Running head: STANDARDS OF PRACTICE

Nursing Standards of Practice Jessi Chipman Ferris State University

STANDARDS OF PRACTICE Abstract The American Nurses Association is a professional nursing organization that wrote the Scope and Standards of Practice (2010) and Code of Ethics for Nursing (2001). There are 16 ANA standards and nine ethical provisions. Throughout my ongoing clinical experiences I have met many of these standards. I have provided specific examples for how I have met those standards and for the standards that I have not met, I have developed a plan, which outlines my goals and actions for how I intend on meeting those standards. As a future nurse it is essential that I am knowledgeable and strive to meet all of the standards and the ethics. In return, I will provide patients with evidence-based quality care and promote health and safety.

STANDARDS OF PRACTICE Nursing Standards of Practice The Standards of Professional Nursing Practice are authoritative guidelines, standards, and principles of duties that all registered nurses are expected to perform

competently (American Nurses Association [ANA], 2010, p. 31). Assurance of competency is a right to the public and enhances quality care within nursing professions. Competency is dynamic and situational so it allows the nursing profession to be flexible but consistent within those dynamic environments (ANA, 2010, p. 12). The Code of Ethics for Nurses is also authoritative nonnegotiable duties that fulfill ethical standards and ethical obligations for anyone who enters the nursing profession (American Nurses Association [ANA], 2001, p. 2-3). Nurses have the duty to provide quality care while acknowledging and obeying moral norms (ANA, 2001, p. 3). The framework for both Standards and Code of Ethics is developed using the nursing process which includes; assessment, diagnosis, outcome identification, planning, implementation, and evaluation. Duties and obligations will have opportunities for change through evaluation and revision due to the expanding body of nursing research (ANA, 2010). Standards of Practice Assessment The first standard of practice expects the nurse to collect comprehensive data pertinent to the healthcare consumers health and/or the situation (ANA, 2010, p. 32). This includes health care information about a patient that directly affects their care. Such information includes; individualized and unique personal values, beliefs, and attitudes, current expression and knowledge of their healthcare needs, and potential barriers to effective communication. A nurse must perform the assessment duty while applying ethical and legal standards to abide by patient autonomy and by recording accurate and truthful documentation. A nurse must also establish a

STANDARDS OF PRACTICE relationship with the individuals family or support systems to reach an appropriate and attainable healthcare goal (ANA, 2010). I have met this standard by collecting data regarding the patient using physical, functional, psychosocial, emotional, cognitive, sexual, cultural, age-related, environmental, spiritual, and economic assessments. Since I had the opportunity to student nurse on several different units and facilities, all of these assessments were applied at one time or another for patients I collaborated with. For example, during the mental health rotation I was able to have a one-on-one interaction with a young homeless female who had a diagnosis of severe depression

with suicidal ideation and schizophrenia. I used therapeutic communication to complete an entire assessment covering all data listed above. This also included assessment of potential barriers to effective communication and care. With assessment information gathered I was able to analyze and create appropriate nursing diagnoses. Diagnosis The second standard for nurses is to analyze the assessment data to determine the diagnosis for the issue (ANA, 2010, p. 34). Nursing diagnoses are developed to make the patient and their support teams aware of potential barriers or risks that are related to the medical diagnosis. Nursing diagnoses are formulated from a standardized classification system which helps to validate issues, barriers, and risks derived from the diagnosis. Diagnoses are the framework to creating expected outcomes and an initial health care plan to reach appropriate goals (ANA, 2010). I have met the standard of diagnosis by participating in plans of care for patients in clinical rotations. During my experience at Munson Medical Center, I completed weekly paperwork on an assigned patient creating appropriate nursing diagnoses for that individual. The

STANDARDS OF PRACTICE diagnoses that I created derived from the assessment data that I collected and analyzed. I would discuss the diagnoses with my clinical instructor to validate my reasoning behind the risks or barriers identified. Outcome Identification

