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Practice and Competency
Development By Julie K. Dean
• What are the competencies of nurses prepared with an associate’ ...
Practice and Competency
Development By Julie K. Dean
• What are the competencies of nurses prepared with an associate’s degree and nurses
prepared with a baccalaureate degree?
• What might happen if a nurse practiced outside of the defined n ursing scope of practice?
• Evaluate contributions of state and federal legislation for nursing scope of practice.
• What is the value or importance of nursing certifications?
• What factors or ideas show competency in nursing as a profession?
• What examples can be used to show the importance of evidence -based practice in
• How are the different parts of developing a scope of practice in nursing identified?
• How would Johnson & Johnson’s campaign for nursing and Hollywood’s perception of
In the most basic description, nursing can be defined as someone taking care of someone else,
but nursing is much more complicated. Nursing includes providing care to patients, families, and
communities to maintain health, prevent disease, and tr eat illness. Nursing’s primary focus is a
holistic approach to care for patients and their families. The discussion of how to maintain
standards for safe patient care and quality outcomes is a central component of the nursing
profession. Each level of nurs ing education has defining standards of care. Nurses must
understand the limitations of their specific education level for safety and quality care for all
patients. Having regulations and standards across all nursing specialties helps to improve
outcomes a nd patient safety. Nursing scope of practice is defined by “the ‘who,’ ‘what,’ ‘where,’
‘why,’ and ‘how’ of nursing practice” (American Nurses Association [ANA], 2017a, p. 8). The
nursing profession is responsible to its members and the public to define th e scope of practice
and standards of practice (ANA, 2017a).
Nursing as a Professional Discipline
The definition of nursing is a complex and unique description of the requirements needed to
practice in the nursing profession. Nursing includes wellness promo tion, plans to achieve the
optimal level of health for the individual, education on prevention of sickness and injury,
advocacy for patients and families, emotional assistance with complex diagnoses, and treatment
plans for patients and their support. The history of nursing is vast; it is said to have begun with
the medicine men in ancient times, continued into Florence Nightingale’s time during the
Crimean War, and progressed to the profession known today. Today’s view of nursing as a
profession is describ ed as applying evidence -based practice (EBP) with acceptable social aspects
of care. Acceptable social aspects of nursing care are the view the patient and family have on the
illness and/or care the patient is receiving. EBP is described as the integration of clinical
expertise, the most up -to-date research, and patient’s preference to care. This assists the nurse in
understanding and substantiating care when needed.
Example of EBP
In the past, patients admitted to the hospital were given a Foley catheter no matter the reason for
admission; however, research has shown that there are criteria, such as retention, hemodynamic
instability, and medical diagnosis (e.g., neurogenic bladder) , that the patient must meet prior to a
Foley catheter being placed. Through research, nurses were able to prove that increased Foley
catheter use in acute care settings increases catheter -associated urinary tract infections (CAUTI).
Now, Foley catheters a re placed on patients in an acute care setting based on criteria, not out of
convenience for the nurse.
Evidence -Based Practice
Note . Adapted from “What is evidence -based practice (EBP)?” by Duke University, 2008. Copyright 2018
by Duke University
Professional Nursing’s Scope and Standards of Practice
Scope of Practice
The nursing scope of practice assists nurses to understand their responsibilities. Organizations
are lobbying for change sponsor legislation at both the federal and state levels. One such piece of
legislation is the Nurse Practice Act (NPA), through which each state enacted laws to maintain
competent nurses and provide patients with a safe environment. Each state’s NPA established a
board of nursing (BON) to give the clarity needed to practice nursing that is not provided in the
NPA’s general information for safe nursing practice (National Council of State Boards of
Nursing [NCSBN], 2017). Therefore, each state governs t he exact requirements for nursing,
which include standards for education, licensing policies and guidelines, description of the
authority of the BON, and disciplinary action (NCSBN, 2017). The BON cannot create rules and
regulations that go beyond the expe ctations of the NPA. The BON has avenues for disputes and
disciplinary action to maintain the integrity of the nurses that it governs.
Development and Function of Nursing Standards
Standards of nursing practice are designed to give a general understanding of all duties expected
of a registered nu rse without regard to role, specialty, or competency. These standards are
constantly changing with the nursing profession. Remaining competent in nursing standards is
key for all nurses. According to the ANA (2010a), standards of nursing practice consist o f three
1. Professional standards of care define diagnostic, intervention, and evaluation
2. Professional performance and standards identify role functions in direct care,
consultations, and quality assurance.
