Running head: PROFESSIONAL DEVELOPMENT PLAN

Standards of Professional Nursing Performance Ronda A. Mott Ferris State University - Nursing 324

PROFESSIONAL DEVELOPMENT PLAN Abstract

Any plan for professional development, particularly in a discipline such as nursing, for which lifelong work, skills maturation, and new knowledge must be assimilated and applied, by definition does not remain static, and must include a careful and objective view of the past in order to chart a path forward. The following then, is a candid, retrospective review and analysis of my previous and current work and professional nursing experiences, in which I examine key experiences, accomplishments, mistakes, and missed opportunities, in light of the American Nurses Association Standards of Professional Nursing Performance (ANA SPNP) criteria. In the honest context of my past, I then construct and critique goals for my best possible professional future.

PROFESSIONAL DEVELOPMENT PLAN Standards of Professional Nursing Performance Unlike any other time in the medical profession and certainly within the field of nursing, rapid changes require nurses to consistently assess foundational knowledge and competencies, and to respond appropriately to remain current, effective, and qualified in the market place. I

would prefer to anticipate and prepare for these trends rather than being inundated by them. This anticipation includes formulating new goals and planning to expand my professional education and capabilities into areas that build upon the benchmark nursing skills set. The following retrospective review of my practice life is undertaken with the fundamental intent of future professional goals planning that comports with American Nurses Association Scope of Nursing Practice (ANA SNP) criteria. To these aims, and to do so with any measure of professional integrity, requires this examination of my professional past as a necessary premise and prelude upon which to construct professional plans for my future. Standards of Professional Nursing Performance

Standard 7. Ethics

With my primary commitment to the patients in our practice, and charged with the ethical duty to promote health and protect the autonomy, dignity and rights of the patient and to speak up when appropriate to question healthcare practice when necessary for safety and quality improvement (American Nurses Association, 2010, p. 47). I regularly advocate for practice etiquette, protocols and formalities which safeguard these ideals. As an example, when a recent department proposal was floated to condense and marginalize our current process for assembling and maintaining a comprehensive patient medical record for the length of a patients treatment association with our clinic, I forcefully petitioned for our current process, which has proven to

PROFESSIONAL DEVELOPMENT PLAN insure the best quality patient care, least duplication of services, maximum patient safety, and most error free consultation and treatment for our population. I renounced other suggestions to

the contrary, and maintained, on behalf of patients, that any other option, which could potentially harm or disservice our patients was untenable, and would be tantamount to an assault to effective nursing practice.

Standard 8. Education I have a duty to demonstrate a commitment to lifelong learning and to acquire knowledge and skills appropriate to the specialty, setting, and role (American Nurses Association, 2010, p. 49). Over the last 20 years of my nursing practice, and particularly within the last 15 years of radiation oncology practice, my commitment to ongoing academic instruction and skills competence has been met not only through individual CEUs credit and consistent reviews of the professional radiation therapy and oncology literature, but more recently includes annual RT conferences, competencies and webinars. With the University of Michigans involvement in our Radiation Oncology Center, we continue to meet national best practice standards and translate the quality typically observed in a university setting to our local community, through weekly didactic educational teleconferences and video chart rounds with their department physicians and nurses. Lastly, the formal addition of the RN to BSN curriculum to my academic enrichment, and the skills learned and already being applied to my nursing practice are further testament to my appreciation for the highest ideals in nursing education.

Standard 9. Evidence- based Practice and Research

PROFESSIONAL DEVELOPMENT PLAN Given our unique practice atmosphere that endorses nursing self-governance and

autonomy, I have been able to incorporate evidence when initiating changes in nursing practice (American Nurses Association, 2010, p. 51). I am able to integrate current treatment trends, products and give suggestions to physician staff regarding protocol and procedural initiatives that allow nurses to function more effectively in these roles. For example, my recent comprehensive independent literature review finding a lack of evidence based skin care treatment protocols in use in radiation oncology, resulted in my ability of offer treatment insights that are now directly effecting how we address these complications and initiate cost effective response plans for our afflicted patients. This includes the choice of which office based products, dressings, and drugs we presently stock and employ in our clinic for these agendas. According to the American Nurses Association (2010, p. 51) standards, the nurse in practice can share personal or third party research findings with colleagues and peers. I completed an Evidence Based Practice (EBP) research project this term, aimed at an improvement I would like to see in our practice. I shared these results with my nursing colleagues. From this research, I have proposed and envision a future, evidence based quality initiative that adds a formalized and systematic telephone triage process with a telephone triage nurse to our practice. Though we see an immediate need for such a process now, and recognize its potential value to patients and staff, fiscal realities demand a patient base in which more than forty patients are treated with radiation daily to support the resource needs inherent in such an initiative.

