The Metamorphosis of the Practical Nurse

The Metamorphosis of the Practical Nurse
October 23, 2006

The Metamorphosis of the Practical Nurse
It takes a great deal of courage to let go of what is known, familiar, and comfortable. Change is a driving force in everyone. Like a butterfly, individuals in the nursing field may go through similar stages of metamorphosis, which is a process of growth, change, and development. (Wikipedia Foundation, 2006) Nurses have a vast amount of opportunity for growth and change in the healthcare field. "The nursing profession has often been viewed as the target of change rather than a force that proposes, leads, and implements change." (Habel, 2005) Many individuals are choosing to evolve and expand their careers and obtain their bachelor 's degree in nursing. While the LPN performs much of the same skills, the student professional nurse must refine his or her skills in clinical judgment, collaboration, leadership, and delegation to effectively care for their patients as a professional nurse.
The Role of the LPN
Licensed practical nurses have an enormous responsibility- to their patients and coworkers alike. The LPN may work in a supportive role and can be paired up with Registered Nurses, creating a "team nursing" approach to patient care. Team nursing is a method in which different nursing personnel work together and perform separate functions for the same patients. Each member of the team has a specific role in patient care. (Wikipedia Foundation, 2006) The LPN has several responsibilities which include: monitoring the patient for abnormalities, checking and recording vital signs and measurements, administering medications, and providing basic bedside care. In the hospital setting many LPNs are used in medical/surgical floors which tend to occupy very acute patients. Although the practical nurse has many of the same technical skills as the professional nurse, the practical nurse may choose to advance their career and train to be a professional nurse to achieve a higher level of critical thinking skills, leadership skills, and delegation.
Transitioning
Role Transition for the LPN
Although change is necessary for forward movement and growth, it can sometimes cause stress and anxiety for the LPN. The LPN can face many challenges during their transition into the field of professional nursing. Duncan and Depew (2005) examined the stages of work transitioning according to Nicholson and West in relation to the practical nurse 's pursuit of his or her professional nursing degree. The four stages of transition include: "preparation, encounter, adjustment, and stabilization." (Duncan & DePew, 2005, p.42) "The preparation stage is mostly concerned with psychological preparedness for the transition that is to occur." (Duncan & DePew, p.42) During this time the student nurse is struggling with personal reflection; the student is deciding if he or she has what it takes to become a professional nurse. This period is dominated by thoughts of self-worth and self-confidence as well as the student nurse questioning if this is the "right" decision. "During the encounter phase, the LPN makes the necessary contacts to enroll in college, makes financial arrangements, and revises his personal schedule to accommodate class and clinical schedules." (Duncan & DePew, p.42) The student nurse could face periods of anxiety and struggle to rearrange their life and may also have difficulty financing their education. "In the adjustment stage, one focuses on and establishes a new set of priorities." (Duncan & DePew, p.42) The student nurse is struggling with role conflict- they still feel like an LPN but they have the basic foundation of education as do RNs. The student nurse may feel torn between the two different roles and must collect their own set of rules. "In the stabilization stage, the LPN takes on the values of the RN role… and makes adjustments and minor changes as needed and enjoys the successes of the new role." (Duncan & DePew, p.42) During this time the student nurse has completed, or nearly completed the education and is learning to be confident in their new role. As Duncan and DePew have explored, the LPN faces several conflicts during their role transition; however, their experience as a practical nurse is valuable to the patients that await them in the future.
Clinical Judgment
Each member of the health care team has an enormous responsibility to their patients. In the context of ethics, accountability is described as the state of "willingness to contribute to an expressed or implied outcome." (Wikipedia, The Free Encyclopedia, 2006) Professional nurses must exercise their critical judgment and critical thinking skills to remain accountable and autonomous with patient care. Professional nurses are given the freedom to make their own choices, within the limitations of the scope of practice and state law, and to conduct patient care according to the nurse 's own judgment. Professional nurses must practice good critical thinking skills in order to make good decisions for their patients and their team.
Collaboration
During the early years of nursing, women were predominantly used assist physicians in caring for the wounded. As early as the Civil War, the role of the nurse changed; nurses provided more insight and collaboration with physicians and assisted in the planning of patient care. (American Nurses Association, 1998) Scopes of practice were originally intended to divide roles and responsibilities between healthcare providers and to reduce conflict. Now that healthcare has evolved and the nursing team is working with other members of the healthcare organization, collaboration is a key element in providing complete and individualized patient care. Each member of the healthcare team is dependent on the other to provide complete patient care; no individual component of the team can effectively care for the patient alone. Each department is specialized and provides exclusive knowledge and expertise in their field of study. The professional nurse must collaborate with all members of the healthcare team to provide superior care to each patient.
Leadership Skills
Nursing requires good leadership skills to achieve excellent patient care and to satisfy the needs of the nursing staff. "Leadership used to be most often associated with solitary heroic figures, usually men, who were considered to be the inspirations behind organizations, military units or sporting teams" (Martin, 2006, p.1) In the field of professional nursing, each member is encouraged to participate in the process of improving patient care and nursing morale. As noted by Hellriegel and Slocum (as cited in Blais, 2006), there are five "core leadership skills" that should be highlighted: empowerment, intuition, self-understanding, vision, and values congruence. By encouraging and promoting nurses on a team, a nurse can make superior changes in the way patients receive care. Empowering members of a nursing team give every member a voice and a sense of self-confidence in their work. Intuition also plays a key part of being a good leader; being aware of what is going on around and anticipating the needs of clients and the healthcare team ensures complete care. To the nursing leader, it is often helpful to discover each member 's strengths and weaknesses to make the team work together effectively. Good nursing leaders will capitalize on the team 's strengths as well as improve on weaknesses to make the team more effective. As Martin reflects, "…visions describe a future that is attractive, or ideas that provide hope." (Martin, p. 2) Leaders that have inspiration and initiative create a pathway that directs the team into meeting the needs of their patients. A nursing leader who has values congruence has the ability and the insight to integrate the nursing team and the facility. Each member of the healthcare organization has rules, goals, and concerns that must be addressed. By integrating the team and the organization the effective nurse leader creates an environment that promotes accord. A good nursing leader can make many changes and encourage the nursing team if they recall and refine effective leadership skills.
Delegation
Professional nurses are responsible for providing the best care possible to their patients. The professional nurse has a duty to coordinate care from other members of the healthcare team to ensure proper care of the patient. As discussed by the ANA, "The profession defines the scope and standards of nursing practice. State nurse practice acts define the legal parameters for nursing practice, which may include delegation." (American Nurses Association [ANA], 2005, p. 5) The scope of practice for a professional nurse includes the duty of delegation. The professional nurse must use good clinical judgment to assess the needs of the client and properly delegate tasks to nursing assistants. The professional nurse also must monitor and supervise the actions of the nursing assistant and to evaluate the effectiveness of care given. The professional nurse remains accountable for the delegated tasks and must take the delegation process seriously to ensure proper patient care.
Conclusion
The acquisition of skills necessary to be an effective professional nurse can be a daunting challenge for a practical nursing student. Transitioning into the field of professional nursing requires the practical nurse to experience many changes in their life, both personal and professional. The student nurse must be aware of his or her new role and exercise good clinical judgment to achieve set goals. Although the transition from practical to professional nurse takes time and experience, the professional nurse will find it rewarding when they acquire the expertise necessary to properly use their skills in critical judgment, collaboration, leadership, and delegation. The field of nursing is constantly changing and evolving and it is the practical nurse 's role and duty to continue with their education to help others in need of more specialized care. References
American Nurses Association (1998, May 5). Collaboration and Independent Practice: Ongoing Issues for Nursing. Retrieved October 6, 2006, from http://www.nursingworld.org/readroom/nti/9805nti.htm
American Nurses Association (2005, September). Principles for Delegation. Retrieved September 29, 2006, from http://nursingworld.org/staffing/lawsuit/PrinciplesDelegation.pdf
Blais, K. K., Hayes, J. S., Kozier, B., & Erb, G. (2006). Professional Nursing Practice: Concepts and Perspectives, Fifth Edition. Retrieved September 28, 2006, from http://ecampus.phoenix.edu/content/eBookLibrary/content
Duncan, G., & DePew, R. (2005). Transitioning from LPN/VN to RN: Moving Ahead in Your Career. Role Transition, p. 42.
Habel, M. (December 22, 2005). The Power of Change. Retrieved October 7, 2006, from http://www.2.nursingspectrum.com
Martin, V. (2006, March). Learning to Lead: part 2. Nursing Management, p.1-2. Retrieved October 16, 2006, from http://web.ebscohost.com/ehost/detail?vid+29&hid+16&sid+85a762bf-eab4-4da7-8030-9f79953b683a%40sessionmgr7
Wikipedia, The Free Encyclopedia (2006, October 16). Team Nursing. Retrieved October 18, from http://en.wikipedia.org/w/index.php?title+Team_nursing&oldid+8719654
Wikipedia, The Free Encyclopedia (2006, October 9). Metamorphosis. Retrieved October 22, 2006, from http://en.wikipedia.org/w/index.php?title+Metamorphosis&oldid+80475233
Wikipedia, The Free Encyclopedia (2006, September 1). Accountability. Retrieved September 29, 2006, from http://en.wikipedia.org/w/index.php?title+Accountability&oldid+73172312