3. Specialty practice guideli nes are protocols of care for specific populations.
Many organizations work together to design the regulations and the scope of nursing practice.
Ensuring that the public has a voice in setting regulations for nursing practice is an essential part
of the N PA. The Citizens Advocacy Center (2017) is an organization that promotes the public
interest by enhancing the effectiveness and accountability of health professional oversight
bodies. This organization offers training, research, and networking opportunitie s for members of
the public and the health care regulatory, credentialing, and governing boards. In 2008, the
Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched The
Future of Nursing , a two -year initiative responding to the need to assess and transform the
nursing profession (Institute of Medicine [IOM], 2010). The Future of Nursing gave the
expectation that nurses would work to the full potential of their education, entry -level nurses
would possess a baccalaureate degree, nu rses would network with other health care professionals
to make changes in health care, and nurses would improve data collection to assist in
improvements in policy and workplace (IOM, 2010). The ANA is the most influential
organization in nursing. All nur ses, facilities, and other organizations look to the ANA for
guidance in the standards of care and practice for all registered nurses.
The Nursing Process
The nursing process has five main components:
• Planning or Outcomes
• Implementatio n
Nursing Process Steps
Note . Adapted from “What is the Nursing Process — Key Factors and Steps,” by H. Meditari, 2016.
Copyright 2016 by Nursection.
Each phase is linked together to ensure the best patient care. Assessment is the phase in which
data collection is completed. Diagnosis is the phase in which the problem is identified.
Planning/Outcomes is the phase in which nursing actions and interventio ns are proposed and
strategized. The implementation phase puts the nursing interventions into place. The
implementation phase includes the plan of care, education, treatments (pharmacological and
nursing care), and consultations that may be needed. The fin al phase, evaluation, is when the
effectiveness of the plan and interventions are assessed.
Forming Nursing Diagnosis
Tenets of Nursing Practice
The tenets of nursing practice (ANA, 2010b) are a simple explanation of nursing code of ethics.
The focus of nursing should always be the patie nt, and for the profession of nursing to excel,
nurses must never lose focus (Jimenez, 2015).
Tenets of the Nursing Practice
Note . Adapted from “Tenets of Nursing Practice,” by the American Nurses Association, 2010. Copyright
2010 by the American Nurses Association.
Check for Understanding
You started at a new RN job three days ago. A patient is a rriving, and your preceptor is
explaining the electronic health record and how to complete the admission. She states all you
must do is read what the Emergency Department nurse reported and click “Agree.” The
preceptor said it is not necessary to ask the p atient all the assessment questions again. Does this
practice meet ANA standards?
Answer: No, you must always assess the patient yourself and form a plan of care for each
patient. Based on your assessment, you can modify the plan of care and communicate th e
patient’s needs with the physicians.
Healthy Work Environments for Nursing Practice
A healthy work environment is one in which key components work together for the benefit of the
patient, staff, and families. The staff must maintain their physical and sp iritual well -being.
Creating a healthy environment helps to empower the staff and patients in the care they provide
and receive, respectively. The critical components of building a healthy work environment
include authentic leadership, meaningful relations hips, appropriate staffing, effective decision
making, true collaboration, empowered nurses, and skilled communication. All these
components work simultaneously to improve safety and patient satisfaction.
Components of a Healthy Work Environment
Note . Adapted from “Healthy Work Environments: Essential for Innovation, Transformation,” by D.
Hanson, 2018, The American Nurse . Copyright 2018 by The American Nurse .
Model of Professional Practice Regulation
The professional practice model of nursing care is a patient -centered. Each level shown in Figure
3.6 explains how care progresses from the environment of care at the bottom to the patient and
family at the top. Environment of care is the foundation of pat ient care and a healthy work
environment. With skilled communication, all the health care disciplines can collaborate with an
interdisciplinary team (IDT) approach. With IDT, effective decisions are made with all health
care professionals working with the patient and family. All members of the team are important
and give input for the optimal outcome for the patient. The nursing code of ethics helps nurses to
practice in a nonjudgmental, caring, and compassionate manner. Using the ANA scope of
practice and Standards (2010a), along with EBP, helps nurses to find solutions that best fit the
patient in each situation. Understanding a nurse’s role in patient care is essential. The role may
change daily and can include training new employees to give proper care t o patients, mentoring
and sharing life experiences, or partaking in professional governance or advocacy. Each of these
leads to quality care, optimal outcomes, and safe, effective care for the patient and family in a
Professiona l Practice Model
Note . Adapted from “Nursing: Professional Practice Model,” by UC Davis Medical Center, 2018. Copyright
2018 by UC Davis Medical Center.