Outcome identification standard expects registered nurses to be competent in identifying expected outcomes for a plan individualized to the healthcare consumer of the situation (ANA, 2010, p. 35). Outcomes are measurable goals that respect patients unique cultures and values using a holistic and timely approach. Outcomes are patient orientated and quite often include families or support teams of that particular patient and their healthcare providers. Outcomes should include benefits, risks, and costs backed up with evidence-based practice including alternative strategies made necessary by a change in patient condition of enviornment. It is also the responsibility of the nurse to provide accurate documentation regarding the measurable goals (ANA, 2010). I met this particular standard by creating plans of care for patients. After assessments and diagnoses are complete, based upon the patients condition and reason for hospitalization, outcomes were created. I would discuss the goals with patients and listen to their concerns or feelings towards those that were set. For example, I had a total knee replacement patient that was a heavy smoker and drinker. He was unsure why he was continuously in and out of the hospital due to infections at incision site. After I explained the importance of smoking cessation and its relation to increased healing time, we created appropriate and attainable goals for him regarding smoking and drinking cessation. Planning

STANDARDS OF PRACTICE Another standard for registered nurses is to competently develop a plan that prescribes strategies and alternatives to attain expected outcomes (ANA, 2010, p. 36). Planning should be unique and individualized, respecting the patients values, beliefs, and culture. The framework for planning should address, promotion and restoration of health, prevention of illness, alleviation of suffering, and supportive care for those who are dying across the lifespan (ANA, 2010, p. 36). Similar to all other nursing standards, planning should be developed using evidence-based practice from current research and include all members of the healthcare team. Changes are applicable due to changing patient conditions and environment. Accurate documentation using standardized language is crucial (ANA, 2010).

I have met the planning standard by practicing health promotion and restoration of health. Working with a patient whom was a heavy drinker and smoker allowed me as a student nurse to focus on health promotion so the particular patient could restore his health. Our main focus was smoking cessation because of his frequent infections related to an invasive surgery. He was not healing properly and did not understand the consequences of smoking and drinking while in recovery. The patient and I created a plan based upon smoking and drinking cessation as well as healthy eating habits. It was important for this patient to restore his health because of his dedication to work and family. Implementation Another crucial nursing standard is for a registered nurse to implement the identified plan (ANA, 2010, p. 38). This involves retrieving pertinent information regarding nursing practice to enhance quality and safety within the nursing process. Information gathered should be evidence-based and specific to the diagnosis or problem (ANA, 2010, p. 38). Collaboration within and outside of the hospital plays a crucial role in implementation. This means utilizing

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community resources for the patient, patients family, and healthcare providers so the patient can reach their healthcare goal. Promotion of autonomy and allowing the patient to problem-solve and participate to their fullest capacity is also a competency nurses must display. The more educated the patient is on their care and being able to choose their plan of care, the better the outcomes (ANA, 2010). I believe that there are some competencies that I have completed within the implementation standard. I had the opportunity to utilize community resources by providing car seats to under privileged patrons within Osceola County. There were two different circumstances where the nurse and I had to drive to a home to provide car seats for toddlers that had out grown their carriers. The parents within the home did not have the means to buy new seats to get their sick children to and from the hospital. Providing a car seat meant that the children were able to get the care they need and deserve. This was important to me as a person and student nurse. I was honored to be a part of providing care within diverse populations. Coordination of care. The sub-standard of implementation is the coordination of care that requires registered nurses to coordinate care delivery (ANA, 2010, p. 40). This involves organizing the plan, managing care, assisting in care decisions, communication with all healthcare providers, advocating for the patient, and documentation of care. Coordination of care emphasizes maximizing independence and quality of life (ANA, 2010, p. 40). I believe I have met this standard by creating care plans for patients on several different units. I have had many opportunities during my clinical experience to do patient admissions and create a care plan. Along with admissions, I have also discharged and finished up the care plan I stated during admission. Being able to provide care to the patient throughout their entire hospitalization allowed me to manage their care as well.

