1 Running head: SELF-ASSESSMENT OF NURSING STANDARDS

Self-Assessment of Nursing Standards of Practice Michelle M. Johnston Ferris State University

2 SELF-ASSESSMENT OF NURSING STANDARDS Abstract This paper is a first person informative document of its writers analysis and evaluation of her practice as it relates to the standards of nursing practice established by the American Nurses Association. The paper will lead its reader through the analysis of standards of practice and the writers perceived nursing performance. Standards will be deemed either met or unmet based upon competencies established by the American Nurses Association. The writer provides a brief description of her professional behaviors for evidence of both met and unmet standards. Specific and measurable goals for attaining and maintaining each of the standards are identified. An action plan that provides brief and measurable parts to reflect each goal will then be addressed. In finale, the writers evaluation plan, which provides the reader with the plan to measure progress toward goals, will be presented.

3 SELF-ASSESSMENT OF NURSING STANDARDS Self-Assessment of Nursing Standards of Practice The professional field of nursing practice is regulated and expected to meet certain standards. The American Nurses Association (ANA) has set standards of performance for practicing professional nurses. The purpose of this paper is to lead the reader through the analysis of the standards of nursing practice as it relates to my profession. I will analyze myself in practice as I relate to each standard of performance. I will provide examples of how I either meet or do not meet the standard throughout the paper, and I will provide information regarding my goals in attainment and maintenance of the standards of performance. My plan to meet my goals will be identified and a plan to evaluate those goals throughout my professional practice will be revealed. Description and Analysis of Current Behavior Standards of Practice There are a total of sixteen standards of practice described by the ANA. The first six standards are those that are a part of the nursing process. Assessment, diagnoses, outcomes identification, planning, implementation, and evaluation make up the first six standards. The last ten standards are labeled as the standards of professional performance. All sixteen standards are very important in practice. Upon my reflection, I found that I am well established and competent in the first six standards of practice, so I will focus on the standards of professional performance. Standard #7: Ethics There is a standard of ethics in professional nursing that the ANA expects nurses to uphold. The ANA (2010) states that the registered nurse: delivers care in a manner that preserves and protects healthcare consumer autonomy, dignity, rights, values, and beliefs (p. 47). This standard is in place to protect any healthcare consumer from unethical care. In my

4 SELF-ASSESSMENT OF NURSING STANDARDS professional nursing practice I allow the Code of Ethics for Nurses with Interpretive Statements to guide my practice. I am sure to follow code and to treat my patients with respect for their rights. I have much strength in the standard of ethics identified by the ANA, and after reflection, I believe that I meet this standard. Each day I work to keep my patients informed about their health care so they can make educated and well informed decisions regarding their care (ANA, 2010). I work to keep all health care matters confidential within their legal bounds, and I am sure to respect my patients independence when making their own health care decisions (2010). I have had experiences where family members as well as patients have been confused about their advanced directive and I have had to give them information regarding the different decisions that could be made. In these experiences, I am sure to respect the family and the healthcare consumer as being part of the health care process and an active member of the team of professionals making decisions in the patients best interests (2010). I also work as a patient advocate and am involved in matters that are seeking to resolve ethical issues in my workplace (2010). Standard #8: Education The standard of education as identified by the ANA is a standard that holds an expectation that registered nurses will stay current in their practice and further their education. As stated by the ANA (2010), the registered nurse attains knowledge and competence that reflects current nursing practice (p. 49). It is important in my professional nursing practice to keep current with new practices and information regarding my practice. The world of nursing care is ever-changing and improving and I must keep myself informed as to provide the best possible care for my patients.

5 SELF-ASSESSMENT OF NURSING STANDARDS In my practice, I keep up to date on licensure as well as any new information that is used in my practice. I attend meetings and in-services that are supplemental to my practice. One of my passions is to teach others skills of nursing. In my practice, I am sure to create an environment that is conducive to learning and I love to help others when needed (ANA, 2010). While completing my Bachelors of Science in Nursing (BSN), I come across new information through research that I am eager to share with my co-workers. I am committed to improving myself and my practice through acquiring knowledge (2010). I plan to continue my education and pursue a masters degree in nursing education. Currently, I meet the standard of education and its competencies as defined by the ANA. Standard #9: Evidence Based Practice and Research As a nurse, evidence and research inform my practice. Nursing as a profession is one that is built upon evidence. Each nursing action that I can take has some evidence attached to it and research to back that evidence. Nursing practice is ever-changing with research studies being performed continually. It is important for nurses to keep current on the evidence and research as well as to do their own research and provide their own evidence for why they do what they do. As stated by the ANA (2010), the registered nurse integrates evidence and research findings into practice. (p. 51). I believe that I have met all competencies for this standard. I utilize current evidencebased nursing knowledge, including research findings, to guide my practice (ANA, 2010). When making changes in my practice, mostly in the form of care plan changes, I am sure to incorporate evidence as to why the change has been made (2010). As stated above, I am always eager to share new information that I have found with colleagues through doing research in my BSN program. Research in nursing is what fuels the profession. Many of my colleagues who work in

