Running head: PAPER B

PTP Paper B
Amy Polzin
Ferris State University

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Abstract

The purpose of this paper is to distinguish how nurses can be considered professionals in
practice. To accomplish this, Flexners characteristics of a true profession have been applied to
the role of nurses as a way to identify professional identity. We can also look at the American
Nurses Associations Scope of Nursing Practice and Standards of Professional Nursing Practice
to better define the roles and responsibilities of the Registered Nurse. Among these standards, I
find Ethics and Leadership to be the most pertinent to me personally. Transitioning from the role
of a Registered Nurse with an Associate Degree in Nursing to a Bachelor of Science in Nursing
will also be discussed using the Quality and Safety Education for Nurses definitions of
knowledge, skills, and attitudes. The Standards of Professional Nursing Practice will be applied
to the knowledge, skills, and attitudes as well.

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PTP Paper B

Nurses can be considered professionals in practice by looking at a variety of factors.

Defining and understanding the professional identify of a nurse is one way this can be done.
Considering the scopes and standards of practice is another contributing aspect of nursing
professionalism. In this paper, I will also describe the significance of the role of nursing and how
it contributes to quality and safety in a health support system, the role of nurses as leaders, and
the importance of lifelong learning in the nursing field.
Professional Identity
Many have come up with definitions and criteria of what it means to be a professional.
Probably one of the most widely agreed upon set of criteria, though, is the one developed by
Flexner (1915). As quoted in Black (2014, p. 53), Flexner suggests that a true profession:
1. Is basically intellectual (as opposed to physical) and is accompanied by a high degree
of individual responsibility.
2. Is based on a body of knowledge that can be learned and is developed and refined
through research.
3. Is practical, in addition to being theoretical.
4. Can be taught through a process of highly specialized professional education.
5. Has a strong internal organization of members and a well-developed group
consciousness.
6. Has practitioners who are motivated by altruism (the desire to help others) and who
are responsive to public interests.
Nursing is an occupation that fits each of these criteria of true professions in one way or
another. Nursing fits into Flexners first bullet point as a profession in that nurses must be well
educated and continually use the knowledge they have gained from classes, educational
resources, other nurses, and their own experience. They are also held to a high degree of
individual responsibility (Black, 2014 p. 53) in that they must be liable for their own actions as

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well as the actions they delegate to others. Nursing fits into Flexners (1915) second criteria of a
profession in that evidence based practice is used to determine the safest and most effective
courses of action for patients. Nursing is practical, in addition to being theoretical (Black,
2014, pp. 53) in that it is a profession in which hands-on skills, critical thinking skills, and
educational materials must be used and applied. Nursing fits into Flexners (1915) fourth criteria
of a profession by using a combination of lectures and clinical experience to train and prepare
nurses for their career. Once becoming a nurse, continuing education is not only expected, it is
required. Nursing is a profession according to Flexners (1915) fifth bullet point in that there are
many organizations, such as the American Nurses Association (ANA), which support the
interests and welfare of nursing. Flexners (1915) sixth criteria of professions is probably the
most specific to nursing out of them all. Nurses are motivated by the desire to help and heal
others. Everything a nurse does is focused toward the goal of helping others. Nurses must uphold
these principles in practice because it is important that their patients view them as professionals.
The patients that nurses see and care for are often times at the most vulnerable points in their life,
so it is important that the nurses are trusted and respected by their patients in order to safely treat
them and ensure they will be compliant with their care.
As a newer nurse with just over one year of experience, I consider myself to be a
professional and believe I meet each of Flexners (1915) characteristics in practice. However, I
feel I meet some of them more prominently than others, as some take more time to develop. I
think the criteria that I most strongly identify with at this point are the first and sixth. The first
one because I am expected to have my own foundation of knowledge in order to make the safest
decisions and provide the best care for my patients. As a Registered Nurse, I have to hold myself
accountable for the actions that I take, or do not take. There is no one that directly oversees what

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I do throughout my shift. I have to use my own judgment and rely on my education and
experience in order to do the right thing for my patients at all timeswhatever that may be. I
think I identify with the sixth criteria as well because altruism is what guided me to become a
nurse to begin with. As a nurse, it is my greatest joy to see my patients heal from the ailments
that initially brought them in. Advocating for them and knowing that I played some small role in
their recovery is what drives me to continue in this profession.
Some areas that I am still developing in professionally, based on Flexners (1915) criteria,
are the second and fourth characteristics. Nursing is an ever-changing field, and as such,
evidence based practice will continue to change the actions we, as nurses, take. I am still learning
about many different diseases and the treatments for them, and this will continue throughout the
course of my career. Continuing education requirements will ensure that I stay current in practice
in order to retain my license. I will be expected to partake in many in-service educational
opportunities for a variety of new medicines, treatments, and equipment, as well as complete
yearly competencies which will confirm my ability to perform certain procedures or treatments
safely. Because this is ongoing, and I am still a newer nurse, I feel that my exposure in these
areas is limited but will progress over time.
Scope of Practice
As professionals, nurses must follow their scope of practice to appropriately care for and
treat their patients. According to White and OSullivan (2012, p. 12), the scope of nursing
practice is comprised of the first six standards of nursing practice: assessment, which is the
collection of data pertinent to the patients current situation; diagnosis, which is determined by
analyzing the obtained data; outcomes identification, which is predicting the patients response to
planned nursing interventions; planning, which is when the Registered Nurse (RN) develops a

