Professional Accountability Coaching - How to Be Accountable

Nursing Theory 

The theory that influences my values and goals is Patricia Benner's 'From Novice to Expert.' The theory is important because it encourages me to take every event as a learning experience. Although I went to nursing school, I target learning from every opportunity to increase my knowledge to become a better nurse. 

Nurses use this theory to keep learning and improving their skills in everything that they do ( Ozdemir, 2019) . The theory is in line with my professional practice as it provides a platform for my growth from a novice nurse to an expert based on my practice experience and the knowledge gained. 

Historical Nursing Figures 

I would like to analyze Florence Nightingale and Patricia Benner as two invaluable nursing figures. Nightingale's contribution to nursing is in regards to the environmental theory ( Pirani, 2016) . The theory focuses on practices related to sanitation and the role of the environment in providing care to patients. On the other hand, Patricia Benner's contribution is in terms of designating the learning levels of a nurse's career path ( Ozdemir, 2019) . Experience is a prerequisite to one attaining the level of an expert. The difference is that whereas Benner focused on a nurse attaining experience in order to provide quality care, Nightingale focused on the role that the environment plays in reducing harm to the patient and hence improving outcomes. 

Nightingale's theory plays a role in my daily activities as an operating room nurse. I am focused on ensuring proper sanitation and provision of the right environment to enhance healing in the OR ( Pirani, 2016) . My career path is also guided by Benner's theory, where I take every opportunity as a learning experience. 

Differences between the State Board of Nursing and the American Nurses Association 

The State Board of Nursing is a licensing and regulatory body exclusive to a particular state. It is mandated to set standards for nursing care and the scope of nursing practice within the state. The State Board of Nursing is also responsible for the issuance of licenses to those qualified individuals. On the other hand, the role of the American Nurses Association is to advance the profession of nursing through the process of fostering high standards of practice, promoting workplaces that re safe and ethical, and enhancing the wellness of nurses ( Roux, 2017) . The American nursing association also advocates for healthcare issues that affect nurses or the public. 

The two organizations influence my nursing practice by setting the standards that I have to follow in everything I do. The standards ensure that my patients get the best care and all the necessary nursing assistance required for successful recovery. The ethical code of conduct ensures that my practice adheres to the requirements set by law. 

A professional license in the state of Texas cannot be renewed two months before the actual date of expiry ( Roux, 2017) . The applicant must also meet the mandatory continuing nursing education requirements. Renewal also calls for one to pass the criminal background check. The license number and the social security number should always match what is on the system. Failing to maintain the requirements makes it hard for the holder to renew the license in Texas. Moreover, the person may be forced to apply for the license afresh at a costly price, unlike when using the reduced renewal cost. 

In a compact state, a license allows one to practice in other compact states. The flexibility ensures that any certified and qualified nurse can practice in any state without any restrictions. This model contrasts with the non-compact state where the nursing license is only valid to the issuing jurisdiction and nowhere else. 

FDA, Medicaid, and Medicare 

The FDA's role is to protect the public against harm from drugs, medicines, foods, and medical devices. Medicare is a federal program that covers people who are above 65 or under 65 if they have disabilities. Medicaid provides one with health coverage if you have low income ( Mark, Parish, & Zarkin, 2019) . 

The FDA influences my nursing practice by setting regulations on the administration of certain drugs. Medicare and Medicaid provide cover to ensure that my patients can take care of themselves comfortably ( Mark, Parish, & Zarkin, 2019) . My role as a patient advocate is to ensure that the patient makes the best decision. Therefore, I have to provide the patient with the right information that is in his/her best interest. Consequently, everything that I must be geared towards helping my patient recovers. 

Nurse Practice Act 

The Nurse Practice Act provides the right rules and regulations in writing that promote the safe and competent practice. The scope of practice for an RN in the state of Texas includes nursing supervision or teaching and observation, assessment, evaluation, rehabilitation, and care of patients. Another scope relates to the prevention of illness ( Russell, 2017) . An RN is also involved in the development of a specific nursing care plan in the state of Texas. In Texas, a RN is involved in the observation, assessment, intervention, rehabilitation, and care of individual who are ill or injured or those who are experiencing changes in their normal health. A RN also administers medication or treatment as ordered by a physician. There is also the supervision or teaching of nursing as well as the development of care plans. 