Scope of Pra ctice
Standards of Professional Nursing Practice
Standards of nursing practice include both standards of practice and standards of performance.
The ANA has formulated these guidelines for all nurses. These standards are reviewed and
changed as the nursing profession changes. The standards help to define the responsibilities of
Standards of Practice
Standards of practice are defined as the level of nursing care that is expected throughout the
nursing process. Each standard of practice has a list o f competencies to help nurses better
understand the expectations. Standards of practice include assessment, diagnosis, planning,
coordination of care, health teaching, consultation, prescriptive authority, and evaluation (Case
de Leonardi, 2014).
Standards of Professional Performance
Standards of professional performance are defined by nurses’ behavior in their nursing role.
Standards of professional performance include ethics, education, evidence -based practice and
research, quality of practice, communicat ion, leadership, collaboration, professional performance
evaluation, resource utilization, and environmental health (Case de Leonardi, 2014).
Legislation and Licensure
The BON must regulate and keep patients, communities, and fellow nurses safe. The BON se ts
the standards of care with the use of the NPA and state regulations. RNs are responsible for
staying up to date on all changes in nursing practice for each state in which they are employed.
The BON has many responsibilities that include educational prog ram standards, scope and
standards of practice, title and licensure, disciplinary actions, the statute of limitations, remedies,
and reciprocal discipline.
Each state’s BON is responsible for the safety of all patients based on the nursing licensure. All
RN candidates must pass the NCLEX -RN exam, which deems them competent in their
educational background to care for patients. Nurses can practice in the state in which they take
and pass the NCLEX -RN. If that state is a part of the National Licensure Compact (NLC), then
they may be eligible for a “multistate license to practice physically, telephonically, or
electronically in the home state and other original NLC states” (NCSBN, n.d.). On January 19,
2018, changes were made to NLC state agreements (Colduvell, 2018), including allowing new
nurses getting a license in a compact state to practice in all other compact states. Each state is
responsible for updating nurses about changes that affect the license in all the compact states.
Nurses who already have a lice nse will have to ensure that the states they are practicing in are
still included in the compact nursing state agreement, if not they will have to obtain a license
from that state.
Accreditation and Regulatory Bodies
Many nursing schools want to be accredi ted by the Accreditation Commission for Education in
Nursing (ACEN) or the Commission of Collegiate Nursing Education (CCNE). Accreditation
provides students with opportunities for financial aid, credibility in the nursing program and
faculty, student recr uitment, job placement for graduates, and the ability to transfer credits from
one college/university to another. ACEN maintains a standard of education for nursing students
and informs all accredited nursing schools of weaknesses, changes, and requirement s for
advancement of degrees. Accreditation requires the continual assessment of the program and
improvements to the quality of education for each nursing program. The CCNE, a branch of the
American Association of Colleges of Nursing (AACN), ensures the qu ality of the curriculum and
the integrity of the nursing program (American Association of Colleges of Nursing [AACN],
2017). The CCNE accredits GCU's nursing programs according to their provisions for
baccalaureate, master, and doctoral degree programs. Th e AACN accredits all nursing programs,
including baccalaureate and associate’s degrees as well as those that lead to becoming licensed
Nursing Organizations and Associations
Nursing organizations and associations are composed of nurses wh o work together to offer
support, maintain the integrity of the nursing profession, share knowledge, and make changes to
the nursing profession. A nursing organization advocates for individual nurses and nurses as a
group. A nursing association is a nonpro fit group that attempts to further nursing as a profession.
Joining a nursing organization or association provides nurses with the most up -to-date
information on the changes occurring in the world of nursing, continuing education, support,
networking, and leadership opportunities. There are many organizations to choose from, and
joining is a personal choice.
Political Action Committees
Political action committees (PAC) are for nurses who are interested in making changes for
nursing. PACs give nurses the opportunity to support legislation and political candidates who
believe in what nursing is trying to complete or change and support the mission and principles of
the change requested. The ANA advocates for nurses on Capitol Hill and in state legislatures as
well. Having a voice at the government level helps nurses have the ability to fight for changes
within the profession, such as safe st affing ratios.