Standard 10. Quality of the Practice As the nurse, according to American Nurses Association (2010, p. 52) standards, I lead in the efforts to minimize cost and unnecessary duplication, and identify problems in day to day

PROFESSIONAL DEVELOPMENT PLAN work routines in order to correct process inefficiencies. I collect comprehensive data pertinent to the patients health, treatment, social and personal circumstances and clinical situation in a thorough medical record, which is essential to insuring the best quality of care, least duplication of services, maximum patient safety, and most error free consultation and treatment both short and long term. For example, via phone, computer, interoffice communication and direct meetings, I systematically assemble, prepare and collate every patients comprehensive medical database prior to every physician consultation. Subsequently, every patient visit, reevaluation, treatment update, multidisciplinary feedback, and follow up progress pertinent to our ongoing health care relationship is filtered, verified and acted upon by myself and my nursing colleagues

to maintain the patient clinical record in real time. Data collection involves my direct interaction with the patient, significant others, and health care providers, when appropriate.

Standard 11. Communication

According to American Nurses Association (2010, p. 54) standards, the nursing professional should, convey information to the healthcare consumers, families and interprofessional team. In addition to developing diagnoses and individual care plans, clinical assessments and assisting with treatments, my role as nurse includes providing compassionate care, recognizing individual attributes, socioeconomic and cultural diversities of my patients, while directly communicating, with respect and dignity, the care plan, expected outcomes, challenges and successes to patients and their families at each clinic visit. For example, when reevaluating radiation therapy patients at follow up and treatment visits, when I learn through direct questioning and examination of my patients that they are not experiencing an expected resolution of symptoms, a new clinical side effect or a new functional disability, I communicate

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these findings to physician staff to redevelop a new action care plan and timeline to address these patient developments and then actively implement the new strategies with my patients.

Standard 12. Leadership

I function independently to validate diagnoses and to develop, approve and implement individual care plans, bringing my insights to the whole team with direct communication across staff roles, but within the direct supervision of the physicians. As the chief manager of clinical information for every patients extended treatment experience within our practice, I lead and am responsible for referencing diagnoses, responses to treatment, complications and clinical milestones that permit the determination of expected outcomes and plan of care by our physicians and multidisciplinary team.

In addition to collaborative efforts with physicians, physicists, dosimetrists and therapists regarding changes in radiation therapy strategy, I and my nursing colleagues oversee the nursing care given by others while retaining accountability for the quality of care given to the healthcare consumer (American Nurses Association, 2010, p. 55). I independently recognize, address and determine the day to day management strategies for our patients pain management, weight loss and treatment related failure to thrive and cutaneous reactions to radiation therapy, and review the care prescribed by my nursing colleagues and the physicians for effectiveness. In taking the lead on these issues when they arise, I am able to individualize and prescribe the use of pharmaceuticals and pain management philosophies, recruit appropriate consultants to initiate nutritional and dietary support, initiate cross-disciplinary consultations with social work, finance, transportation, translation services, interventional radiology and medical oncology, as well as utilizing on site and other institutional clinical resources to specifically address these sequelae

PROFESSIONAL DEVELOPMENT PLAN among our patients. For each patient, I develop an active problem list, timeline for implementation, make periodic progress reports to physician staff and consult with patient families to communicate with and monitor the patient for the expected consequences, while holding myself and colleagues accountable for the outcomes.

Standard 13. Collaboration In our practice, we routinely partner with others to effect change and produce positive outcomes through the sharing of knowledge of the healthcare consumer and or situation (American Nurses Association, 2010, p. 57), wherein I regularly screen and analyze the assessment data in my interactions with patients, their families and caretakers managing clinical questions, verifying treatment orders and patient compliance and communicate both clinical findings and progress to physicians, and other outside consultants. The health care team that I work with daily includes a multidisciplinary team. A typical day consists of collaboration with one other nurse, one or two radiation oncologist physicians, radiation therapy technicians, dosimetry staff, radiation physics staff, front desk office staff, dietitian, medical social worker and occasionally, the medical oncology nursing staff and their physicians.