References: American Nurses Association (1998, May 5). Collaboration and Independent Practice: Ongoing Issues for Nursing. Retrieved October 6, 2006, from http://www.nursingworld.org/readroom/nti/9805nti.htm American Nurses Association (2005, September). Principles for Delegation. Retrieved September 29, 2006, from http://nursingworld.org/staffing/lawsuit/PrinciplesDelegation.pdf Blais, K. K., Hayes, J. S., Kozier, B., & Erb, G. (2006). Professional Nursing Practice: Concepts and Perspectives, Fifth Edition. Retrieved September 28, 2006, from http://ecampus.phoenix.edu/content/eBookLibrary/content Duncan, G., & DePew, R. (2005). Transitioning from LPN/VN to RN: Moving Ahead in Your Career. Role Transition, p. 42. Habel, M. (December 22, 2005). The Power of Change. Retrieved October 7, 2006, from http://www.2.nursingspectrum.com Martin, V. (2006, March). Learning to Lead: part 2. Nursing Management, p.1-2. Retrieved October 16, 2006, from http://web.ebscohost.com/ehost/detail?vid+29&hid+16&sid+85a762bf-eab4-4da7-8030-9f79953b683a%40sessionmgr7 Wikipedia, The Free Encyclopedia (2006, October 16). Team Nursing. Retrieved October 18, from http://en.wikipedia.org/w/index.php?title+Team_nursing&oldid+8719654 Wikipedia, The Free Encyclopedia (2006, October 9). Metamorphosis. Retrieved October 22, 2006, from http://en.wikipedia.org/w/index.php?title+Metamorphosis&oldid+80475233 Wikipedia, The Free Encyclopedia (2006, September 1). Accountability. Retrieved September 29, 2006, from http://en.wikipedia.org/w/index.php?title+Accountability&oldid+73172312