The ANA (2017b) defines professional role competence in the following position statement:
The public has a right to expect registered nurses to demonstrate professional competence
throughout their careers. ANA believes the registered nurse is individually responsible
and accountable for maintaining professional competence. The ANA further belie ves that
it is the nursing profession’s responsibility to shape and guide any process for assuring
nurse competence. Regulatory agencies define minimal standards for regulation of
practice to protect the public. The employer is responsible and accountable to provide an
environment conducive to competent practice. Assurance of competence is the shared
responsibility of the profession, individual nurses, professional organizations,
credentialing and certification entities, regulatory agencies, employers, and other key
stakeholders. (p. 23)
Code of Ethics in Nursing
The nine provisions in the code of ethics in nursing provides a framework for care (Case de
Leonardi, 2014). Each provision defines the expectations for the nurse in practice and gives the
public an understanding of the standards to which nurses should practice.
Code of Ethics in Nursing
Note . Adapted from “Professional Nursing Practice: An Update,” by B. Case de Leonardi, 2014, RN.com.
Copyright 2014 by RN.com.
Professional Competence in Nursing Practice
Overall nursing competence is gained by developing cognitive and technical, as well as
interpersonal and ethical, competencies. Cognitive and technical competencies involve seeing
changes in patients and knowing the proper treatment within the scope of practice, which
requires the nur se to use critical -thinking skills to treat the patient. Interpersonal and ethical
competencies are based on the well -being of the patient, which include advocacy and legal
aspects of the nursing process. Competencies aid in developing and maintaining know ledge as
well as helping nurses to improve their critical -thinking skills.
A competency is an expected level of performance that integrates knowledge, skills, abilities,
and judgment (ANA, 2013). Competencies can be measured subjectively (influenced by the
nurse) and objectively (impartial, nonbiased measurements) depending on the situation in which
the nurse is being tested. Some of the basic nursing competencies include collaboration,
communication, education, environmental health, ethics, evidence -based practice and research,
leadership, professional practice, quality of practice, and resource utilization.
Collaboration is how well a person is able to work with others to achieve a common goal or
result. Nurses must work with other health care professional s, families, and patients. The use of
an IDT outlook aids in this collaboration competency. Members from all areas of the health care
team, including the patient and family/support members, comprise an IDT. These teams come
together to design a plan for th e optimal outcome for the patient. The use of the IDT is an
effective method of communication and collaboration because all voices are heard, and
understanding is achieved. For example, if a family does not understand why therapy is
scheduled only three ti mes a week instead of every day, clarification on this can be provided in
an IDT meeting. The collaboration of all health care workers, patients, and family or support
members is needed to achieve the common goal for the patient.
Communication in nursing i s interpersonal, which means that there is an exchange of
information and/or feelings in verbal and nonverbal forms. Nurses must be able to relay
information between the patient and family and other health care professionals in a manner that
helps the reci pient understand. Because nurses have face -to-face interaction with the patient and
family, nurses are the gateway for communication.
Education levels differ in nursing: licensed practical nurses, associate degree nurses,
baccalaureate nurses, advanced pra ctice nurses, and doctoral -level nurses. Different
competencies are expected of nurses based on their level of education. For example, licensed
practical nurses cannot perform an assessment; instead, they only gather information. Realizing
the specific sco pe of practice for each level of nursing education is essential to maintain a safe
and healthy environment.
Nurses are responsible for many things, but maintaining a healthy and safe environment for all
patients and themselves is essential. Nurses must als o take care of themselves mentally and
practice in an ethical manner at all times. Nurses advocate for their patients daily and assist them
in making life -changing decisions. Honesty, trustworthiness, responsibility, and credibility are
essential qualities to display during these interactions.
Nurses use EBP to make changes in the nursing profession. EBP is the standardization of the
practice of nursing with the basis of science, research, and evaluation of outcomes (Stevens,
2013). EBP helps the nursing pr ofession have a more standardized and supported practice base,
but with each state able to govern nursing practice, it is not yet standardized. With EBP, when
questions in baccalaureate nursing practice arise, there is research to support that specific nur sing
practice, which helps to support leadership decisions. Changes can also be made with EBP and
research, as shown in the Foley catheter example discussed at the beginning of this chapter.
Leadership is a vital component to great patient outcomes. Leader ship is the ability to put one’s
feelings and responses aside and support others in a variety of situations. A good leader can
admit failure as well as offer support and express appreciation when others do well. According to
Contino (2004), the main aspects of a leader include organizational management skills,
data/operations analysis, strategic planning skills, communication skills, and creation/visionary
skills. Nurse leaders need to lead by example. Being an effective leader means that the nurse is
open and h onest, communicates well, works well with others, and gives understanding to all
viewpoints. A leader must have good time management skills. The leader must triage all
situations into urgent, nonurgent, critical, and noncritical situations. Empowering the staff can
improve their time management skills as well. Leaders understand that telling employees, “good
job” or “thank you” is appreciated and that respect is gained, not given. Delegation is another
task of leaders and nurses alike. Giving clear expectat ions, time limits, and a description of the
task being delegated reduces the possibility of error. Leaders must have communication skills
that allow them to discuss budgets, new policies, staffing issues, and product changes so the staff
understands the ch anges and the reasoning behind them.