Standard 14. Professional Practice Evaluation

In our outpatient radiation oncology practice, though we utilize a host of institutionally mandated professional practice standards, (including, universal precautions, patient basic safety and protection standards, patient identification protocols, translation services standards, etc.) we do not employ any additional radiation oncology specific nursing practice standards at this time. However, in our nursing practice, whether communicating or collecting protected health data, I

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and my colleagues use institutionally approved and HIPPA sanctioned techniques, document and protect all communications in retrievable form and abide by all other relevant hospital, state and regulatory agency procedures. My nursing coworkers and I evaluate our nursing practice through annual, individual informal nurse- to- nurse feedback, annual performance Employee Performance Evaluations (EPE) and patient and cross departmental feedback satisfaction surveys. This is consistent with the American Nurses Association (2010, p. 59) standard for obtaining informal feedback regarding his or her own practice from healthcare consumers, peers, professional colleagues, and others. Lastly, this year, our nursing staff conducted a future best practice analysis for the purpose of future goals setting and department strategic planning.

Standard 15. Resource Utilization

Finally, as the nurse, who is the champion advocate for our patients over an extended course of treatment in our practice, we assess individual healthcare consumer care needs and resources available to achieve desired outcomes (American Nurses Association, 2010, p. 60). We not only actively participate in the coordination of all care, and act as the primary patient and family educators of all things clinical, but are fundamentally the principle intercessors for all health, financial, family, spiritual, safety and life issues that arise during the often months of association we have with a patient and family. These efforts are in keeping with the American Nurses Association (2010, p. 60) standard of assisting the healthcare consumer and family in identifying and securing appropriate services to address needs across the healthcare continuum. Whether it is boiling down the conclusions of an interdisciplinary Friday chart rounds, or clinical consultation teleconference for a frightened patient or significant other, or arranging economical

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crisis transportation needs for out of town patients to meet treatment schedules, I and my nursing colleagues are the tip of the spear in coordinating care, providing effective service, and managing resources.

Standard 16. Environmental Health

Our department is fully compliant with all current institution and hospital safety, environmental and quality procedures and protocols, however no pending or new initiatives for study or implementation are currently being considered. We, as nurses, are charged with the primary identification and reporting of hazards, risks, violations or the results of our environmental monitoring, in keeping with the American Nurses Association (2010, p. 61) standard of promoting a practice environment that reduces environmental health risk for workers and healthcare consumers. As a department, we continue to monitor patient safety to insure proper treatment has been rendered and quality care has been achieved.

The aforementioned critical analysis of my outpatient radiation oncology nursing practice convinces me that my colleagues and I regularly comport in large measure to the ANA nursing performance and practice standards. Upon this foundation of nursing practice excellence, I can create authentic personal and professional goals, and plans for meeting those goals, with a mode for evaluating progress toward those aims.

Future Professional Goals

5 Year Goals

PROFESSIONAL DEVELOPMENT PLAN My first 5 year goal is to complete Oncology Nurse Certification (OCN) no later than December 31, 2016.

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The OCN examination tests the knowledge necessary for the nurse to practice competently at the basic level in adult oncology nursing. This certification validates an individual's specialized knowledge in cancer nursing. Candidates who pass the OCN Test may use the certification mark "OCN" as a credential to verify that they have met all eligibility and testing requirements. The certification mark may be used only as long as certification is valid, which is usually for a period of four years. According to Oncology Nursing Society (), compelling professional rationale for obtaining this certification includes: 1. 95% of certified nurses agree: certification validates specialty knowledge, enhances credibility, and provides personal satisfaction. 2. 8 out of 10 people are aware nurses can be specialty certified. 3. Certified nurses score higher than non-certified nurses on their knowledge of pain and nausea; two of the symptoms that patients with cancer fear most. 4. 90% of nurse managers prefer hiring certified nurses over non-certified nurses when other factors are equal. 5. Certified nurses have a higher average annual income than non-certified nurses.

