of all nurses are employed in medical offices and clinics, home healthcare agencies, nursing homes, temporary help agencies, academia, and government agencies. The big payoffs of any nursing career include a solid paycheck, reliable employment, and the immeasurable reward of helping others. Outside of these constants, though, the nursing field is spread along a wide spectrum of specialties, paradigms, and settings. These variables subdivide the industry into more measurable salary ranges. But other elements factor in as well:

* Region of practice
* Degree attainment
* Years of experience
* Public or private sector practice
RNs in specialties such as Critical Care, Emergency and Trauma medicine, Intensive Care Unit nursing, and OR and Recovery Room Nursing are at the higher end of the salary spectrum, while nurses in Home Health, Long Term Care, and Geriatric Nursing, are most typically at the lower end of the salary scale.


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Nures Salaries Increasing

Written by kimmel52 on November 11, 2008 – 11:58 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

In today’s economy with declining employment in many fields that require degrees, the profession of nursing is as solid as it ever was. People with prior degrees are looking to enter the nursing profession.

Nursing careers are appealing for many reasons. One positive aspect of nursing careers is the opportunity to serve others through medical treatment and rehabilitation. Nursing careers also boast a glowing job outlook that has consistently risen along with increasing demand for registered nurses. Plus, nursing careers offer a wide range of employment options within various sectors of the health care field. When you become a registered nurse, you open the door to a variety of nursing career paths, including forensic nursing careers, traveling nurse careers, and nurse coordinator careers.

The salary of a nurse varies greatly. There is really no base salary but a fluctuation across the board. The reasoning for this is a varied as the salaries in nursing.

The base pay of a nurse is determined by many different factors. The first of these factors are the years of experience that the nurse brings to the table. A GN or graduate degreed nurse will start out at the lowest salary of nurse pay. They will remain at this level until they pass their board exam or NCLEX. Upon passing their boards they will receive a small increase in pay anywhere from $2.50 per hour to $5.00 per hour. The most important factor in this scenario is to keep in mind that if the graduate nurse does not successfully pass the board exam the hospital can terminate their employment or extend to them a grace period in which they have the opportunity to pass the boards a second time. In the past years, it was not unusual for a graduate nurse to stay on as a hospital employee for years before finally passing or taking their boards. This practice is no longer widely accepted. Also the graduate nurse is not allowed to pass any medications until they have their licensure. The question remains, what is the typical base salary for a graduate nurse. It is safe to say that the salary ranges in the low to mid forty thousand dollars per year. This discrepancy of several thousand dollars has much to do with the location of the hospital. For instance, in rural communities where much of the hospital funding comes from the government, the pay rate may be higher or lower than a privately funded institution. The mitigating factor is how successful the grant writers are at tapping into government funds, and how much private endowment monies are bestowed to the hospital. Even with these two factors in place comes the process of dissemination of the funds. This is dependent on how the board of directors see fit to use the funds. These funds could be put to the construction of a new hospital wing, or to the purchase of new diagnostic equipment.

Whether or not the nurses are unionized is also another factor in entry level nurse pay. Unions can either work for or against nursing wages. Sometimes non-unionized hospitals pay more.

Shift premiums are also a factor. Read more »


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Learning Patient Assessment Skills

Written by kimmel52 on November 11, 2008 – 11:50 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Nurses are trained to learn and apply patient assessment skills. These skills are the cornerstone of being a proficient nurse. The knowledge and procedures for developing these skills are learned in the first two years of nursing school and honed in clinical as the student nurse takes on a greater patient load. The “Standards of Care” that are the basis of nursing include the following:

Standard 1. Assessment

In an assessment the nurse must use all of his or her senses. These include hearing, touching, visual, and therapeutic communication. The cephalocaudal approach is most always used. In other words, assessing a patient from head to toe. The nurse must self aware to be able to conduct a thorough assessment. Data collection forms the basis for the next step in standards of care which is diagnosis. A nurse must have all the necessary equipment, such as a scale, tape measure, thermometer, sphygmomanometer, a stethoscope and pen light. The setting is also very important in doing an assessment. If a client is nervous or anxious they may not be as willing to answer questions that the nurse asks or to be examined. Obtaining a quiet environment is not always possible, especially in an emergency situation. Therefore, the nurse must be very observant, and try to get as much pertinent data as possible to formulate an nursing diagnosis For example, when doing an assessment on a client that is complaining of severe stomach pain, asking them what foods they last ate would give the nurse more pertinent information than asking them how many brothers or sisters they have.