6 SELF-ASSESSMENT OF NURSING STANDARDS administration perform their own research to find the newest evidence that can be applied in our practice. Because I am currently working per diem, I am not performing research for my practice while at work and this is not expected of me at this time. In the future, I look forward to finding my own evidence for practice which can be presented to my employers. Standard #10: Quality of Practice The standard of quality of practice in the nursing profession is all encompassing of every other standard. Quality of practice means that the nurse is doing all in her power to be sure to deliver quality care and improve her practice. In my practice, I am contributing to quality. I am looking for creative ways to enhance the care I give (ANA, 2010, p. 52). An example of this is how I am always trying to find ways to please my patients as well as meet their needs with creative interventions. A patient of mine was having a difficult time moving to my facility from home and she was very unhappy with giving up some of her freedoms before moving in. She would often complain about not having fresh coffee whenever she wanted it. I presented this problem to my Director of Nursing (DON) and offered a solution. The solution I had thought of was to give a decanter of coffee to the patient first thing in the morning when food service went through the hallway and then bring another with each meal to ensure that the coffee stayed hot. My solution had worked and the patient no longer had this complaint. Another way I meet this standard is that I am sure to pay close attention to cost savings (2010). In the past, I have found holes in charging of patients supplies and I have brought this to the attention of management who took further action in ensuring that charges are not missed. I do feel that there are competencies within this standard that I do not meet. I am not a part of making decisions based on quality. Most of the larger decisions are made by upper

7 SELF-ASSESSMENT OF NURSING STANDARDS management in meetings that I am not invited to attend. If I notice issues I do bring them to the attention of the quality nurse, though I do not often find any issues. The facility in which I work does a very good job at finding issues related to quality and fixing those issues. At this time, I do not find many issues regarding quality, but I remain attentive to possible issues and make them known when necessary.Standard #11: Communication Communication is a very important standard identified by the ANA. According to the ANA (2010), the registered nurse communicates effectively in a variety of formats in all areas of practice (p. 54). Communicating effectively is a large part of caring for others as a professional nurse. If a nurse cannot communicate, then the job cannot be done. I feel that I meet all competencies of the standard of communication. I display the competency of conveying information to my patients, families, and other members of the healthcare team in ways that are accurate and are sure to provide quality (ANA, 2010). I normally speak to the physicians by telephone using the SBAR tool to help me convey appropriate and necessary information. I am sure to read back all orders to the physician to be sure that I have written the orders correctly to prevent error. When I speak with families and patients I try to speak and use my body language in a way that is non-threatening and sensitive to the patients situation. I am always sure to find ways to improve my communication with my patients, their families and coworkers (2010). Standard #12: Leadership Leadership skills are essential in nursing practice. As stated by the ANA (2010), The registered nurse demonstrates leadership in the professional practice setting and the profession (p. 55). The registered nurse is a figure of leadership. There are many that seek counsel from

8 SELF-ASSESSMENT OF NURSING STANDARDS nurses and look to them as trusted and highly skilled professionals. With this image comes responsibility. As a leader, I must hold myself accountable for the actions of others that I lead (ANA, 2010). I am able to use my communication skills to delegate care and resolve conflicts within my practice (2010). In the past, I have had to resolve conflict on my unit between two Certified Nursing Assistants (CNAs). The conflict was resolved by pulling the two CNAs aside and leading a conversation about the issue and thoughts about how we can resolve the issues. Since the time of conflict resolution, the two CNAs have worked well together and there have not been any issues regarding the conflict. Upon reflection, I believe that I have one competency in the standard of leadership that has not been met. I currently do not participate in any professional organization. In my future, I plan to join a professional organization that can enhance my leadership skills as well as provide me with support and further knowledge in my career. Standard #13: Collaboration Collaboration is the action of working with someone to produce or create something (Dictionary.com). In the nursing profession, collaboration is achieved when the nurse partners with other members of the health care team to provide quality care. The standard of collaboration is met daily in my practice and shown by my working with other members of the healthcare team to care for my patients. According to the ANA (2010), the registered nurse: communicates with the healthcare consumer, the family, and healthcare providers regarding healthcare consumer care and the nurses role in the provision of that care (p. 57). I am always sure to include my patient, their family, the physician, and when needed, therapists and social workers in the care of my patients. I work daily with the patient and members of the healthcare

9 SELF-ASSESSMENT OF NURSING STANDARDS team to provide the highest quality of care. I communicate and work effectively with other members of the healthcare team to complete tasks daily. Upon reviewing the competencies for this standard, I feel that I meet the standard of collaboration. Standard #14: Professional Practice Evaluation The ANA (2010) states that the registered nurse: engages in self-evaluation of practice on a regular basis, identifying areas of strength as well as areas in which professional growth would be beneficial (p. 59). In order for a nurse to grow professionally, she has to evaluate her practice and get a baseline for where she has grown. A nurse should ask for and accept feedback from supervisors and coworkers in order to evaluate her current practice (2010). I often reflect on my nursing practice and try to find ways to improve it. I feel that I nearly meet all competencies of this standard of practice, though I have areas which need improvement. I have written reflection papers in my bachelors program such as this paper, and I believe them to be good reflections upon my practice and how it measures up to the standards of nursing practice as defined by the ANA. I often ask for feedback from my supervisors and coworkers in order to find areas that need improvement. I often will take action to improve myself once I have found weak areas and this has made me a stronger nurse. The areas in which I have not met this standard are those that involve peer review and offering feedback to my coworkers. I feel that these areas are in need of improvement. I currently work as needed, and I do not feel as though I have the right to give feedback or write reviews based upon my limited rapport with many of my coworkers. Standard #15: Resource Utilization The resources available to nurses are abundant. Nurses are expected to utilize resources that are appropriate for providing safe, effective, high quality care to those they serve. In my reflection of the competencies of this standard, I believe that I have met the standard. I assess