Goal Process, Timeline and Evaluation - 5 Year Goal #1 According to Oncology Nursing Society (), certification requires:

PROFESSIONAL DEVELOPMENT PLAN 1. Apply for certification as a current OCN member for premium application fee discount September 1, 2016 2. Complete the nine areas of OCN focused subject matter contained in the OCN Test Blueprint before the 90 day testing window 3. Take and pass formal OCN examination December 2016

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The cost and timing of the OCN application, the review of the necessary subject matter and the tentative date for sitting the exam are based on having first completed BSN degree work, simultaneously maintaining my current employment, and are extrapolated from realistic expectations from interviewing current OCN certificate holders, regarding the necessary study, investment, time and preparation that should precede an examination attempt. This goal reflects maintenance of the ANA Education Standard #8, which states seeking formal and independent learning experiences to develop and maintain clinical and professional skills and knowledge to the role, population, specialty, setting (American Nurses Association, 2010, p. 49). Though, I do not foresee any specific difficulties with accomplishing this goal on the schedule outlined I, nonetheless have developed an accountability strategy which includes: 1. Submitting this goal to my employer as an official goal for completion as part of my annual EPE. This action allows me to officially declare my intent and solidify the expectation for an interested third party (hospital organization). 2. Solicit my nursing colleagues and spouse as accountability partners. My second 5 year goal would be to establish and standardize a telephone triage system for our practice to improve the effectiveness of telephone communications with patients, by January 6, 2014. Earlier this term through a formal EBP exercise, I identified that our radiation oncology practice lacks an effective telephone triage process for managing the daily needs of a

PROFESSIONAL DEVELOPMENT PLAN diverse oncology population. Currently, the telephone calls are screened by front desk secretaries, who lack the clinical knowledge to fully assess the needs of patients and how to manage the issues that arise. I see the need to establish a single, standard, effective nursing

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phone triage practice to save time and enhance the continuity of care, streamline communications between our entire staff, (physicians, nurses, therapists, clerical) meet and satisfy the patients critical needs, stratify triage workflow to the most appropriate staff person, and enhance our efficiencies by solving the problem of an unpredictable demand on workload. Abundant nursing literature supports the use of nursing telephone triage systems in clinical practice. (Gleason, Brennan O'Neill, Goldschmitt, Horigan, & Moriarty, 2013). Currently, a shortcoming in our practice was the lack of formal, nursing- initiated practice standards for which we could hold ourselves accountable and constructively engage in self-evaluation of our practice on a regular basis, identifying areas of strength as well as areas in which professional growth would be beneficial (American Nurses Association, 2010, p. 59). I believe the goal of a phone triage system project, which is evidence based, achieves this standard and the related standard according to American Nurses Association (2010, p. 51) incorporating evidence when initiating changes in the nursing practice. Goal Process, Timeline and Evaluation - 5 Year Goal #2 1. Draft and submit formal nursing phone triage system proposal to medical director, clinical manager, institutional Quality Department and enlist a specific quality department contact for this project (due September 16, 2013). 2. Assign process duties to radiation oncology practice RNs (due September 30, 2013). 3. Forecast capital needs for the system based on nursing Fulltime Employees (FTE) projected practice growth and call volumes (due October 14, 2013).

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4. Adapt an evidence based triage model currently being used in clinical practice to our radiation oncology practice (due October 28, 2013). 5. Introduce concept to all staff and schedule training and coordination of the new system with the practice staff that will be affected by implementation (due November 29, 2013). 6. Sign off on system by medical director, clinical manager (due December 20, 2013). 7. Set go live date for practice (January 6, 2014). Currently, with practice RNs already in support of this initiative, a draft proposal already prepared for preliminary review, and a suitable triage template already selected for adaptation, I do not foresee significant obstacles to the current timeline. However, one possible challenge could develop from the need for probable additional RN FTEs to manage the current call volume and to plan for future increases in call volume and complexity. This however, as a capital and budget item, could be rectified in a forward looking proposal to our future capital expenditures or subsidized from organizational quality ventures funding with endorsement from Chief Nursing Officer and Vice President for Quality Improvement, until such time that our clinic revenues (i.e. treating 40 plus patients per day with radiation), consistently match any fiscal outlay needed to support the program and staff needed. (U.S. Department for Health and Human Services,) The accountability method that I would exercise includes: 1. Monthly progress reports from RNs to medical director, clinic manager and Quality Department on progress from research, implementation and go live pilot phases. 2. Subsequent biweekly call volumes from the clinic practice to medical director and quality department contact.