Standard II. Diagnosis

A nursing diagnosis is not a medical diagnosis. A medical diagnosis would be the medical condition of “Diabetes”. Whereas, a nursing diagnosis would be, “Altered Tissue Perfusion”, related to decreased oxygenation of tissues as evidenced by a pulse oximetry of 92% , secondary to the medical condition of “Emphysema”. A nursing diagnosis is a formal statement that relates to how a client reacts to a real or perceived illness. In making a diagnosis the nurse attempts to formulate steps to assist the client in alleviating and or mediating how they respond to real or perceived illness.

Standard III. Outcome Identification

In this process the nurses uses the assessment and diagnosis to set goals for the patient to achieve to attain a greater level of wellness. Such goals may simply be that the patient now comprehends the regime of testing their blood sugar, or perhaps a new mother gleans a sense of security now that she has been instructed in the correct method of breast feeding. The nurse must plan the goals that the client is to achieve around the clients ability. For instance, the goal that a client will walk normally after two days of having knee surgery is unrealistic, in the sense that the client’s knee will not be completely healed. However, the goal that the client will be able to demonstrate the correct use of crutches, would be more realistic. This goal is also measurable, since the patient will be in the hospital and the nurse can teach and observe a return demonstration. Therefore, the goals or outcomes for the client must also be measurable.

Standard IV. Planning

The planning standard is designed around the clients activities while in the hospital environment. Therefore the nurse must plan to teach and demonstrate tasks when the patient is free to learn. This would involve administering pain medication prior to learning to walk with crutches or waiting until after a patient has finished a meal before teaching on how to use a syringe. The atmosphere should be conducive for the client to learn.

Standard V. Implementation

This standard requires that the nurse put to the test the methods and steps designed to help the client achieve their goals. In implementation, the nurse performs the actions necessary for the client’s plan. If teaching is one of the goals then the nurse would document the time, place, method and information taught.

Standard VI. Evaluation

Evaluation is the final standard. In this step the nurse makes the determination whether or not the goals originally set for the client have been met. If the nurse concludes that the goal or goals have not been met, then the plan has to be revised and documented as such. Goals therefore should be timely and measurable. If the client’s goal was to use crutches successfully, and the client was able to perform a repeat demonstration for the nurse, then the goal was met.

The above standards are the cornerstone of the nursing profession. These standards take time and experience to learn and to implement. Experience is the best teacher, and a nurse should continuously strive for excellence in their care of patients, and recognizing how to help patients achieve a higher level of physical and emotional wellness.


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Do You Know Your Nursing Code of Ethics?

Written by kimmel52 on November 11, 2008 – 11:48 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Nursing is a profession that places on its participants a great responsibility for maintaining the highest possible standards to ensure superior quality of care. Each state has its own Board of Nursing which is responsible for the regulation and licensing of nursing practice. As the profession of nursing continues to grow and change the practicing nurse will bear more responsibility as well as legal accountability for their actions. This truth is evident in the various professional licensures that are available for nurses, such as Nurse Practitioners, Nurse Midwifes and Nurse Anesthetists. It therefore behooves each licensing board to not only self regulate judiciously but to also refine the scope of nurse practice from time to time. The individual states must also act in accordance with the overall nursing theory in mind. Self regulation is done by continually refining such goals as 1) Defining its scope of nursing practice, 2) Developing a code of ethic, 3) Establishing standards for nursing education and practice and for structures through which nursing services will be delivered,4) Developing a system of credentialing, 5)Providing for peer review and quality assurance, 6) Providing for research and continuing development of the knowledge base for nursing. (Michigan Nurses Association, Legal & Professional Regulation,, Co. 1999, ISBN0-9634643-1-0, Okemos, Michigan)

As with most professions there is a code of ethics that are inherent to each. Nursing is no different. The code for nurses consists of eleven major topics that each nurse across the nation is required to adhere.

Code for Nurses

1. The nurse provides services with respect for human dignity and the uniqueness of the client unrestricted by consideration of social or economic status, personal attributes, or the nature of health problems.

2. The nurse safeguards the client’s right to privacy, by judiciously protecting information of a confidential nature.

3. The nurse acts to safeguard the client and the public when heath care and safety are affected by the incompetent, unethical or illegal practice of any person.

4. The nurse assumes responsibility and accountability for individual nursing judgments and actions.

5. The nurse maintains competence in nursing.

6. The nurse exercises informed judgment and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities to others.

7. The nurse participates in activities that contribute to the ongoing development of the profession’s body of knowledge.

8. The nurse participates in the profession’s efforts to implement and improve standards of nursing.

9. The nurse participates in the profession’s efforts to establish and maintain conditions of employment conducive to high quality nursing care.

