Analysis Of Nursing Scope Of Practice

Individual Analysis
Phil Linn
Ohio University

Introduction In this paper I will cover different scopes and guidelines that nursing professionals use in their daily practice and some examples in my practice that are affected by those guidelines. Also how ethics, morals and values affect nursing policies and ways the affect the nurse in providing care.
Scope of Practice The nursing scope of practice was developed by the American Nurses Association (ANA). The ANA describes the scope of practices as “the ‘who’, ‘what’, ‘where’,’ when’, ‘why’ and ‘how’ of nursing practice.” (ANA, 2010 p.2). This scope of practice sets the guidelines of how I perform my job on a daily basis. It allows me to asses my patient and based
on that assessment I can form a plan of care for that patient. The scope also allows me to delegate tasks to others to help me provide the best, most efficient care for the patient. It also sets my limitations on care for the patient and forces me to seek assistance to help provide safe care for my patient. The scope also puts in place very specific nursing guidelines on specific procedures, for example, how to place a foley. These instructions are very specific and need to be followed exactly. The instructions are written based on evidence based practice. When followed it provides the least risk to the patient and safe, quality care. Overall the scope of practice gives the nurse the guidance to provide safe, quality, and efficient care to the patient
State Legal Regulations Each state plays a role in how a nurse performs their job.
In my practice the State of Ohio sets guidelines and laws on how I perform my daily tasks. The most important and obvious way is by licensing me to practice in the State of Ohio. I am required by the State of Ohio to keep my license current and meet the requirements to renew my license. To renew my license I am required to complete continuing education. These continuing education requirements keeps me current on my nursing skills along with updates in laws and practice requirements. This assures that I am giving competent care to my patients. There are also laws put into place to deal with Registered Nurses (RN) who practice outside their scope or engage in illegal activities. The laws deal with how the RN’s situation will be reviewed, penalties, and how they may appeal their
case. The state also provides a specific scope of practice for RNs and what they are able to do under that scope. As I mentioned above, it allows me to delegate specific duties to others such as Licensed Practical Nurses (LPN) or nursing aides. It is specific on what task that RN can and cannot delegate and that the RN must realize they are still responsible for the tasks they delegate. The state laws also dictate medications or intravenous (IV) drugs that I can give and how I may give them.
Provision 7, 8, and 9 Provision 7 of the ANA Guide to the Code of Ethics for Nurses suggest that as nurse we actively participate in advancing nursing and healthcare policy by participating in developing policies and implementing them in our daily practice (ANA, 2010).
ANA states in their guide that it “encourages individual nurses to use their own talents and interests to create the moral link between their personal life, their individual practice and the nursing profession as a whole.” (ANA, 2010 p.100). One way I do this in my practice is by participating in our units shared governance meetings. In these meetings we work on topics such as Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. These scores are related to surveys fill out by patients about how care was provided for them. We look at the scores and develop ways to improve the scores and by improving these scores provide better care for the patient. We put together surveys to send to different employees to compile their thoughts on how to improve score and then implement them in our
unit. Provision 8 makes sure nurses provide care for all people without bias and that we are aware of those who are subject to violence or neglect. In my job I provide the same level of care whether the patient is an affluent professional with insurance or is a homeless person without insurance. I do not judge any of my patients based on choices that they have made. Also in our assessment of the patient we try to identify any needs that the patient may have when they are in the hospital or when they leave. We make sure they are leaving to a safe environment and have access to the things they need for a healthy lifestyle. The ANA provision 9 relates to inter-professional integrity and integrity of associations related to the nursing field (ANA, 2010). As a member of American Association of Critical-Care Nurses I am also responsible to help work with the organization to better care in critical-care areas. I am also required to not only be professional to patients, but I am to be professional when it comes to interaction with my colleagues.
Philosophical Forces There are several philosophical forces that steer a nurse’s practice. Politics is one of these forces that impact nursing care. Obama care is one issue currently that nurses are seeing impact practice. Whether the nurse agrees or disagrees with universal healthcare they are affected by it. Obama care has the healthcare industry cutting back do to the future uncertainty of the program. These cutbacks effect nurses by limiting resources, cutting staffing and new healthcare guidelines. Even with all of the above nursing has to continue to give the patient the highest level of safe and quality care. Other philosophical forces nurses face are religious and cultural beliefs. The healthcare system in the United States is seeing a more diversified patient population than ever before. Nurses need to give competent care to all patients and be able to vary their way of caring for a patient based on the patient’s cultural or religious beliefs. They have to also put aside their beliefs and have no cultural biases to best serve their patient.
Ethical Principles, Theories and Values As a nurse you are faced with ethical and moral value situations daily in your practice. Nurses need to do what is best for their patients but need to understand that the patient is ultimately the one who controls their care. Nurses need to provide patients with all the information needed to make the right decision. The nurse does not make the decision for the patient, but honors the decision that is made. This is where things like informed consent play a role in ethics. It makes sure the patient is educated in their decision and that the patient agrees with the plan of care. Confidentiality is important in the healthcare system and this is enforced by Health Insurance and Portability and Accessibility Act (HIPAA) of 1996 (Unites States Department of Health and Human Services, 2013). Nurses need to respect the privacy of their patients and need to be vigilant for their patients to make sure all respect their privacy. This a moral and legal aspect that a nurse need to uphold.

Conclusion In conclusion there are many different guidelines and scopes of practices that are in place to help the nurse perform their job. These scopes and guidelines are in place to protect patients and to make sure they get safe and quality care. Nurses also need to understand that their values and morals also come in to play when caring for patients. Nurse need to recognize their moral and values and make sure they are steering the nurse in the right and legal direction. The nurse need to put aside any of their biases or beliefs that do not best serve the patients.

References
American Nurses Association (2010). Guide to the Code of Ethics for Nurses: Interpretation and Application. Baltimore, MD. Nursebooks.org.
American Nurse Association (2010). Nursing: Scope and Standards of Practice (2nd ed.). Silver Springs, MD. Nursebooks.org.
United States Department of Health and Human Services (2013). Health Information Privacy. Retrieved from: http://www.hhs.gov/ocr/privacy/index.html