PROFESSIONAL DEVELOPMENT PLAN 10 Year Goals My 10 year nursing plan is to complete a MSN Master of Science in Nursing

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with Concentration in Informatics. Twenty- first century medicine has not only blown open the doors to medical knowledge advancement in the areas of human genomics, advanced pharmaceuticals, immunotherapy and advanced procedures and diagnostics (i.e. robotic surgery, nanotechnology based diagnostics etc.) (Understanding Nano, ) but also has seeded an explosion in the information systems and technologies needed to record, monitor, access and secure the data used clinically in the health care systems of today and the future. This area of technical expertise, built upon previous academic and professional experience for the registered nurse is the area of Nursing Informatics. (U.S. Department for Health and Human Services,) The rationale for pursuing masters level training in the informatics arena is supported by the fact that this area is a growing specialty recognized as a discipline marked for career growth in the past few years. This new practice area addresses the burgeoning need for experts who have a health care background, such as nursing, to manage the continuous expansion of information technology in the health care setting. The use of technology in the storage, dissemination and utilization of patient data has become a constantly evolving challenge for the health care industry. Suitably trained professionals in this area should anticipate high career demand and mobility. (Ferris State University,) This degree work is consistent with furthering ANA Standard #9 in participating, as appropriate to education level and position, in the formulation of evidence based practice through research (American Nurses Association, 2010, p. 51) and Standard #8, where the nurse acquires knowledge and skills appropriate to the role, population, specialty, role or situation

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(American Nurses Association, 2010, p. 49). I would like to cultivate career options that allow me to apply informatics expertise in developing technology platforms for use by clinicians in radiation oncology.

Goal Process, Timeline and Evaluation - 10 Year Goal

1. Complete RN to BSN degree work with satisfactory GPA (August 2015). 2. Finalize admissions criteria and submit applications to MSM Program (October 1, 2015). 3. Matriculate/begin MSN coursework (Spring 2016). 4. Complete necessary course work toward degree and sit comprehensive post course examination in (2020).

An honest appraisal of my personal strengths accompanied preparation for the RN to BSN program. I have done the same in my consideration of MSN level training. The personal strengths that assure my successful MSN degree completion include my faith, which grounds me emotionally during the grueling academic pursuit, leaves me at peace with the process and serves as the cornerstone to my worldview. Equally important to my success is the broad support system of people who are vested in the outcome; a very supportive spouse, close personal friends and family, longtime professional peers, and even an agreeable employer, all of which are committed with me to MSN achievement. Having considered the literal physical and cognitive challenges that follow any new pursuit, I am blessed with excellent health enabling me to invest the necessary time and energies toward my degree. In this respect, I am equally motivated to preserve good health as a proven mechanism for stress relief. Other strengths include my age and experience, which have helped crystalize my perspective for the value of advanced level

PROFESSIONAL DEVELOPMENT PLAN nursing degrees and a measure of humility that allows me to take counsel and instruction from professors, classmates, peers and institutional administrators. Finally, my nuclear family has weighed the financial cost and outlays necessary for my scholastic success and is capable of supporting my efforts without undue duress.

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Conclusion

After weighing the perspectives gained during the compilation of this paper and considering the value of this exercise in personal introspection both past and future, it is abundantly clear to me that as a professional nurse, I have signed on to a lifelong odyssey of never ending development, novel academic and clinical pursuits, and sequential improvements in my skills, thinking and professional aptitude. After appreciating the solid foundation that I have enjoyed in nursing practice, which is firmly grounded in ANA principles, I am excited about my prospects for an equally challenging, stimulating and rewarding pursuit of the contemporary objectives outlined above.

