Running head: POSTION PAPER

Position Paper
Clayton Jensen
Professor Kristen Espinoza
NURS*409*01

Running head: POSTION PAPER

Society very often underestimates the value of a nurse. So much so that even those in the
profession refer to themselves and their job as just being a nurse. This thought process isn't
exactly anyone's fault. Nursing has come a long way from where it started. Look back at where a
nursing started in history. In England during the protestant reformation (1517 - 1648), the care of
the sick was provided by common women, often those of the lower classes who were too old or
too ill to find any other type of work. That definition sounds a lot like what a Walmart greeter's
would be. They were also seen as people prone to fighting, foul language, petty theft, and
extortion of money from patients (Pavey 1953). So in all reality they were worse than a Walmart
greeter's definition. They were the scum of society.
Due to the advancement of a nurse's skill-set, nursing education has blossomed to
something of a prestigious undertaking amongst the medical community. As one who is currently
in this educational endeavor of becoming a nurse, I will say that the safety of those patients in my
nursing future will be extremely grateful for the high nursing education standards that are
required of any nursing student through their educational process. Acquiring a nursing degree
means that you have learned and understand the mechanisms of the body and the many
pathophysiologies that come with it, have learned the language of the medical profession, and
how to take care of any severity of patient from a textbook point of view, medications included.
There is a lot missing still from a nursing education that is required to be a great nurse. The main
thing missing is simply experience, which no schooling program can truly provide. That being
said though, you can't acquire that experience before acquiring the tools needed for its
acquisition. That is why nursing school is so important to the preparation of a future nurse and
the quality of care of their patients. You can't play the game without learning first how the game

Running head: POSTION PAPER

is played.
As a nurse progresses and develops in their field it is hard not to notice the things in the
health-care and societal system that need modifying. This brings up the power, authority, and true
influence on the organizational and legal systems, that govern our society, that a nurse possesses.
Often times nurses don't see this important influence for good that they have and often ask how
can I make a difference. The response to this question lies in the many different powers a
nursing professional has. There are 6 main sources of power that a nurse has and should use to
not only better care for those they serve but also better advocate for those who can't. These six
powers are: The Potential Power of Numbers, Expert Power, Legitimate Power, Referent Power,
Reward Power, and Coercive Power.
Potential power of numbers is exactly what it says it is. Nurses sometimes forget that as
the largest group of health care providers, they could generate enough power to successfully
reform the health care system based on numbers alone. According to the 2004 National Sample
Survey of Registered Nurses, there are 2.9 million registered nurses who are dispersed in every
voting district in the nation (U.S. Department of Health and Human Services, n.d.).
Expert power is related to possessing the knowledge and skill that someone else needs
(Cohen, Leavitt, Leonhardt, & Mason, 1998; French & Raven, 1959; Lee, 1997; Rakich, Longest,
& Darr, 1992)..
Legitimate power is that bestowed by the particular status or the role of an individual
(Cohen et al., 1998; French & Raven, 1959; Lee, 1997; Rakich et al., 1992). Every nurse
possesses this source of power whether they know it or not. They receive this power through the
license they are required to have in order to practice by their State Board of Nursing.
Referent power is a source of power available to nurse policy advocates. It is gained by

