Running head: NURSING STANDARDS FOR MEDICAL SURGICAL NURSES

Nursing Standards for Medical Surgical Nurses

Leslie Rush
Ferris State University

NURSING STANDARDS OF MEDICAL SURGICAL NURSES

Abstract
As a professional, nurses are held to a certain set of standards. Using the American Nursing
Associations (ANA) standards of practice and education, I am reminded of what the
expectations of the nursing profession is and will able to make adjustments to my current
practice as needed. The professional development plan will work to develop my nursing career
over the next several years.

NURSING STANDARDS OF MEDICAL SURGICAL NURSES

Nursing Standards for Medical Surgical Nurses

In the ever changing world of nursing, it is critical to keep up on the latest practice
standards, technology, and continuing education requirements. This paper will demonstrate how
my nursing practice uses the standards of practice and education set forth by the ANA. The
paper will also include a plan for my future in nursing over the next several years, complete with
a time frame and goals.
American Nurses Association Scope and Standards of Practice and Education
Standards of Care
Assessment. Every shift there is a minimum of three assessments completed on each
patient. Starting with the admission to the floor and concluding with discharge paperwork
understanding, assessments are critical for patient education and understanding of what is
happening with their care.
Diagnosis. Nursing diagnosis are created when a patient arrives and initial assessments
are completed. These diagnosis are individualized to each patient's needs and can/will change
over the course of his/her hospitalization period.
Outcome Identification. By creating a nursing diagnosis, a nurse can identify specific
outcomes for each individual patient case.
Planning. When a nursing diagnosis and outcomes have been identified, the healthcare
team and the patient can begin to plan how to proceed with improving his/her health outcomes.

NURSING STANDARDS OF MEDICAL SURGICAL NURSES

Implementation. Implementation occurs when outcomes and planning have successfully

completed. When using the implementation process, nurses begin to educate the patient and the
treatment process begins.
Evaluation. Evaluation is a continual process. By evaluating, the healthcare team can
make adjustments to the diagnosis, outcomes, planning, and implementation process, repeating
this process continually through the patient's hospital stay.
The above standards of care are considered the nursing process. As a nurse, I will
continue to utilize this process each and every time I provide care to a patient.
Standards of Professional Performance
Ethics. According to The Essential Guide to Nursing Practice, "The code reflects the
profession's central and enduring values, which include service to and duties toward those for
whom we care, as well as to ourselves" (2012, 113). I find that I use justice, veracity,
nonmaleficence, and beneficence as the central ethical principles in my own personal nursing
practice. Treating all patients equal regardless of race, sex, religion, or ability to pay is at the
center of many patient encounters over my years in health care. Veracity, or better know as,
"Telling the truth, or not lying" (Chitty, 2011, 110) is important with building a trusting
relationship with my patients. I am both open and honest with my patients about their care.
Beneficence and nonmaleficence go hand in hand. "The doing of good" (Chitty, 108) and "The
duty to do no harm" (Chitty,2011, 109) should be at the forefront of any nursing personal
practice. Nurses are there to protect the patient from any harmful process and maintain a safe,
healthy environment. I do this every time I assess for a fall risk or skin breakdown.

NURSING STANDARDS OF MEDICAL SURGICAL NURSES

Education. Education is something every nurse has to do whether or not the nurse wants
to. Nurses continually have to undergo educational updates in order to maintain a nursing
license every two years. Many of the hospitals have cut back on hiring Associate Degreed
Nurses (ADN) because they feel Bachelor Degree Nurses (BSN) are better prepared. I have
chosen to continue with my education by obtaining a BSN and look forward to the possibility of
a Master's Degree to further expand my knowledge base. I have taken the course for the
Medical-Surgical Certification and look to complete the exam in the near future.
Evidence-Based Practice and Research. Research is not something I have ever
conducted, unless you include the various assignments I have had to complete for school.
Research and evidence based practice have changed the way I work. Most of the changes have
been implemented in my personal practice because I was told to change due to policy in the
health system. Change based on evidence based practice improves patient safety and allows for
nurses to provide a better quality care. Nursing practice has a research base, for the most part, but
you cannot teach someone to be caring and understanding toward a patient that is having a
difficult time. Research is the weakest area of nursing for my practice.
Quality of Practice. Quality of care/practice is delivered everyday that within my
nursing practice. This is done with the simple act of donning the gloves to protect the patient
and myself and more extensively by working together as an interdisciplinary team. Care is
delivered using evidence based practice and the knowledge gained from education. As a nurse,
one can evaluate this quality of care by making sure to following the policies and procedures set
forth by my employer and whether or not the patients health conditions are improving.

NURSING STANDARDS OF MEDICAL SURGICAL NURSES

Communication. Nurses find out about the newest methods of treatment, research is
presented, education of patients, and shift to shift report is conducted through various
communication methods. It comes in many different ways, including talking, writing, and
electronically. Communication falls into all areas of nursing standards. After all, "Effective
interpersonal communication (IPC) between nurses and the healthcare consumer is one of the
most important elements for improving satisfaction, compliance, and health outcomes" (White,
2012, 153). There are a couple of ways that I communicate in my personal practice. At the start
of the shift, the nursing staff conduct a bedside report. This not only allows the nurses to
communicate, but allows the patient a recap of what events have occurred during that day/night
along with what to look forward to during the upcoming shift. Secondly, I provide education to
my patients about procedures, medications, and various other items throughout the day. This is
done verbally and/or through reading material. Communication not only happens with the
patients, but with their families, the physicians, and other staff in the hospital.
Leadership. Merriam Webster's dictionary defines leadership as, "The act or an instance
of providing direction, guidance, and influence" (2014, Para 1). All nurses are leaders in some
way, whether it is the simple act of directing a nursing assistant in the bathing of a patient or as
complex as having the patients trust in the nurse to take charge of a situation. The quote from
The American Journal of Nursing talks about what is a good leader. "The nurse leader assists
staff RNs in gaining the necessary skills and confidence to do this by acting as a coach and
guide" (Burke, 2013, 48). As one of the seasoned veterans on the medical specialties unit, I fall
into a rotation as the floor charge nurse. As a charge nurse, it is my responsibility to make sure
the staff is able to care for their patients, both staff and patients are happy, and the unit runs
smoothly. I am also a preceptor for new nurses. This allows for mentoring of new nursing