Check for Understanding
A diabetes educator is giving four continuing education units (CEUs) to attend a four -hour
session discussing the hospital’s new policies and procedures for diabetic patients. You are in the
brea k room and overhear many of your fellow nurses say that they will go only if food is
provided. How does this match the ANA standards of practice?
Answer: It does not match the ANA standards of practice. According to the ANA, education is
continual and the nurse’s responsibility. Nurses are lifelong learners, and education should not be
sought only when given something.
There have been many initiatives and research studies encouraging nurses to obtain
baccalaureate degrees and competencies through programs such as Quality and Safety Education
for Nurses (QSEN), AACN BSN Essential, College of Nursing and Allied Health (CON AH)
RN -BNS. An economic evaluation of a workforce in which 80% of the nurses had obtained their
BSN degrees showed a decrease in the length of stay and readmission of the patients these nurses
treated (Auerbach, Buerhaus, Staiger, 2015). With a decrease in length of stay and readmission,
the result would be a cost savings that would more than off -set expenses for increasing the
number of baccalaureate -prepared nurses in hospital settings.
In addition to cost savings, having a large staff of baccalaureate -pr epared nurses is a requirement
for hospitals to achieve magnet status (American Nursing Credentialing Center, 2008). Magnet
status indicates that a hospital employs well -educated leaders and has superior ratings for patient
outcomes. Obtaining magnet statu s is a lengthy and costly process that can take more than four
years and more than $2 million to receive accreditation (Gerardo, 2017). Magnet hospital status
is achieved by meeting criteria set by the ANCC, which includes requiring that 50% of all BSN
nur ses on staff be certified in their area of specialty (Summers, 2015). Other requirements
include data collection, feedback, BSN nurses, management, Chief Nursing Officer, and
empowerment. Hospitals’ desire to receive magnet status explains the push for bac calaureate
Employment of registered nurses is projected to grow 15% from 2016 to 2026, much faster than
the average for all occupations (U.S. Bureau of Labor Statistics, 2017). Within this increased
need, the focus will be on RNs because the y are versatile assets to health care. There is more
than one way to become an RN: through the completion of an associate degree nurse program or
a Bachelor of Science in Nursing program. Once students complete these programs, they must
take the National C ouncil Licensing Exam -Registered Nurse (NCLEX -RN), which is the
standard licensing exam for registered nurses. After completing their programs and passing the
NCLEX -RN exam, RNs can choose many different areas of nursing in their careers, such as
advance p ractice nurse practitioner, nurse educator, clinical nurse specialist, or doctorate in
nursing practice. Lastly, the RN is educated in holistic care and critical -thinking skills to give the
patient the most optimal care possible.
Regardless of degree type or specialty, all nurses must have certain traits to be a quality RN,
including, but not limited to, empathy, compassion, mental and physical agility, attention to
detail, flexibility, and stamina. These traits help produce a well -rounded, successful RN.
Empathy is the ability to understand and feel others’ emotions without allowing one’s feelings to
interfere. Compassion is the ability to care for all patients in an efficient nonjudgmental manner.
Mental and physical agility is the ability to think and rea ct quickly, which is important when
assessing patients to gain an understanding of when action needs to be immediate, or referral can
be placed. Organization is important so that all patients are given appropriate, timely care.
Attention to detail ensures that each patient is receiving the proper treatment and medicines.
Flexibility in nursing is constant, as a patient’s status can change minute to minute. Stamina is
the ability to function and perform physical tasks for long periods of time.
Quality and Sa fety Education for Nurses (QSEN)
The QSEN is an organization that maintains competencies necessary for nurses to improve the
quality and safety of the health care system in which they work (Cronenwett et al., 2007). The
QSEN takes a collaborat ive approach to its mission, focusing on the education, practice, and
scholarship for nurses (QSEN Initiative, n.d.). The QSEN -designed competencies for nursing
students include patient -centered care, teamwork and collaboration, EBP, quality improvement,
safety, and informatics.