Running head: POSTION PAPER

having other peoples admiration and respect (Cohen et al., 1998; French & Raven, 1959; Lee,
1997; Rakich et al., 1992). Nursing is often defined as a the protection, promotion, and
optimization of health and abilities, prevention of illness and injury, alleviation of suffering
through the diagnosis and treatment of human response, and advocacy in the care of individuals,
families, communities, and populations (LeMone, 2013). The Gallup Organizations 2006 annual
poll on professional honesty and ethical standards ranked nurses as number one in terms of public
respect (Saad, 2006).
Lastly there is Reward and Coercive power. A nurse has the ability to practice both and
obtain power from either but the power that will be retained the longest would be through
Reward power. We often times see those of high legitimate power utilize Coercive power to
manipulate those around them. This always ends badly, where the power acquired through reward
power would have granted them more influence in the end. A nurse is much better off utilizing
reward power when he or she can in almost all situations.
Legal authority as described by Eleanor J. Sullivan states that legal authority is defined by
the Nurse Practice Act whereas organizational authority is defined by the companys job
description. In other words, legal authority includes all registered nurses regardless of their
employment. The legal authority of a nurse includes obtaining a license through the state in order
to verify the competence of the individual. It is compiled of a series of steps that require proof of
graduation from an accredited nursing school, sufficient clinical hours and completing the
application process for licensure and background check, and passing the NCLEX (Utah
Department of Administrative, 2015).
Organizational authority is more individualized. For example, when applying for a
nursing position with an organization such as the American Fork Hospital, the position posting

Running head: POSTION PAPER

will describe the hierarchical status, such as management or staff, and the responsibilities
expected while in that specific position.
The roles of a professional nurse are endless. Nurses are a leader, medication
administrator, supporter, collaborator, motivator, teacher and many more. Based on my individual
practice, I have found that the most significant roles to me include being an advocate for clients,
teacher, confidence builder and safety specialist. When putting myself in a nursing role, I
anticipate starting my career by focusing on the safety of my clients, and addressing their most
basic needs to create a sound basis for care. Furthermore, being an advocate for clients is
essential to provide a trusting relationship. As I become more experienced, I see myself
developing more advanced roles such as a delegator and even a leader.
Just understand that the nurses scope of practice is defined in two ways: the
state boards of nursing, and the hospital job description. Each state has the
legal authority to define the role that the RN has. If ever needed I can refer to the
Nurse Practice Act for guidance before jumping into a task that I could be legally accountable
for. The Nurse Practice Act, which defines a nurses scope of practice for each state, will be my
ultimate guideline when determining my scope of practice.
Due to delegation being defined according to each state, and therefore, I will also refer
back to the Utah Nurse Practice Act for the appropriate delegation to LPNs, UAPs, and CNAs
(LaCharity, Kumagai, & Bartz, 2013). By learning how to delegate tasks such as ADLs to others
in your team, patients needs will be met sooner than if a nurse was working alone. Delegation
comes with a price though, those who you delegate are operating under the nurses license and
good judgment making the nurse accountable for the delegatee's actions.

Running head: POSTION PAPER

To be accountable is defined as upholding obligations or taking ownership for decisions

and results (Sullivan, 2012, p. 132). Breaking down accountability you would find that it consists
of two main aspects, answerability and responsibility. Responsibility is the process of carrying
out that action while answerability is the ability to say "yes" to an action one performs.
The Nurse Practice Act of Utah states that a registered nurse is accountable for operating
within their scope of practice. (Utah administrative code: Nurse practice rule, 2015). A
registered nurse is accountable for their own actions in regards to direct patient care, as well as
their communication to other healthcare providers. accountability can be applied to nurses within
both organizations and the professional field. Nurses are accountable within the professional
organization when they consistently work to improve patient care, and promote safety.
Accountability applies to the professional field when a nurse implements evidenced based
practice, complies and is involved in governance issues that influence nursing practice, and
continuing education (Battie & Steelman, 2014).
Accountability not only relates to the scope of practice the nurse performs personally but
also to those the nurse delegates task to and their personal performance. By delegating a task to
another LPN, CNA, or UAP you are saying that that person has your trust to perform a task for
you in their scope of practice. They are operating now under the nurses license as well as theirs.
This is the same for managers and charge nurses who have more authority and therefore can
delegate down the chain of command, but are also responsible for the deferred tasks.
Even though education, authority, nursing roles, and accountability are extremely
important, I feel ethics is the most important. You can't exercise any of these principles without
ethics. It is important that as a member of the health care team I know what my own personal
ethics are so to not pass bias as much as possible.