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graduates and hires. The medical specialties unit has a Unit Based Council (UBC) that I served
as chair person for two years. The UBC helps to make decisions for the department and brings
information back to the department from management for updates to the staff.
Collaboration. Collaboration occurs when, "The registered nurse collaborates with the
healthcare consumers, family, and others in the conduct of nursing practice" (White, 2012, 173).
Knowing how to work together as a team and who to call when there are needs that the nurse is
unable to provide for the patient. There needs to be a willingness to want to have a relationship
between team members. Teamwork is key in the healthcare field. Being a team player
contributes to a healthy work environment. Working collaboratively requires nurses to work with
interdisciplinary teams and routinely refer patients to other resources within the healthcare
system. Nurses tend to be put in the middle of the team and are expected to "manage" the
patients care. By being the "manager", nurses are expected to communicate between physicians,
social workers, and various therapies to make sure the patient is getting the best care possible
and is discharged home safely in a timely fashion. This can mean calling the social work team to
let them know what the therapy team has written about the home needs of a patient at discharge
or communicating to the primary doctors that a specialist has signed off on a patient with
recommendations of care and discharge follow up. Interdisciplinary team work is an intricate
part of any nursing practice. Within my practice, I strive to round daily with my physicians.
This is done for two reasons: So that I know what the physician has to say to my patients as well
as to build strong working relationships with the physicians.
Professional Practice Evaluation. Registered nurses evaluating their practice, "Begins
with the collection of many forms of evidence through formal and informal sources (e.g.,
reflection, performance evaluations, oral situational feedback, and other sources) with the goal of

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fostering professional growth and development" (White, 2012, 187). An evaluation helps to
encourage growth in nurses and provides direction in ways to improve patient care.
Reflection occurs when something goes wrong or someone has had a stressful day at the
hospital, even looking back on the days that have been successful. I look back at what happened
and see where the process can be changed or improved upon. Management does yearly
evaluations of the staff to help monitor the staffs progress and encourage growth. Hearing that
you have done a good job or that a patient is improving because of the care I have provided are
positive evaluations.
Resource Utilization. Resource utilization is the responsibility of all hospital staff.
Nursing plays a key role as nurses are the ones who conduct the dressing changes, administer
medications, and assist patients with any needs that they may have upon discharge. Nurses need
to be mindful of the cost for supplies and equipment in order to keep costs to a minimum. As
stated in the White's Essentials Guide to Nursing Practice, "The registered nurse utilizes
appropriate resources to plan and provide nursing services that are safe, effective, and financially
responsible"(2012, 193). Many times I have looked up the cost of medications for patients that
limited funds on Wal-Mart or Meijer's Internet sites or request our social workers to help provide
indigent prescriptions.
Environmental Health. Florence Nightingale realized the importance of a patients
environment when she first began her nursing career. Her nursing theory was built around
ensuring that her patients had adequate sunlight, air, water, food, and waste removal.
Environmental Health is just as important today as it was back then. "Nurses have an immense
capacity to affect environmental conditions for their patients, themselves, and their communities"

NURSING STANDARDS OF MEDICAL SURGICAL NURSES

(White, 2012, 203). Environmentally, I try to open the blinds on the windows to let in the
natural light or close those when it is night time to promote sleep. Our unit is trying to promote
a quieter environment by closing the patients doors during both the day and night hours to
decrease the level of noise from both hallway traffic as well as the nurses' station.
Professional Development Plan. The first portion of the plan is to finish my Bachelor's
Degree in Nursing (BSN). This is on track for completion in December of 2014. I have taken
the course for the Certified Medical-Surgical Registered Nurse (CMSRN) and waiting for the
assigned test date this summer with the goal of passing the exam . After graduation, there will be
a year sabbatical to determine which Masters of Nursing (MSN) program I will be applying for
and to choose the school. I hope to be finished with my MSN in the next five years and be
working in the field of choice.
Conclusion
Nursing has some pretty tight standards to uphold in order to provide appropriate patient
care and safety, but also for nurses to be educated and work as a team with other health care
professionals. Despite the ever changing world of healthcare, As a nurse, I will continue to grow
and change .

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10

References
Burke, W. &McLaughlin, D. (2013, February). Partnering for Change. The American Journal of
Nursing. 113(2). 47-51.
Chitty, K. K. & Black, B. P. (2011). Professional Nursing Concepts & Challenges. (6th ed.).
Maryland Heights, MO: Saunders Elsevier.
Merriam-Webster. (2014). Online dictionary. Springfield, MA: Merriam-Webster. Retrieved
from http://www.merriam-webster.com/dictionary/leading?show=o&t=1304279227.
White, K.M., & O'Sullivan, A. (2012). The Essential Guide to Nursing Practice: Applying ANA's
Scope and Standards in Practice and Education. Silver Spring, MD: Nursebooks.org.