• Patient -Centered Care: Treating the patient holistically
• Teamwork and Collaboration: The student nurse can perform tasks with a practicing
nurse to learn nursing skills
• EBP: Research, clinical expertise, and individualized care for the patient
• Quality Improvement: Communicating with respect and realizing that all measures
affect the outcomes for the patient and family
• Safety: Providing effective care for the patient while decreasing risk of harm
• Informatics: Understanding that comple ting documentation promptly leads to better
communication, knowledge, decreased errors, and supported decisions
The QSEN competencies were designed to give the best patient outcomes in all nursing care
settings. Using a holistic approach is standard and ha s helped to improve outcomes. Teaching
using the knowledge, skills, and attitudes (KSA) strategy in conjunction with QSEN
competencies improve the quality and safety outcomes in health care. The knowledge in KSA is
the examination of the team and identifyi ng the roles and accountabilities for each team member,
then recognizing each team member’s strengths to promote optimal outcomes for the patient. The
skills in KSA include the assessment and quality improvement of the patient’s care. This requires
gatheri ng information from the patient as well as health care staff and evaluating the success of
patient care. Evaluation enables the health care team to recognize changes that may need to be
made. The attitudes in KSA addresses how well the team works together to provide the best
possible patient care and identifies areas that need improvement.
American Association of College of Nursing (AACN)
The AACN originated in 1969 as a national consensus -based process to regulate and standardize
nursing schools’ curriculu m (AACN, 2017). The AACN assists with certifications,
accreditations, health policy advocacy, curricula standards, research and data services,
conferences and webinars, and special projects (AACN, 2017). Other agencies that assist the
AACN in choosing guid elines for the education and accreditation process for all nursing
education include the Accrediting Commission for Education in Nursing (ACEN) and the
Commission for Nursing Education Accreditation (CNEA). The ACEN grants accreditation to
nursing schools based on standards for education and curricula. The CNEA is governed by the
National League of Nursing (NLN) in the global look at nursing education. Key elements
required for CNEA include a culture of caring, diversity, integrity, and excellence. AACN
Ess ential provides the framework for the curricula in nursing and gives expectations of the RN at
the completion of education. The AACN Essentials are for baccalaureate and advance practice
Commission of Collegiate Nursing Education (CCNE)
The Commission on Collegiate Nursing Education (CCNE) is officially recognized by the U.S.
Secretary of Education as a national accreditation agency. The CCNE is an autonomous
accrediting agency, contributing to the improvement of the public's health (AACN, 2018). CCNE
accreditation is sought after to maintain the stature of the baccalaureate and graduate and nursing
CCNE defines programs that provide effect ive educational nursing practice guidelines. The
process of CCNE accreditation is self -regulating for each college/university. They must complete
self -assessments and provide continual growth and ways to improve through education and
Certification is the formal process by which a certifying agency validates a nurse's knowledge,
skills, and abilities in a defined role and clinical area of practice, based on predetermined
standards set by several certifying bodies (AACN, 2017 ). Nurses obtain certification by taking a
certifying exam and continuing education. Nurses can achieve certification by practicing within a
specialty area for at least one year, then taking an exam to show proficiency in that area.
Nursing certification i s the process in which a nurse may test to show expertise in practice in a
specific area. Obtaining certification is not a requirement for all nurses. Certification is a
personal decision for the nurse. After achieving a certification, it must be maintaine d with
continued education in that area and constant vigilance in maintaining all new standards or
changes in practice that would affect the specific area of specialty. Many nursing certification
organizations have magazines, blogs, and websites to network and maintain the most up -to-date
information on the nursing practice.
Certification in a specialty area shows that a nurse has expertise in that specific area.
Certification demonstrates that the nurse has the knowledge and skills to improve quality and
safety outcomes. There are many certifications that a nurse can obtain, and each has a specific
qualification to meet before applying to test. The list of availa ble certifications changes
Understanding that hospital certifications have requirements for the nursing staff employed is
also important. There are many different certifying organizations for hospitals, including The
Joint Commission, American Heart Association, American Stroke Association, and The
American Nurse Credentialing Center (ANCC), which certifies magnet hospital status.
Example of Certification
A nurse wants to become a certified diabetic educator (CDE). This nurse must have CEUs in this
area of expertise, must educate a certain number of patients or have a certain number of hours in
giving education under a CDE in a clinical setting, and the nur se must have the degree standard
for the CDE.
Advancing Public Understanding of Nursing Role
The public perception of nursing varies depending upon the timeframe. When nursing emerged
as a profession, it was performed by men who were thought to possess mag ical healing powers.