Delegation is essential for the RN to maximize the care received by the patients. In the state of Texas, delegation is usually based on the needs of the patient, the RN's assessment of the potential for patient harm, task complexity, outcomes, and the abilities of those to handle the delegated task. 

Application of Roles to Professional Practice 

As a scientist, I am always looking for advancements in nursing knowledge based on research being conducted so that I can hone my skills. Nursing relies on science, and one has to apply knowledge on science to analyze the patient and apply the right interventions. 

In a detective role, a nurse has to conduct research and create connections to everyday practice. One has to research the medical history to get a clear picture of the health situation of the patient. 

As a manager of the healing environment, the nurse should champion the establishment of a pleasant healing environment as the patient advocate. This is possible through the use and depiction of behaviors beyond what is taught in a nursing school, such as being sympathetic and culturally sensitive. It is the role of the nurse to know some of the alternative therapies that are in place. When a patient has selected alternative medicine, the nurse should discuss the patient’s preferences and expectations. The nurse should conduct a review of the safety and efficacy of the alternative medicine that is selected by the patient. Consequently, the nurse should also offer an explanation of the science that is related to the alternative medicine. Explanation of the science involves educating the patient on how the alternative medicine works and the best option based on the symptoms. In explaining the science, the nurse has to remain respectful and nonjudgmental by letting the patient understand that what they are saying is not wrong although it may not be the best therapy to follow. The nurse can also collaborate with other health practitioners offering the alternative medicine in order to increase the benefits to the patient. The nurse should negotiate with the patient in those instances when the alternative medicine selected affects the effectiveness of the conventional medicine. 

American Nurses Association (ANA) Code of Ethics 

The first provision requires nurses to practice with compassion and respect for the dignity and worth of patients. Secondly, the nurse should collaborate with other health professionals in order to protect human rights while also reducing health disparities. These provisions influence my professional practice because they form an integral part of my daily routine ( Gurney, Gillespie, McMahon, & Kolbuk, 2017) . Besides being compassionate and respectful to all my patients in order to protect their dignity, I have to work with and share information with other healthcare professionals to ensure that my patients receive the best care that enhances their recovery. 

One of the nursing errors that may occur is the failure to record any allergies to medication or that the patient may be having before being administered. This is a common occurrence in emergency rooms when patients require urgent medical help. 

Through collaboration, the nurse can reduce this error by getting assistance on what should be done before administering the drugs ( Gurney et al., 2017) . Physicians and other healthcare professionals may pinpoint some of the allergies that the patient may be having, which reduces the chances of the error occurring. 

It is expected that a nurse practices with compassion and respect of the dignity and worth of the patient according to the ANA code of ethics. Compassionate care allows the nurse to care for the patient through actions and deeds by applying the emotional aspects of the relationship. Some of the things that are included in compassionate care include being empathetic to better understand the patient and their needs. The nurse should also be an active listener to the patient in order to understand their health issues. It also entails taking time to explain tests and procedures as well as answering patients’ questions for them to fell engaged in their care. 

Leadership Qualities 

Critical thinking, integrity, initiative, and stress management are invaluable leadership qualities that indicate excellence. Integrity is essential in being able to analyze the situation and build trust with patients and coworkers. To get the nursing job done, one needs initiative, especially in collaborating with other healthcare professionals. Critical thinking helps in performing the job efficiently and safely that promote the dignity of the patients and work effectively in a team. Stress management is essential for one to handle stressful situations that may occur when nurses work in teams. Critical thinking helps in making the right decisions in regards to promotion of patients’ dignity and autonomy in the care process. A nurse is able to respect the patient’s right to make decisions in regards to the preferred treatment. With integrity, a nurse is able to practice ethically through the use of the nursing code of ethics. Initiative helps in enabling a collaborative environment in a healthcare setting. With multidisciplinary aspects represented in a team, initiative helps in sharing information and promotion of teamwork to better the patient’s outcomes. 