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plan that will lead to the expected outcomes; implementation, which is the carrying out of the
plan developed by the RN; and evaluation, which is evaluating whether or not the expected
outcomes were met. The nursing process is the method which is used in order for the scope of
practice to be carried out.
The nursing scope of practice ties in with Flexners (1915) characteristics of a profession
by allowing for standardized care across the board. Although nursing is a highly individualized
field, and each patient and circumstance is unique, the scope of practice lays the foundation of
expectations in order to create a more universal understanding of what is expected from the RN.
The nursing scope of practice allows the RN to know what they are responsible for. It has
continued to develop and has been utilized over many years as nursing has continued to grow as
a profession. It can be used and taught both in practice and theory, as well as with hands on
experience. The nursing process is a skill that nurses develop and learn to perfect over time.
Standards
In addition to the first six standards of nursing practice, White and OSullivan (2012) list
ten more: ethics, education, evidence-based practice and research, quality of practice,
communication, leadership, collaboration, professional practice evaluation, resource utilization,
and environmental health. Although each of these standards are highly valued in nursing, I have
chosen to discuss two that are most pertinent to me.

Ethics
According to White and OSullivan (2012, p. 114), many of the ethical issues
encountered daily by nurses relate to protecting the rights of patients and families, upholding

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their autonomy, ensuring informed consent, and assisting patients and families in the expression
of self-determination such as advanced directive decisions. I act ethically in my practice by
giving my patients the best and safest care I can provide, regardless of whether or not I agree
with their personal choices or lifestyle. For instance, if a patient is well known on my unit
because he has chronic obstructive pulmonary disease and has frequent exacerbations because he
refuses to quit smoking, I will still treat that patient to the best of my ability even though I
disagree with his decision to continue smoking. I will try to find new ways to approach the
subject of smoking in order to continue educating the patient on the need to quit, and it is my
responsibility to ensure the patient is aware of the consequences should they choose to continue
smoking.
Another way that I act ethically in practice is by providing my patients and their familys
autonomy. If I have a ninety-seven year old patient who is dealing with a terminal illness and is
no longer able to make his or her own medical decisions, but has a designated power of attorney
(DPOA) in place who wishes for the patient to be a full code, I must respect that. It is up to me to
make the DPOA aware of the statistics and potential outcomes that would occur if chest
compressions were to be done on a patient in such a condition, and evaluate their understanding
of such, but should they still choose for their loved one to be a full code, I must set aside my
personal opinion on the matter in order to provide autonomy to my patients.

Leadership
Leadership is a professional responsibility shared by all registered nurses at all levels of
practice in all settings (White & OSullivan, 2012, p. 163). I act in a leadership position by

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taking on the role of charge nurse of the floor. As charge nurse, I must make sure that I assign
patients and new admissions to each nurse equally and fairly. I do this by considering the acuity
of each patient, the experience of each nurse, and any other special circumstances that may be
present. It is also my responsibility to ensure that everyone on the floor is working efficiently and
no one gets behind or overwhelmed. I act as a resource to othersif they have questions or
concerns about their patients, or just need a second opinion, as charge nurse I am the one they
should come to. If there are any issues that take place during my shift, such as dissatisfied
patients or family members, I am the one who should address the problem.
Another way I act in the leadership role is by making executive decisions in emergency
situations. Often times, patients decline unexpectedly, and there is no doctor present to obtain
orders from. I must make instant decisions in order to keep my patients safe. I must prioritize
which things should be done first. Should I take action and then page the physician? Do I have
time to wait for the physician to call me back, or should I call the rapid response team? These are
choices that I must make with little time to debate. In these situations I must also delegate tasks
to other personnel in order to manage my time most effectively. Vital signs or glucose checks can
be done by a nursing assistant in order for me to update the team on the condition of the patient.
Transition
White and OSullivan (2012, p. 25) describe the Standards of Practiceassessment,
diagnosis, outcomes identification, planning, implementation, and evaluationas representing
the problem-solving process that the registered nurse follows in daily interactions with patients,
groups, communities, and systems. The Standards of Professional Performance include ethics,
education, evidence-based practice and research, quality of practice, communication, leadership,
collaboration, professional practice evaluation, resource utilization, and environmental health,