This early form of nursing practiced through trial and error. Later, nursing was conducted by
indigents and prostitutes, lowering the public opinion of the profession. With Florence
Nightingale, nursing began to flourish into the more modern -day view of nursing.
Through history, the nursing profession has faced discrimination, prejudice, and a less than
desirable public perception. Today, many people view nursing as a good profession to pursue,
but the stigma and discrimination still oc cur. Despite an annual Gallup poll ranking nursing as
the most honest and ethical profession in the United States for 16 years straight, (Brenan, 2017),
the profession still faces negative perceptions.
Johnson & Johnson Discover Nursing Campaign is designe d to assist nurses and the public in
understanding the nursing profession (Johnson & Johnson, n.d.). This campaign gives
information for nursing students to assist with choosing a school, scholarships, and federal
assistance. It also assists the practicing nurse with information on different specialties available
in nursing. The campaign’s website features a “Meet the Nurses” section, which allows the
public to read nurses’ profiles, some of which offer a day -in-the -life description of nursing
(Johnson & Jo hnson, n.d.).
Cultural and Media Influences
Cultural practices may influence nursing as a profession. For example, in 1970s Europe, the
nursing profession was viewed no differently than that of prostitution. Such perceptions and
cultural practices could af fect care. Understanding that cultural differences affect the nursing
practice will aid in positive patient outcomes.
Hollywood has a big influence on public perception of the nursing profession. Unfortunately,
Hollywood often depicts nurses in ways that a re far from reality, with nurses portrayed as
everything from sex symbols to drug addicts. There are television shows that give a closer
depiction of nursing as a profession and others are just comedies that bear little resemblance to
the daily reality of nursing. The public will always have varying ideas about nursing, but by
practicing within the scope of practice and advocating for the patient, nurses can reverse the
Media influences go beyond TV shows and movies to include the news and social me dia. Kelly
Johnson, Miss Colorado in the 2015 Miss America Pageant, became an overnight rallying point
for nurses after her monologue about nursing was mocked by hosts of the TV talk show “The
View” (Udell, 2015). The nursing community pulled together to g ive support and education in
every avenue available, be it social media, campaigning, or marching. In Utah, a nurse was
arrested for not obtaining blood from her patient (Hayden, 2017). She was practicing within her
scope of practice by not drawing the blo od from an unconscious patient who had not given
consent and had not been arrested. This incident showed the public that nurses advocate for their
patients, which sometimes requires them to take extreme measures.
There are many different social media platf orms — such as Twitter, Facebook, and Instagram —
but all can affect nursing. Because social media is at almost everyone’s fingertips every day,
nurses need to maintain professionalism at all times. Policies had to be set in place for social
media, giving guid ance on posts, pictures, and friends. Nurses have been fired from positions
because of social media accounts.
Additional influences in nursing include the Technology Informatics Guiding Education Reform
(TIGER) initiative, Advancing Car e Excellence for Seniors (ACES), and genomic competencies.
These describe advancements in nursing that are continuing to be developed and implemented.
Technology Informatics Guiding Education Reform
The TIGER initiative was designed to help improve the advancement of technology in the
nursing world. The TIGER initiative has three phases: summit meeting, reports, and foundation
of Healthcare Information and Management Systems Society (HIMSS) (Technology Information
Guiding Education Reform) (Healthca re Information and Management Systems Society
[HIMSS], 2016). The summit was the first phase, and those in attendance worked to define the
vision and plan of action for informatics in the nursing workplace. This phase formulated the 10 -
year vision and 3 -ye ar action plan (HIMSS, 2016). The summit phase designed pillars of action
to include communication and collaboration, education, informatics design, information
technology, culture, management and leadership, and policy. Reports was the second phase, in
wh ich the plan was set into action and where changes and re -evaluation were initiated to create
an optimal nursing practice. In this phase, the 3 -year action plan was completed, and the 10 -year
vision remained intact. In the final phase, the TIGER initiative transitioned into the foundation of
HIMSS, which provides the integration of informatics into professional practices and
organizations. The TIGER initiative promoted the inclusion of informatics in all nursing content
as well as made important changes to the nursing curriculum, such as the ability to reach more
nursing students than before without face -to-face interaction. Using online education allows
communication with more students and enables nurses to advance their careers.
Advancing Care Excellence f or Seniors (ACES)
ACES is an initiative by the NLN to make sure that there is an adequate gerontological education
in place in the curricula of nursing schools to give proper care to the aging population. Student
and professional nurses and nurses need to understand that the aging population requires
complex care. ACES discusses three phases, including individualized care, complexity of care,
and vulnerability during life transition (Tagliareni, Cline, Mengel, McLaughlin, & King, 2012).