Nursing leadership becomes successful when the environment is cooperative, and all nurses are working towards a common goal. If the leaders do not foster teamwork, the work environment is negatively affected. Nursing leadership requires the establishment of an environment that fosters cooperation. Concerning decision-making, an accommodating environment means that all stakeholders take part in the decision making process. However, an environment that does not promote engagement limits the number involved in making an important decision, which subsequently demotivates those who feel disenfranchised. Professional development entails one improving his or her skills while working in an organization. A work environment that awards excellence and advancement in skills promotes professional development. 

References 

Gurney, D., Gillespie, G. L., McMahon, M. P., & Kolbuk, M. E. (2017). Nursing code of ethics: Provisions and interpretative statements for emergency nurses.  Journal of Emergency Nursing ,  43 (6), 497-503. 

Mark, T. L., Parish, W., & Zarkin, G. A. (2019). Association between Medicare and FDA policies and prior authorization requirements for buprenorphine products in Medicare Part D Plans.  JAMA ,  322 (2), 166-167. 

Ozdemir, N. G. (2019). The development of nurses' individualized care perceptions and practices: Benner's novice to expert model perspective.  International Journal of Caring Sciences ,  12 (2), 1279. 

Pirani, S. (2016). Application of Nightingale's theory in nursing practice.  Annals of Nursing and Practice ,  3 (1), 1040. 

Roux, G. (2017). Issues and trends in nursing . New York, NY: Jones & Bartlett Learning 

Russell, K. A. (2017). Nurse practice acts guide and governs Update 2017 .  Journal of Nursing Regulation ,  8 (3), 18-25. 

Task 2 

Responding to the Request 

While responding to Mr. Newcomb's request, I have to determine the ethical issues and challenges at hand. Although the wishes of the patient must always supersede in any situation, the nurse should not be held hostage into doing things against their moral standards and professional requirements. Nonetheless, I have to ensure that his interests prevail because of my advocacy role matters health. I will focus on professionally and respectfully decline to fulfill his request of wanting to see his mistress based on the knowledge that he is happily married. My action will not impede my desire to provide an environment that promotes his recovery: being with his family is the best environment. Acting as an intermediary to issues unrelated to health is not part of my practice scope as a nurse ( Burlone & Richmond, 2018) . Although the nursing code of ethics requires me to listen to the patient and respect his wishes, I must ensure that the wishes do not put me in an ethical dilemma or do anything that is complicit to unethical practices. 

Applying Ethical Principles 

Nurses are required to act based on the principles of autonomy, beneficence, non-maleficence, as well as justice. Autonomy relates to respecting a person's right to make decisions as they choose. Mr. Newcomb can still make all-encompassing decisions, although he is nearing death ( Burlone & Richmond, 2018) . Therefore, nothing prevents him from telling his wife the truth of having a mistress, calling the mistress, or organizing on how she would see him. As an ethical nurse, I have to avoid instances that predispose me to act immorally ( Fazljoo, Abbaszadeh, & Loghmani, 2018) . 

Beneficence deals with the promotion of goodness and kindness to others. Although Mr. Newcomb's request to see his mistress may benefit him by getting the peace of mind and emotional wellbeing, using me as a conduit to seeing her is detrimental to the principle of beneficence ( Fazljoo, Abbaszadeh, & Loghmani, 2018) . In essence, his request goes against my moral compass because I will have to hide the meeting from his family, who are the next of kin. 

The principle of non-maleficence is based on the duty to inflict no harm to the patient. I complied with this principle because I used a safe and ethical nursing practice when dealing with Mr. Newcomb. I am not supposed to do anything that goes beyond my scope of nursing practice, especially if it creates a moral dilemma ( Gurney et al., 2017) . My respectful decline to the patient's request does not inflict any harm on him. I must manage his health, provide him with a conducive environment, and not interfere with his personal life ( Schiller, Pesut, Roussel, & Greig, 2019) . If he makes the arrangements himself, I would be happy to facilitate the visitation if it adheres to the ethical standards that are in place and not in violation of my moral standards. 