10. The nurse participates in the profession’s effort to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing.

11. The nurse collaborates with member so the health professions and other citizens in promoting community and national efforts to meet the health needs of the public. (Michigan Nurses Association, Legal & Professional Regulation,, Co. 1999, ISBN0-9634643-1-0, Okemos, Michigan)

One can interpret from the above Nurse Code that many of the hospitals employ a similar code to their organization for promotion of client health care needs. Some of the principals that hospitals employ include the responsibility of each of its employees to maintain the highest standards of care for each client served, to judiciously guard the privacy of clients, to maintain a safe environment and to take independent action when a situation arises where they are the only one that can act.

There are states that allow nurses that have attained advanced practice degrees to write prescriptions and bill insurance agencies independently. With the health care field burgeoning continuously with a growing aging population, the need for Nurse Practitioners will also continue to grow as well as the responsibilities of the Registered Nurse.


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Should Nurses Be Unionized?

Written by kimmel52 on November 11, 2008 – 11:46 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Since the days of Florence Nightingale, the profession of nursing has been viewed as a career consisting of self sacrificing individuals who, with caring and compassion have devoted their lives to easing the pain and suffering of those in need. Such noble and honorable individuals would surely never strike for what ever reason, right? Wrong! So, what has happened over the centuries to the profession of nursing?

To begin to understand what has taken place in the arena of nursing, one needs to understand what the nurses of today are faced with in the hospital settings. First, many nurses are required to care for more patients than they can handle safely. This is to say that a patient care load of seven on a medical surgical unit can go up to eleven during the afternoon and midnight shift. Depending on the acuity (level of care needed) of the clients, the nurse may not be able to safely attend to all of the clients needs, and need to forego certain aspects of care just to be able to get the majority of their responsibilities completed by the next shift.

This situation of patient overload can result in very serious health consequences for the patient and ultimately, death. The direct consequence of patient neglect for the nurse involved would usually entail a law suite being filed by the family naming the nurse and the hospital as well. Patient overload is just one of the many reasons that nurses have sought to form a coalition and be represented by their own organizations.

Another reason for nurses to organize is due to the policy of pulling nurses to other floors where the patient acuity care process requires specific knowledge to be able to practice safely as a nurse. An example would be a maternity floor nurse being pulled to a medical surgical floor and being assigned a patient load consisting of newly admitted pre-operative patients and others that require suctioning and vent care. The maternity floor nurse would not only be unsafe to work on the medical surgical floor, but could also put patient’s lives in jeopardy due to her inexperience. So, what is that nurse supposed to do if they decide to decline being pulled to another floor? Many nurses feel that they may be reprimanded by the shift supervisor and perhaps written up for insubordination. But are they not in fact, declining for a valid reason? Also, shouldn’t quality patient care be the utmost priority as well as patient safety? The answer to both of these questions is of course a resounding, YES! However, many nurses are faced with these dilemmas day in and day out. They leave at the end of the day feeling as if they haven’t been able to give proper nursing care. They would be correct. It is an unsafe practice to float nurses that are unfamiliar with a particular floor to work there. The fact is, that it is done on a regular basis. Would this be a sufficient reason to strike? Many nurses think so. The list could go on and on. How safe would you feel with a nurse caring for a loved one who was on the sixteenth hour of a double shift? Not very, right? Approximately 60% of nurse in practice are providing care in hospitals (Work-Place issues, 2005)

In 1946, the American Nurses Association’s House of Delegates unanimously approved a resolution that opened the doors to nurses to engage in collective bargaining. Then about thirty years later the legal precedent that determined that state nursing associations are qualified under labor law to be labor organizations is the 1979 Sierra Vista decision. The important consequence that affected nurse was that they were free to organize themselves and not be organized by existing unions. Currently, it is the American Nurses Association that is in the forefront of establishing coalitions and bargaining for nurses nation.

The Patient Safety Act:

What the Bill Does

It protects patients safety

– The Act calls for the Massachusetts Department of Public Health (DPH) to develop and implement limits on the number of hospital patients assigned to Registered Nurses in Massachusetts. The limits would be based on scientific research and testimony from public hearings. Once established, the staffing levels would be adjusted in accordance with patient needs and requirements using a standardized, DPH-approved acuity system. An acuity system provides a means of measuring the illness level of the patients on a particular unit and their needs for care.
– These scenarios represent just an overview of why the nursing profession has sought to organize themselves into a union status.

“It is time for a new generation of leadership to cope with new problems and new opportunities. For there is a new world to be won.” – John F. Kennedy

References
Zerwekh, J.,Claborn, J.(2006).Nursing Today Transition and Trends.
(5th ed). St. Louis: Saunders
The Coalition to protect Massachusetts Patients, P.O. Box 309 Canton Massachusetts 02021 617.731.2813


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