10 SELF-ASSESSMENT OF NURSING STANDARDS the needs of my patients and find the appropriate resources to help achieve the goals and outcomes that are set in place for them (ANA, 2010). I am able to delegate care appropriately and consult the correct professionals when issues arise and their consultation is necessary (2010). In the past, I had competencies in the standard of resource utilization that I believed I did not meet. Now, I feel that I have improved my practice in this area and I have no hesitations when it comes to utilizing the correct resources in order to provide care to my patients. Standard #16: Environmental Health The registered nurse practices in an environmentally safe and healthy manner (ANA, 2010, p. 61). After review of each of the competencies for the standard of environmental health, I find that I have met this standard. In my practice, I work in a manner that is conducive to healing. When things are not conducive to healing, such as having unclean rooms and bathrooms or having noisy hallways I am sure to bring things to order (ANA, 2010). I work to be sure that the environment I practice in is free from safety and health concerns. If there is any issue with faulty equipment or other threats to the safety of my patients or their family members, I am sure to contact our maintenance and environmental health supervisor immediately. Professional Development Plan Goals My overall goals are to attain competency in all areas of each standard. I will work hard over the next five years (year 2018) to reach or maintain these goals. My goals over the course of these five years are as listed: I will maintain competence in assessment, diagnoses, outcomes identification, planning, implementation, and evaluation, I will maintain competence in the standards of ethics, education, evidence based practice and research, communication, collaboration, resource utilization, and environmental health, I will be a part of making decisions

11 SELF-ASSESSMENT OF NURSING STANDARDS based on quality of practice by the year 2016, I will join a professional organization by the year 2015 in order to meet the standard of leadership, and I will participate in peer review and provide feedback to my coworkers to meet the standard of professional practice evaluation by the year 2015. Action Plan I have created a plan of action to attain and maintain my goals. In order to maintain the first six standards of practice over the next five years, I plan to continue working competently in the field of nursing. I plan to continue to practice ethically over the next five years in order to maintain my competence in the standard of ethics. My expected date of graduation from Ferris State University with my BSN is May 2014. After my graduation, I plan to continue my education in a masters nursing program which will maintain the standard of education. In order to maintain the standard of evidence based practice and research, I plan to continue with my education doing research for my practice along the way. I also plan to continue to share my research findings with my colleagues in order to enhance the practice of nursing. In order to attain competence in the standard of quality of practice, I plan to become more involved in quality through my facility. There are committees that a nurse can join at my facility that will keep her up to date with current quality issues and will involve the nurse in decisions based on these issues. My plan for maintaining the standard of communication is to continue using the communication skills I have to help resolve conflict, communicate with other members of the healthcare team, communicate effectively to promote accuracy in practice, and also to continue to improve my overall communication skills. By 2015, I will be a member of the ANA, which is a broad purpose organization. My current financial situation does not warrant my joining of a professional organization at this time. I plan to maintain the standards of collaboration and

12 SELF-ASSESSMENT OF NURSING STANDARDS resource utilization by continuing to work with other members of the healthcare team effectively to care for patients. I will continue to utilize my resources and make the necessary referrals to collaborate and care for my patients. Once I am a full time employee, I will have a more established rapport as well as grounds for providing feedback and participation in peer review and I plan to participate in both at that time. Finally, I plan to maintain the standard of environmental health by continuing to practice in a safe and healthy manner. Evaluation Plan My plan for evaluation will take place at different times depending on the goal times. The evaluation regarding leadership and professional practice evaluation will take place in 2015. At that time, if my goals have not been met, I will create a new goal and a new plan of action that will be more effective. I believe that my goal times for each standard to either maintain or attain are all reasonable and attainable goals. My evaluation of the standard of quality of practice will take place in 2016. If at this time the standard of quality of practice is not met, I will change my plan of action and goal time to better suit this standard. Each of the goals to maintain competencies in the standards that I have met will have evaluation taking place in 2018. In the year 2018, I will decide whether the goals have been met or unmet. I will reflect and review the standards of practice as I have done now to further ensure that my practice is encompassing all the professional standards and that I meet each competency in my practice. Goals, plan of action, and plan for evaluation will then be written to ensure that I am improving in practice and following all standards that the ANA has established.

13 SELF-ASSESSMENT OF NURSING STANDARDS References American Nurses Association [ANA] (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author. Dictionary.com. (2013). Collaboration. Retrieved from http://dictionary.reference.com/browse/collaboration