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Health teaching and health promotion. This sub-standard of coordination of care states that registered nurses must employ strategies to promote health and a safe environment (ANA, 2010, p. 41). The importance of health promotion is expressed and helps diminish any barriers that have been created through the absence of preventative care and risk taking behaviors. In order to promote healthy lifestyles the patients culture, values, beliefs, and developmental abilities must be considered. This will also diminish barriers and empower patients to express their concerns on whether or not the care is suitable (ANA, 2010). Since health promotion is an important part of patient education, I have had a lot of exposure. As a student nurse we were required to do daily patient education tasks to reduce the amount of uncertainty the patient has regarding their hospitalization, disease process, or resumption of activities of daily living. In one particular I had a patient who had reoccurring infections related to an invasive shoulder surgery. This patient in particular was a smoker and was not able to heal from surgery. I expressed the importance of smoking cessation and how tobacco use will double the amount of time it takes to heal. I was able to help him look at smoking cessation techniques and what could potentially work to meet his goals. Consultation. This sub-standard of coordination of care requires graduate-level prepared specialty nurse of advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of other, and effect change (ANA, 2010, p. 43). This involves competencies for graduate-level prepared nurses or advanced practice registered nurses. This does not include the bachelor prepared nurses therefor I have not met this standard. However, consultation will be an importance piece to providing quality care if I decide to advance in my nursing education. I will complete the consultation standard by using evidence-

STANDARDS OF PRACTICE based practice to make decisions regarding the patient and everyone involved in their line of care. Prescriptive authority and treatment. This sub-standard of coordination of care involves the advanced practice registered nurse to use prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations (ANA, 2010, p. 44). Again, this involves the practice of higher level than bachelor prepared nurses so I do not meet this standard. If I decide to pursue a higher education within nursing, I will be expected to have these competencies. It involves prescribing evidence-based treatments and pharmacologic agents that will be cost-effective and most suitable for the patient (ANA, 2010). With more advanced education, I will gain the knowledge necessary to complete this standard. Evaluation

The evaluation standard requires registered nurses to remain competent in the evaluation of progress towards attainment of outcomes (ANA, 2010, p. 45). This standard involves evaluating the outcomes set by the nurse, healthcare team, and patient to determine if the goals are suitable for the patient. This involves evaluating the barriers and communication between all members of the healthcare team and using the nursing process to revise goals if necessary. It is the duty of the nurse to disseminate outcome results to the care plan team as well as documenting the information (ANA, 2010). I have met this standard by helping patients reach their goals set by the nurse, myself, and all others involved. Goals set are not always life changing and may be small but impact in a big way. For instance, I helped set goals with a 55 year-old total knee replacement patient. She was nervous to get up and move around so we started small and set goals for her to go to the

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bathroom. This was a distance of approximately ten feet. After she made it to the bathroom, we set a goal for her to ambulate down one of the hallways. This seemed impossible to her so we moved it to the nurses station, which was significantly closer. Both days that I was there working with her, we did this. If the goal set did not work, we set a new one that seemed more attainable. This keeps the patient involved in her care and builds confidence as well. Ethics The ethics standard expects the registered nurse to use the Code of Ethics for Nurses with Interpretative Statements (ANA, 2001) to practice ethically (ANA, 2010, p. 47). Ethics standard expresses the importance for nurses to be competent in protecting the patients values. All people should be treated equally no matter the reason is for hospitalization. When I am in the clinical setting I always feel the need to give my patients choices. I do not want them to feel like they are being told what to do. For example, I had an older client that did not ever want to get out of bed. It was difficult and painful for her, but the doctors did not want her lying in bed all day, so I gave her the liberty of setting her own schedule. I asked her when she wanted to take a shower and when she wanted to get up and sit in her chair. This way she was still getting up and following the doctors orders, but on her own schedule. Since she was the one making the decisions, she was much more compliant with the orders set by the doctors. Education The education standard requires registered nurses to attain knowledge and competence that reflects current nursing practice (ANA, 2010, p. 49). This standard I have definitely met and will continue to meet throughout my nursing career. It is a necessity that nurses are always educated on the most up-to-date evidence-based practices. As nurses, it is important to

STANDARDS OF PRACTICE understand the field of healthcare is ever changing and developing new and better ways to do