Justice entails the practice of fairness, aspects of equal treatment, and respecting the patient's rights. Although I respect the patient's right to make healthcare decisions, I should not participate in decisions that affect his family negatively ( Gurney et al., 2017) . The respect for the dignity and principle of justice should not come above my professional responsibility of doing what is right to not only the patient but also his family. This justifies my act of recusing myself from his request as it affects my moral obligation because assisting him would negatively affect his wife. 

The Influence of My Personal Beliefs 

This scenario required an examination of my personal beliefs and value system based on my obligation to enhance the patient's interests. However, my beliefs and conscience would not allow me to be part of a scheme to lie and deceit Mr. Newcomb's wife, to whom he had been married for forty years. Although it is the patient's last wish, I believe that I should not be involved in a private matter that solemnly depends on the patient, and the affected parties that are the wife and the mistress. When I encounter an ethical dilemma, I tend to use the 'Situation Assessment Procedure and the Ethical Decision Making Model' to get myself out of the dilemma. The model entails the identification of health issues and problems, analysis of the available alternatives, selection of an alternative, and justification of the adopted solution ( Gurney et al., 2017) . Besides ensuring that the best solution is selected, it appreciates the possible alternatives that can be used in solving the problem. I can also analyze the role of my personal beliefs and ethical standards in shaping my decisions ( Young, Froggatt, & Brearley, 2017) . Therefore, I can collaborate with other healthcare professionals to get their ideas on the right course of action when solving a dilemma. 

Strategies to Promote Self-Care 

Nursing is a demanding profession because it involves caring for patients' physical and emotional wellbeing. A nurse must practice what we tell our patients to do, such as proper nutrition, getting enough sleep, taking part in exercises, and mental health. However, nurses fail to have a balance between work and personal lives ( Trettene, Fontes, Razera, & Gomide, 2016) . An excellent work-life balance entails minding one's body, achieving mental health, and emotional status. I find solace in religion as a source of fulfillment, hope, and courage to continue with my nursing profession as a calling from God. Taking care of my spiritual wellbeing has enabled me to take better care of my patients. 

I also take care of my wellbeing by spending time with my family. Family provides a time away from the duty schedules and thoughts of work. Therefore, it is an opportunity to relax and reenergize my body before returning to my regular schedules. Spending time with my family provides peace and solace, and I feel supported for what I do daily ( Trettene et al., 2016) . Lastly, I use hobbies to take care of myself. I tend to spend much time either walking with my pet or reading books. These activities help me relieve the pressure I feel from work while also managing my stress levels. Nursing is a life of servitude; we owe it to our patients not only to take care of themselves but also ourselves. 

References 

Burlone, N., & Richmond, R. G. (2018). Between morality and rationality: Framing end-of-life care policy through narratives.  Policy Sciences ,  51 (3), 313-334. 

Fazljoo, S. E., Abbaszadeh, A., & Loghmani, L. (2018). Comparison of moral reasoning of nursing students and nurses in Meybod City in facing with dilemmas.  Medical Ethics Journal ,  12 (43), 1-9. 

Gurney, D., Gillespie, G. L., McMahon, M. P., & Kolbuk, M. E. (2017). Nursing code of ethics: Provisions and interpretative statements for emergency nurses.  Journal of Emergency Nursing ,  43 (6), 497-503. 

Schiller, C. J., Pesut, B., Roussel, J., & Greig, M. (2019). But it's legal, isn't it? Law and ethics in nursing practice related to medical assistance in dying.  Nursing Philosophy ,  20 (4), e12277. 

Trettene, A. D. S., Fontes, C. M. B., Razera, A. P. R. & Gomide, M. R. (2016). Impact of promoting self-care in nursing workload.  Revista da Escola de Enfermagem da USP ,  50 (4), 635-641. 