Running head: POSTION PAPER

The health care profession is one that often places ethical dilemmas in the hands of the
professional working in the field. Knowing my own ethical principles allows me to know my
own potential bias in a situation.
Professionally a nurse's ethics were defined by the 9 provisions stated by the ANA in
2015 Code of Ethics for Nurses. Provision one states that the nurse, in all professional
relationships, practices with compassion and the recognition of human dignity and worth that is
present in every individual. Provision two states that the primary commitment of the nurse is to
the patient, whether the patient is defined as an individual, group, or community. Provision three
states that the nurse seeks to protect the health, safety, and rights of the patient. Provision four
states that that the nurse has accountability, authority and responsibility, for nursing practice.
Provision five states that the nurse has a duty to self to maintain competence and to continue
professional growth. Provision six states that the nurse facilitates improvement of the healthcare
environment. Provision seven states that the nurse assists in advancement of the profession
through contributions to practice, education, administration, and knowledge development.
Provision eight states that the nurse collaborates with the public and other health professionals in
promoting community, national and international efforts to meet health needs. Lastly, provision
nine states that the profession of nursing collectively must strive to articulate nursing values,
maintain the integrity of the nursing profession, and integrate social justice.
In conclusion there is a lot to being a nurse and a student right out of school is not
expected to know what all those aspects are. Nurses are a continually learning and growing mass
of powerful and influential people. As Florence Nightbale put it, "Nursing is an art: and if it is to
be made an art, it requires an exclusive devotion as hard a preparation as any painter's or

Running head: POSTION PAPER

sculptor's work; for what is the having to do with dead canvas or dead marble, compared with
having to do with the living body, the temple of God's spirit? It is one of the Fine Arts: I had
almost said, the finest of Fine Arts." Essentially nursing is not only structured but also
individualized. If there were the same art in every home or museum it wouldn't be considered art
but rather normal. Nursing is using the structure previously built by those before us while making
it our own. All that truly matters is that you are ready to help people and are open to change.
With that any nurse can and will become great.

Running head: POSTION PAPER

Citations
Baitte, R. & Steelman, V.M. (2014). Accountability in nursing practice: Why it is important for
patient safety. AORN Journal 100(5). p. 537-541.
Pavey, A.E. (1953). the story of the growth or nursing as an art, a vocation, and a profession (4th
ed.). Philadelphia: J.B. Lippincott.
Cohen, S.S., Leavitt, J.K., Leonhardt, M.A, & Mason, D.J. (1998). Political analysis and Strategy.
In D. Mason & J. K. Leavitt (Eds.), Policy and politics in nursing and health care(3rd ed.).
(pp. 139-159). Philadelphia, PA: W.B. Saunders Company.
LaCharity, L.A., Kumagai, C.K., & Bartz, B. (2013). Prioritization, Delegation Assignment:
Practice exercises for medical-surgical nursing. (3rd ed.) St. Louis, MO: Mosby.
LeMone, P. (2013). Medical-surgical nursing: critical thinking in patient care. (5th ed., Pearson
new international ed.). Upper Saddle River, N.J.: Pearson.
Saad, L. (2006). Nursing tops the list of most honest and ethical professions. The Gallup Poll.
Retrieved on December 22, 2006 from www.galluppoll.com/content/?ci=25888&pg=1
Sullivan, E. J. (2012). Effective Leadership and Management in Nursing (8th ed.). Boston, MA:
Prentice Hall.
U.S. Department of Health and Human Services. HRSA. (n.d.). Preliminary findings: 2004
National sample survey of registered nurses. Retrieved January 20, 2007
fromhttp://bhpr.hrsa.gov/healthworkforce/reports/rnpopulation/preliminaryfindings.htm
Utah Department of Administrative services Division of Administrative Rules. (2015). Utah
Administrative Code: Nurse Practice Rule. Retrieved from