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things. We cannot be stuck in our ways, and have to be willing to try new methods (ANA, 2010). I have been fortunate to have an excellent clinical instructor that challenges me to find answers to my questions. For example, I had a patient that was receiving a platelet transfusion and I did not understand why. My instructor insisted that I look up all patient information to understand more about the patients diagnosis. This allowed me to evaluate the information and understand for myself. I took the evaluated information back to her and she praised me for critically thinking and understanding what it was that I was looking for. Evidence-Based Practice and Research The registered nurse integrates evidence and research finding into practice (ANA, 2010 p. 51). It is important for nurses to be competent in using current evidence-based practice to enhance patient quality and safety. It is crucial that nurses use research to collect data regarding best practice. Not only does the nurse have the responsibility of using best practice, but to share that knowledge with colleagues and peers. All new knowledge should be incorporated into initiating changes in nursing practices (ANA, 2010, p. 51). This is a standard that I do not feel I have gotten much experience in. Throughout my nursing education at Ferris State University, I have been taught the most current up-to-date skills and information. However, I have not been able to research enough on my own to determine if change is necessary for those practices. Knowing that research is very important, I understand how crucial reading and studying consistently can help me find the most recent evidence-based practices. For example, if a new procedure can be done in a more efficient manner and promotes faster healing, then I need to be aware of this and incorporate it into my nursing practice. Professional Development Plan

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Goals. I have a bachelors degree in Health Care Systems Administration, with a focus in quality improvement. A large portion of quality improvement is utilizing evidence-based research to reach patient quality standards. I recently completed my first clinical round at a psychiatric facility. This setting is one that I would appreciate working in and gain more experience. Evidence and research are of great value in every field of nursing, but would be very beneficial to me as a nurse in the mental health field. I would look to research to understand the best techniques in dealing with patients with various illnesses. I want to be able to help my patients to the best of my ability by being self-sufficient and taking the initiative to look at the research. It is a task that will not only benefit my patients, but will make me a better nurse as well. Quality of Practice The quality of practice standard requires registered nurses to contribute to quality nursing practice (ANA, 2010, p. 52). The main concept of this standard is the promotion of interpreting and recording safe, quality care. The nurse is responsible in promoting quality assurance to patients and their families and incorporating safety measures at the same time. All activities and duties that a nurse performs should consist of maximum quality assurance (ANA, 2010). As a student nurse I have met this standard. I have a bachelors degree is Health Care Systems Administration and did a sixteen week internship at Spectrum Health Reed City Hospital in Quality and Risk Management. This has really been a benefit to me because I am always on the look-out for opportunities of improvement. Whether it is patient care related or organizational related, I feel like a nurse should always be promoting quality. For instance, when I overheard two nurses discussing culture reading times in the Emergency Department and how

STANDARDS OF PRACTICE important it is for doctors to be reporting them on-time. I immediately thought it would be a

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great initiative. This would enhance quality care for patients because a more accurate reading of their culture means an appropriate diagnosis and medication regimen would be prescribed the first time. Which would in return reduces re-hospitalizations for the same illness. It would be cost-effective and enhance quality. Communication The registered nurse communicates effectively in a variety of formats in all areas of practice (ANA, 2010, p. 54). Communication is a key component to being a quality nurse. Nurses have to able to communicate effectively to a variety of people that are involved in the patients care. Once inpatient communication is established, it is equally important to maintain communication outside of the hospital to aid in accomplishing patient goals. (ANA, 2010). As a student nurse I have learned to communicate with my patient, instructor, other nurses, doctors, and other professionals in all departments. For example, I had to effectively communicate with the physical therapist when discussing the needs of my patient with the bilateral knee replacement. I am consistently communicating with nurses that are working with my patient. It is an obligation for student nurses to report any patient changes to their nurse (ANA, 2010). Leadership The leadership standard expects the registered nurse to competentl y demonstrate leadership in the professional practice setting and the profession (ANA, 2010, p. 55). Leaders oversee the care provided by all healthcare personnel and determine suitability for that patient. It is important for leaders to communicate effectively to colleagues and stay committed to patient