Young, A., Froggatt, K., & Brearley, S. G. (2017). 'Powerlessness' or 'doing the right thing'–Moral distress among nursing home staff caring for residents at the end of life: An interpretive descriptive study.  Palliative Medicine ,  31 (9), 853-860. 

Task 3 

Quality and Safety 

Quality and safety are important aspects if a nurse is to practice patient-centered care. Patient safety is vital to the enhancement of healthcare outcomes. Therefore, one's competence in facilitating the achievement of quality care is evaluated through the acquisition of an appropriate license from the state. The nurse also requires knowledge and skills needed to practice in a unique setting ( Sherwood & Barnsteiner, 2017) . Taking the 'Organization Systems and Quality Leadership' course enabled me to understand the national indicators of nursing quality. It also prepared me to collect evidence-based research aimed at improving the quality and safety in patient-centered care. I have also attained IHI certification that enabled me to appreciate the importance of quality and safety in patient-centered care.   

Evidence-Based Practice 

Evidence-based practice is the standard of care that has been proven safe and effective using clinical studies, responses from patients, and cost-perceptive. It is essential because it allows nurses to execute their roles systematically and within a short time because its effectiveness has been verified through research. A good example is the prevention of hospital-acquired infections. My evidence-based practice project enabled me to have a better understanding they entail and ways of minimizing the infections ( Spyder, 2018) . I believe that EBP is a collection of the standards of practice, which have already been proven through several studies to be safe, efficient, of high quality, and cost-effective. I now have knowledge and skills to analyze sources in terms of credibility and reliability, which is essential in enhancing patient outcomes. My journey at WGU has enabled me to become a nurse who appreciates the need for evidence-based practice when providing care to my patients. 

Applied Leadership 

Nurses are leaders in healthcare settings because they serve as the patient's advocates. Besides being self-driven and motivated, they should use power as a positive attribute while communicating clearly with the patients and other healthcare professionals. I have participated in working in a multidisciplinary team. The membership was based on the length of time that the nurses spent while working with the patients ( Smith & Johnson, 2018) . The professional collaboration was essential in the attainment of patient-centered goals as well as outcomes. I managed to refine my communication skills in sharing information not only with the patient but also with the professionals. In my nursing role, I have to improve my skills continually because I can be assigned tasks that require me to be a leader. I intend to use applied leadership traits that I have learned to foster collaboration in my department and ensure that all my patients are provided with the best care possible. 

Community and Population Health 

A professional nurse has to be involved in promoting the health of the community. The 'Community and Population Health' course allowed me to interact with different community members who offered different and unique health problems. Their challenges fell within the scope of a nurse, especially regarding the assessment and development of interventions that would improve the quality of life (NCCDPHP, 2020) . I was able to appreciate the application of public health nursing, especially on the causative factors and the preventative measures that can be undertaken. While working in a community with low-income families, I understood that obesity was one of the underlying problems. The challenge occurred because poverty limited the ability of the families to afford to eat healthy foods. With the information, I considered the approach of creating meal plans with readily available, healthy, and affordable food sources for this community. Besides, awareness will enable the families can get information on how to observe their diet, exercise, and manage their weight. The experience enabled me to understand the role that nurses play in promoting healthcare within the communities. 

References 

NCCDPHP: Community Health. (2020). CDC. Retrieved April 30, 2020, from https://www.cdc.gov/nccdphp/dch/about/index.htm 

Sherwood, G., & Barnsteiner, J. (2017).  Quality and safety in nursing: A competency approach to improving outcomes . John Wiley & Sons. 

Smith, C. M., & Johnson, C. S. (2018). Preparing nurse leaders in nursing professional development: Theories applied to leadership in nursing professional development. Journal for Nurses in Professional Development ,  34 (1), 38-40. 

Spyder. (2018, July 27). Evidence-Based Practice . Retrieved April 30, 2020, from https://www.amsn.org/practice-resources/evidence-based-practice