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and are described by White and OSullivan (2012, p. 25) as how the registered nurse follows the
Standards of Practice, completes the nursing process, and deals with other nursing practice issues
as they arise in his or her career. Together, the Standards of Practice and the Standards of
Professional Nursing Performance make up the Standards of Professional Nursing Practice
(White & OSullivan, 2012, p. 24).
The knowledge, skills, and attitudes needed to transition into a Bachelor of Science in
Nursing (BSN) practice can be explained using the Quality and Safety Education for Nurses
(QSEN). QSEN (2012) defines the knowledge, skills, and attitudes as the tools needed to
deliver high quality, safe, effective, and patient-centered care. From the perspective of Scope
and Standards of Practice, it can be determined that the knowledge, skills, and attitude needed to
transition into the BSN role include those of patient-centered care, teamwork and collaboration,
evidence-based practice, quality improvement, safety, and informatics.
Knowledge
The ninth Standard of Professional Nursing Practice, Evidence Based-Practice and
Research, can be considered an example for knowledge based on the QSEN. The duty of the RN
with evidence-based practice (EBP) is to integrate evidence and research findings into practice
(White & OSullivan, 2012, p. 133). Evidence based-practice (EBP) guides nursing practice to
use current evidence-based nursing knowledgeincluding research findings rather than
sticking with traditional practice methods that may be outdated, unsafe, or ineffective (White &
OSullivan, 2012, p. 134). EBP is important to nursing knowledge because it guides nursing
practice in a safe and effective manner, and nurses continually learn new information in which
they can apply to their practice.

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The tenth Standard of Professional Nursing Practice, Quality of Practice, can also be
considered an example of knowledge based on the QSENs description. The Institute of
Medicine (IOM, 2003, 2011) identified five core competencies which would ensure quality of
practice. As listed in White and OSullivan (2012, p. 146), these competencies are as follows:

Provide patient-care that encompasses the uniqueness of each patient.

Work on interdisciplinary teams to integrate care, thereby ensuring that care is

continuous and reliable.

Use evidence-based practice that integrates research evidence with clinical

expertise and patient preference.

Apply quality improvement principles and strategies to change patient care

processes and systems of care.

Use informatics to communicate and support decision-making to reduce errors.

The knowledgeable nurse knows these competencies ensure quality of care in that they
incorporate many different aspects which prioritize safety and are patient focused.
A third example of knowledge as described by QSEN could be the eighth Standard of
Professional Nursing Practice, Education. This is described by the ANA (2010) as the
professional obligation to acquire and maintain the knowledge and competencies necessary for
current nursing practice. It is essential for nurses to remain current in practice in order to
comply with ever-changing policies and expectations. This can be done by staying educated and
up-to-date with health care practices.
Knowledge expectations for an Associate Degree in Nursing (ADN) trained RN and BSN
trained RN differ. Those with an ADN do not have the same background in utilizing EBP as
those with a BSN do. They also do not have the educational background, in most instances, to
hold managerial, coordinator, or educator positions. The BSN trained nurse is better prepared to

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provide quality care due to more extensive education in informatics, communication, and
interdisciplinary teams.
Skills
One Standard of Professional Nursing Practice that can be considered an example of
skills based on QSENs description is the eleventh standard, Communication. Communication
can be defined as a complex feedback loop that requires a sender, a message, and a receiver
(White & OSullivan, 2012, p. 153). The messages can be verbal, nonverbal, spoken, or written.
The types of communication styles include passive, aggressive, or assertive. Nurses use
communication skills constantly in practice. They communicate with doctors, patients, and many
members of the care team. They must be careful that the messages they are sending are clear,
concise, and direct in order to ensure accurate information is passed on.
The fifteenth Standard of Professional Nursing Practice is Resource Utilization, and this
can also be considered an example of skills. Resource utilization is described by White and
OSullivan (2012, p. 193) as the amount of a good or service consumed or the pattern of use of
a good or service within a specified time. This is important in nursing in that nurses must utilize
many resources that pertain to patient care. Not only must they refer to educational resources and
human resources, they also must utilize supplies as resources which can contribute to patient
costs as well as the budget of the facility.
Skills for ADN and BSN nurses differ in several ways as well. ADN nurses are not as
equipped as BSN nurses to communicate efficiently with multiple disciplines. They are not
educated as extensively in this area as BSN-RNs, and do not have the same level of experience
dealing with physicians, pharmacists, physical therapists, and many other health care fields
contributing to the patients care. ADN programs also do not focus as heavily on resource