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autonomy and by considering patients cultures, beliefs, and values while performing care (ANA, 2010). I believe as a student nurse, I have not fully met this standard. I do not feel I have enough leadership opportunities in clinical. However, I understand the importance of leadership, and as a nurse it will be necessary for me to be responsible for my actions while caring for a number of patients. I understand that at some point I may need to supervise fellow nurses and in order to be successful I need to be an effective leader. Being a leader also means keeping up-to-date on my education and attending classes provided to me. Professional Development Plan Goals. A leader needs to be able to stay organized and make decisions. Once I am a registered nurse, I will eventually get put into a position where I need to be a leader. It is important to me that I handle issues brought to me and that my fellow colleagues trust me in being their leader. Once I obtain a job, my plan is to immediately start working on my leadership skills. I need to be able to make decisions, continue to advance my education, and treat my colleagues with respect and dignity. Part of fulfilling my goal to be an effective leader will be to take Continuing Education Units (CEUs) that will help facilitate this. Within six months of obtaining a job I would like to have advanced my leadership abilities. Collaboration The collaboration standard requires the registered nurse to be competent in collaborating with healthcare consumers, family, and others in the conduct of nursing practice (ANA, 2010, p. 57). This includes communication with the patient, their family members, other healthcare professionals, and all others involved in patient care. Nurses should promote healthy work environments and aid in building trust and respect for those around them. Collaboration also

STANDARDS OF PRACTICE involves teamwork and nurses must be competent on how to engage within the team-building process (ANA, 2010). I believe I have met this standard because everyday collaboration is used between my peers, clinical staff, professors, patients, and me. For instance, I had a patient that was actively

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dying from Alzheimers and other comorbidities. Collaboration was crucial to give support to the dying patient and his son. Because this situation was devastating to both father and son, it was my duty as a student nurse to collaborate with the healthcare providers, Hospice, and other family members involved to provide the patient with comfort care and help his family grieve. Professional Practice Evaluation The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations (ANA, 2010, p. 59). This includes evaluating own performances to identify strengths and weaknesses as well as giving constructive feedback to peers. Evaluation of strengths and weakness is an important piece to improvement. Acknowledging areas needed for professional growth will help nurses reach their workplace goals and in return, increase quality care (ANA, 2010). I dont feel as though I have met this standard. This is a standard I do not feel I can fully meet as a student nurse. I do receive feedback from my clinical instructor, but I feel that this standard is addressing nurses once they are in the workforce. Professional Development Plan Goals. Once I have obtained a position as a registered nurse, I will welcome feedback from my peers. I believe that I can improve if I am aware of the areas that I have weaknesses in. I will look at my evaluations as a tool that will help me advance my skills as a nurse. I will also attend any peer reviews and participate in constructively helping my peers realize their strengths

STANDARDS OF PRACTICE and weakness so that they can continue to grow in their careers. This is a goal that I plan on beginning to fulfill immediately after being hired. Resource Utilization The resource utilization standard requires the registered nurse to utilize appropriate resources to plan and provide nursing services that are safe, effective, and financially

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responsible (ANA, 2010, p. 60).Resource utilization also involves assessing resources that are needed and available to the patient so their goals are achieved. This includes addressing the risks, benefits, and costs of seeking treatment regarding their care (ANA, 2010). I do not believe that I have fully met this standard in my clinical setting. It is important as a registered nurse to recognize the possible resources that your patient is going to need both during their stay and once they have left the hospital. Doing this in a cost-effective manner is a significant aspect to meeting this standard (ANA, 2010). Professional Development Plan Goals. In the near future, once I have acquired a nursing position, I will provide my patients with the best care possible. This includes recognizing potentially hazardous situations that may harm my patients and by providing them with resources that improve their quality of life. According to the ANA (2010), the registered nurse advocates for resources, including technology, that enhance nursing practice (p. 60). Patient advocacy is essential in keeping patients safe and plays an important role in helping patients receive the highest quality of care. Environmental Health The registered nurse practices in an environmentally safe and healthy manner (ANA, 2010, p. 61). This includes attainment of knowledge regarding safe and unsafe environments and noticing factors such as sound, odor, noise, and light. Environmental health in regards to

STANDARDS OF PRACTICE nursing practice includes keeping self, peers, patient, and family members safe from any