PROFESSIONAL DEVELOPMENT PLAN References

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American Nurses Association (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, Maryland: Nursesbooks. Ferris State University (n.d.). MSN program. Retrieved August 4, 2013, from http://www.ferris.edu/htmis/colleges/alliedhe/Nursing/MSN-program/HOME-NursingMSN.htm Gleason, K., Brennan O'Neill, E., Goldschmitt, J., Horigan, J., & Moriarty, L. (2013). Ambulatory oncology nurses making the right call: Assessment and education in telephone triage practices. Clinical Journal of Oncology Nursing, 17(3), 335-336. Oncology Nursing Society (n.d.). OCN certification. Retrieved August 4, 2013, from http://www.oncc.org/TakeTest/Certifications/OCN Understanding Nano (n.d.). Nanotechnology in medicine. Retrieved August 4, 2013, from http://www.understandingnano.com/medicine.html U.S. Department for Health and Human Services (n.d.). Toolkit: Implementation of clinical guidelines. Retrieved August 4, 2013, from http://rnao.ca/sites/rnaoca/files/BPG_Toolkit_0.pdf

PROFESSIONAL DEVELOPMENT PLAN CHECKLIST FOR SUBMITTING PAPERS CHECK DATE, TIME, & INITIAL Yes rm Yes rm

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PROOFREAD FOR: APA ISSUES

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1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)] 2. Running head: Does the Running head: have a small h? Is it on every page? Is it less than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2 from the top of your title page? (Should be a few words from the title of your paper). [p. 229 and example on p. 40] 3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract and know what to find in your paper. [p. 25 and example on p. 41] 4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use Introduction as a heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and example on p. 42] 5. Margins: Did you leave 1 on all sides? [p. 229] 6. Double-spacing: Did you double-space throughout? No triple or extra spaces between sections or paragraphs except in special circumstances. This includes the reference page. [p. 229 and example on p. 40-59] 7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229] 8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions. 9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a persons name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 8788] 10. Typeface: Did you use Times Roman 12-point font? [p. 228] 11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111] 12. Plagiarism: Cite all sources! If you say something that is not your original idea, it must be cited. You may be citing many timesthis is what you are supposed to be doing! [p. 170] 13. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this: The variables that impact the etiology and the human response to various disease states will be explored (Bell-Scriber, 2007, p. 1). Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p. 170-172]

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14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172] 15. Paraphrase: A paraphrase citation would look like this: Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007). It may also look like this: Bell-Scriber (2007) found that [p. 171 and multiple examples in text on p. 40-59] For multiple references within the same paragraph see page 174. 16. Headings: Did you check your headings for proper levels? [p. 62-63]. 17. General Guidelines for References: A. Did you start the References on a new page? [p. 37] B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often they are not and must be adapted. Make sure all fonts are the same. C. Is your reference list double spaced with hanging indents? [p. 37] PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE 18. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out where you addressed each section.) 19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you become breathless or it doesnt make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did you do this? 20. Wordiness: check for the words that, and the. If not necessary, did you omit? 21. Conversational tone: Dont write as if you are talking to someone in a casual way. For example, Well so I couldnt believe nurses did such things! or I was in total shock over that. Did you stay in a formal/professional tone? 22. Avoid contractions. i.e. dont, cant, wont, etc. Did you spell these out? 23. Did you check to make sure there are no hyphens and broken words in the right margin? 24. Do not use etc. or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.? 25. Stay in subject agreement. When referring to 1 nurse, dont refer to the nurse as they or them. Also, in referring to a human, dont refer to the person as that, but rather who. For example: The nurse that gave the injection. Should be The nurse who gave the injection Did you check for subject agreement? 26. Dont refer to us, we, our, within the paperthis is not about you and me. Be clear in identifying. For example dont say Our profession uses empirical data to support . . Instead say The nursing profession uses empirical data.. 27. Did you check your sentences to make sure you did not end them with a preposition? For example, I witnessed activities that I was not happy with. Instead, I witnessed activities with which I was not happy. 28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?

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29. Did you have other people read your paper? Did they find any areas confusing? 30. Did you include a summary or conclusion heading and section to wrap up your paper? Yes rm 31. Does your paper have sentence fragments? Do you have complete sentences? Yes rm 32. Did you check apostrophes for correct possessive use. Dont use apostrophes unless it is showing possession and then be sure it is in the correct location. The exception is with the word it. Its = it is. Its is possessive. Signing below indicates you have proofread your paper for the errors in the checklist: Teresa Bonham DATE: August 8, 2013