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utilization. They are not required to focus as extensively on pathophysiology, so written works,
such as research papers, are not held to the same standard of importance.
Attitude
The twelfth Standard of Professional Nursing Practice is Leadership and can be
considered an example of Attitude according to QSENs description. White and OSullivan
(2012, p. 163) describe leadership as the ability to influence others toward accomplishing
common goals. Leadership is an important responsibility for nurses, as the primary caretaker for
the patient. The nurse must oversee care provided to the patient, intervene when something
appears wrong or unsafe, and delegate tasks to unlicensed assistive personnel (UAP). Though
tasks performed by the UAP are not always witnessed by the RN, the RN is ultimately
responsible for ensuring that the UAP is competent and qualified to perform the delegated task.
Is a delegated task results in harm or injury to a patient, the RN can still be held accountable.
Another Standard of Professional Nursing Practice which can be considered an example
of Attitude is the seventeenth standard, Professional Practice Evaluation. White and OSullivan
(2012, p. 187) describe this as the responsibility of the RN to engage in evaluation activities to
maintain and enhance her or his professional performance as part of accountability to the
healthcare consumer and the profession. Holding oneself accountable is an important
responsibility of the nurse. Nurses must hold themselves accountable for providing the best care
possible to their patients, reacting appropriately to changes in patient status, and notifying the
appropriate persons of problems or concerns.
When discussing attitudes in nursing, ADN and BSN-RNs differ in several ways. ADN
prepared nurses are not as equipped as BSN prepared nurses to take on leadership roles. An
example of this could be the role of charge nurse. They also are not well prepared to evaluate

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their own practice. BSN programs focus more heavily on leadership roles and prepare nurses to
take charge of a team. They are better equipped with the knowledge of what their professional
practice should consist of, allowing them to more accurately evaluate their own practice.
Significance & Conclusion
There are several ways Bachelor of Science prepared nurses can improve quality and
safety in a health system using support such as the scope of practice. By staying within the
boundaries of their scope of practice, they are ensuring that they are only providing safe, quality
care of which they are competent to do. If something falls into their scope of practice but the
nurse is unfamiliar with it, he or she is expected to seek out the help of someone who is qualified
and competent. The scope of practice can also improve quality and safety by streamlining
expectations across facilities in order to create a universal understanding of the responsibility of
the nurses.
Nurses act as leaders in healthcare by advocating for their patients, holding themselves
accountable to complete their job at a satisfactory level, and by making educated decisions in
emergency situations in order to have the best possible outcome for their patient. The nurse is the
direct overseer of the patient. They spend more time with them than the physicians do, and are
often the first ones to observe an abnormal finding or change in patient status. They are often the
eyes, ears, and hands of the physician, and are expected to use appropriate judgment and not
follow orders blindly. If a physician gives an order that seems inappropriate, the nurse is
expected to know enough to question it.
Based on the standard of education (White & OSullivan, 2014, p. 123), lifelong learning
is an important aspect of nursing. The medical field, and nursing practice specifically, is
constantly changing and evolving. Nurses are expected to earn continuing education credits in

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order to maintain licensure, as well as attend conferences, in-services, and perform yearly
competencies in order to demonstrate they are safe in practice. Evidence-based practice helps us
to develop safe standards of care, in which nurses are expected to uphold.
In conclusion, nurses can be considered professionals by looking at and applying
Flexners characteristics of all true professions as well as the ANAs Scope and Standards of
Professional Nursing Practice. These standards can be applied to nursing practice in many
different ways. The QSENs description and expectations of knowledge, skills, and attitudes can
be applied to the nursing transitioning from an ADN to BSN role, and the Standards of
Professional Nursing Practice can be considered examples of the knowledge, skills, and attitudes
expected of BSN-RNs as well.

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References

American Nurses Association (ANA). (2010). Nursing: Scope and standards of practice (2nd
ed.). Silver Spring, MD: Nursebooks.org.
Black, B. P. (2014). Professional Nursing: Concepts and Challenges (7th ed., pp. 53). St.
Louis, MO: Elsevier Saunders.
Flexner, A. (1915). Is social work a profession? School Soc 1(26):901.
Institute of Medicine (IOM). (2001). Crossing the quality chasm: A new health system for the
21st century. Washington, DC: National Academics Press.
White, K. M., & O'Sullivan, A. (2012). The Essential Guide to Nursing Practice: Applying
ANA's Scope and Standards in Practice and Education (p. 12, 24-25, 113-123, 133-134,
145, 153, 163-173, 187, 193, 201). Silver Spring, MD: American Nurses Association.
Quality and Safety Education for Nurses (QSEN). (2012). Retrieved from http://www.qsen.org