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hazardous situations as well as the promotion of healthy communities through healthy lifestyles (ANA, 2010). When I first made the decision to enter nursing school a great concern for me was safety. I was concerned about catching something from my patients. Now that I have had some experience in working with patients I still want to make myself safe but I also want to keep my patients safe. It is important to me, as a future nurse, to practice in a safe manner and provide my patients with the safest, healthiest environment that I can. For example, I wash my hands before I enter any patients room and when I leave the room. I have also had several patients that are under contact isolation precautions. For example, one of my patients was in contact isolation for Methicillin-Resistant Staphylococcus Aureus (MRSA). I noticed a lot of the staff that entered that room did not put on appropriate attire the sign on the door stated. I made sure that when I entered the patients room I wore proper attire. This not only keeps me protected, but others who are in the hospital as well. Code of Ethics Provision One The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems (ANA, 2001, p. 3). It is important for nurses to treat patients equally. It is an ethical duty to ensure that all patients get the highest quality of care regards of the circumstance. Autonomy provides patients with a sense of self dignity and worth which is crucial in the healing process. Remembering that

STANDARDS OF PRACTICE every patient is unique and as well as the situation will also be beneficial in providing quality care (ANA, 2001).

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During my clinical experiences, I do not place judgment on any of my patients regardless of this situation. For example, I had a patient of a low socioeconomic status that drank alcohol heavily and was also a heavy smoker. This patient had just been given the diagnosis of terminal lung cancer. While others might judge this woman and say she brought this disease upon herself because of her lifestyle choices, I knew it was my responsibility to show this women kindness and empathy. My job is not to pass judgment upon patients but to offer support through compassion and sincerity. Provision Two The nurses primary commitment is to the patient, whether an individual, family, group, or community (ANA, 2001, p. 5). This ethical code, in my opinion, is one of the primary skills that I have been taught throughout my nursing school experience. A nurses total responsibility is to the patient and must always put patients needs and wants first. Nurses are to provide care and guidance to patients, but never to enforce their own beliefs and opinions (ANA, 2001). This may be a difficult task at times if a situation/case challenges your own beliefs and values. However, these types of situations in nursing are a guarantee. It is important to remember to step back from a situation and collect judgmental thoughts and turn them into thoughts that will benefit the patients direct care. For example, my patient diagnosed with lung cancer refused to get treatment and wanted palliative care instead. This challenged my own beliefs and values because as a mother, I could not imagine just letting go. I would not be able to just give in to cancer but every situation was

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unique and this patient has the right to make decisions regarding her end of life care. Those types of decisions take a lot of courage so in fact this patient had more courage than I did. Provision Three The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA, 2001, p. 6). Nursing care should always be beneficial and patient centered. Patients want to get medical care from a person that is going to advocate for them and ensure that they get the best quality of care possible (ANA, 2001). There have been a few times during my clinical experience that I have had to protect the safety of my patients. For example, I came across a dangerous situation passing medications with my nurse. I had to calculate and draw up medication that was ordered by a physician and administer through IV push. My supervising nurse challenged my calculations and with certainty thought more medication needed to be drawn up. As a student nurse, I get intimidated easily and typically when an experienced nurse tells me I am not doing something correctly, I re-evaluate my actions and change them. This time was different, I knew I was right. For the safety of my patient I had to refuse what my supervising nurse was telling me to do and explain to her why I was right. After some debate she realized her mistake and agreed with me. Provision Four The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care (ANA, 2001, p. 8). Delegation is an important skill needed to be an effective and efficient nurse. In order for a nurse to give the best possible care to all of their patients, they need to be willing to delegate tasks that may take up too much of their time, such as showering. It is also important for a nurse to know what tasks can and cannot be delegated (ANA, 2001).

STANDARDS OF PRACTICE At first, delegation was something I was not very good at. As a novice in the field of

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nursing I did not feel as though I had earned the right to delegate to others. My clinical instructor continued to tell me that I needed to delegate more and I needed to be more confident. Typically during clinical if my patient told me that they wanted to be showered, I would just go ahead and do that myself. As I continued to grow and gain more confidence, I learned to delegate more tasks. For example, my instructor needed us off the floor at noon one day for an afternoon infection control conference. I was taking care of a Hospice patient that could not feed herself. When lunch came around and I had to leave I realized that this was a task that I needed to delegate. I was confident about delegating but I was also polite about it. I feel that as a future nurse I need to be able to delegate tasks in a respectable manner. Provision Five The nurse owes the same duties to self as to other, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth (ANA, 2001, p. 9). A nurses primary concern is the care of his or her patients, but in order to give patients the best possible care, a nurse must protect their own health. For example, it is important to always use the proper techniques when lifting or transferring a patient. If a nurse is not careful while attending to their patients, there could be several opportunities where injuries could occur (ANA, 2001). I believe I have met this ethical standard. During clinical I had to turn a rather large patient. I knew that the task was going to be difficult to do by myself, so I made the decision to ask one of my peers to help me turn the patient. Another example is that I always wear gloves at work. Bodily fluids should always be treated as though they are contaminated and wearing gloves is taking responsibility for my own health as well as those around me.