It is important to u nderstand that aging is normal, but that all aging adults are not the same. The
aging population has the most complex health issues and comorbidities. Nurses help this
vulnerable population during life transitions, assisting individuals back to their basel ine of
health. The education necessary to care for older adults is completed through clinical setting,
skills lab, classroom education, and simulation.
Quality Education to Care for Older Adults
Note . Adapted from “Quality Care for Older Adults: Advancing Care Excellence for Seniors (ACES)
Project,” by E. Tagliareni, D. D. Cline, A. Mengel, B. McLaughlin, & E. King, 2012, Nursing Education
Perspectives, 33 (3), 144 -149. Copyright 2012 by Nursing Educat ion Perspectives.
Genomics is the study of genes of an organism or cell. A panel of professional health care
workers designed the essential genomic competencies ( National Human Genome Research
Institute [NHGRI], 2013) . The genomic comp etencies are designed with the knowledge that all
disease processes start with one gene, which allows the guidelines to be formed for competencies
based on each disease process (Badzek, Turner, & Jenkins, 2008). This was completed using
evidence -based rese arch by designing a plan, having the information peer reviewed, and making
changes based on these recommendations. Many professional organizations, such as the ANA,
the American Medical Association (AMA), the National Coalition for Health Professional
Educ ation in Genetics (NCHPEG), the ANA House of Delegates, the International Society of
Nurses in Genetics (ISONG), the National Institutes of Health (NIH), and the NHGRI gave
input, along with open comments from conferences held to design and validate the pr ocess in
forming genomic competencies (Badzek, Turner, & Jenkins, 2008). Genomic competencies
make nurses more familiar and competent with the concepts, enabling them to educate patients
and provide options regarding available genetic services. The Genomic Initiative was started in
2000, but only two of the five goals of this competency have been completed (Anderson, Alt -
White, Boyd, Kasper, & Schaa, 2015). The lack of progression on this initiative has to do with
nurses not having competency in this area, which makes it difficult to discuss and explain
information with patients. The importance of this theory is it could prevent cancer or other
issues. For example, if a patient has a family history of breast and ovarian cancer, a genetic
referral would be an option for this patient to help prevent cancer.
Nurses practicing within the scope of practice set forth by regulating bodies need to understand
how and why there are competencies in nursing. Nursing competencies are always changing, and
advancements are being made, but the end goal remains patient care . It is essential for all nurses
to understand the reasoning for advancement in nursing education as well as the differences in
education levels, the different opportunities with these different levels, and what is needed for
their careers. Nursing is a pr ocess of regulatory boards, standards of care, codes of ethics,
accrediting bodies, education, and evaluation. Many things impact nursing and cause changes to
occur frequently. Remaining up -to-date on education is the nurse’s responsibility. Nursing as a
profession is making strides to be acknowledged for the knowledge and skills that nursing
education provided to the field’s professionals.
Accreditation: A voluntary, peer -reviewed, self -regulatory process by which nongovernmental
associations rec ognize educational institutions or programs that have been found to meet or
exceed standards and criteria for educational quality.
Certification: The process in which a nurse may test to show expertise in a specific area of
Collaboration: Two or more people working together toward a common goal; in a health care
setting, this work is meant to provide safe, quality care to patients in a nonthreatening
Communication: Interpersonal sharing of information and/or feelings are exchanged in verbal
and nonverbal methods.
Competency: An expected level of performance that integrates knowledge, skills, and abilities.
Evidence -Based Practice (EBP): The integration of clinical expertise, the most up -to-date
research, and patient’s preferences to fo rmulate and implement best practices for patient care.
Genomics: Science related to the study of all genes, instead of the focus of genetics on a single
gene. Genomics focuses on the interrelationships of genes striving to identify the processes and
influe nces of gene combinations on growth and development; to determine compete DNA
sequences; and to conduct genetic mapping; thus, aiding understanding of health diseases and
Leadership: The ability to put aside one’s own feelings and responses to s upport others in a
variety of situations.
Nursing Process: Assessment, diagnosis, planning or outcomes, implementation, and
Scope of Practice: The “’who,’ ‘what,’ ‘where,’ ‘why,’ and ‘how’ of nursing practice” (ANA,
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specialty, approval of a specialty nursing scope of practice statement, acknowledgment of
specialty nursing standards of practice, and affirmation of focused practice competenci es
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