STANDARDS OF PRACTICE Provision Six The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care

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and consistent with the values of the profession through individual and collective action (ANA, 2001, p. 11). Healthcare environments are as important to the patients health as the care that nurses provide. Another significant responsibility nurses have is to ensure that a patients environment promotes good health. As a future nurse always being aware of surroundings will be crucial. It will be important to voice concern or correct potential hazards for patient, staff, or self. Best practice will always be keeping everyone safe (ANA, 2010). I had a total knee replacement patient who had been given a shower by a personal care assistant (PCA). Without recognizing potential hazards, the PCA left water and wet towels on the patients bathroom floor. When I saw this I knew it needed to be picked up immediately so that the patient could safely walk into her bathroom. Another safety precaution that I always take note of in my patients room is tubing and cords. Many times I have walked into a patients room and their IV tubing is all tangled and their call light not appropriately placed. After my assessment I do my best to tidy up all the cords so that the patient can safely move around. Provision Seven The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development (ANA, 2001, p. 12). It is essential for a nurse to continue building his or her knowledge base. The healthcare field is constantly changing and discovering new and better ways in providing quality care. Nurses can also make the decision to go back to school to advance their education (ANA, 2001). Being a nursing student I do not feel as though I have met this standard.

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Goals. I have always had the plan to further my education; I was not entirely sure which part I wanted to advance in. Since my first bachelors is in Health Care Administration, I always thought I would pursue a masters in business with a healthcare focus. Now after working bedside with patients, I will most likely pursue a masters in nursing with a leadership focus. It is my goal to have this completed within two years of receiving my bachelors in nursing. Provision Eight The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs (ANA, 2001 p. 12). Nurses can and should be role models to the public. Promoting healthy lifestyles is a key responsibility of the nursing profession. Nurses can do a lot of good for many people, and I believe it is our duty to help everyone; not just those who are able to afford healthcare (ANA, 2001). This is an ethical issue that is very important to me. I have not yet met this ethical standard, but have intentions of doing so. Professional Development Plan Goal. Once I am a nurse I want to volunteer my services to underserved populations. This may involve volunteering at a variety of clinics or assisting other healthcare professionals in educating the public on how they can make important lifestyle changes and take charge of their own health. Provision Nine The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy (ANA, 2001, p. 13). There are many great organizations

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and associations available for nurses and student nurses to join. Its important for nurses to be a part and to be actively involved in these. Nurses can help to bring about social change and being united within an association can be more powerful and effective then an individual nurse trying to make change on their own. These associations are also great tools for networking and staying up-to-date on the latest advancements in the healthcare field (ANA, 2001). In the near future, I plan on joining the Registered Nurses Association in Michigan (RNAIM), and the American Nurses Association (ANA). Conclusion Nursing as a career collaborates with many different healthcare professionals, but ultimately each nurse practices their own career independently. Nurses have to take responsibility for any decisions and/or actions they follow through on. The ANA has set these standards and provided the Nursing Code of Ethics to guide us in our nursing career. Standards and ethics exist as a resource to protect us and the rights of our patients. This is why it is important for nurses to be knowledgeable about the standards and ethics developed by the ANA. Throughout my nursing career I will strive to consistently meet these standards and practice by the Nursing Code of Ethics. Furthering my education will facilitate me to expand my knowledge base, and someday I hope to educate future nurses and instruct them on the importance of practicing by these standards.

STANDARDS OF PRACTICE References American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from:

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http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNur ses/Code-of-Ethics.aspx American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursesbooks.org.