In the twenty-first century, the scope of nursing practice has expanded. Beyond the number of qualified nurses, nursing practice has increased and expanded to unprecedented levels in recent years. In today's complex healthcare environment, most nurses are stretched beyond their limits. This condition has prevailed due to an increase in the number of patients in need of healthcare, as well as the increasing complexity of therapies (Schluter & Griffith, 2009). As a result, nurses require aid from outside their field in order to function efficiently. This has allowed Registered Nurses to assign and delegate their tasks to assistive employees (unlicensed individuals), heralding the arrival of new competencies required in the twenty-first century. The theory of nursing by Patricia Benner analyses the stages of skill and learning acquisitions in the nursing profession. She describes this process by incorporating the Dreyfus model of skill acquisition to the practice of delivering quality care to patients. Benner’s theory proposed that proficient nurses derive their understanding of patient care and high-level skill power by acquiring experiences over a period of time (George, 2011). Essentially, the theory explores the concept of how nurses obtain the understanding of nursing practice; especially the process with which the expert nurses develops a wealth of clinical expertise without much theory.
A Registered Nurse (RN) scope of practice encompasses a number of roles that include Implementing care, planning care strategies, nursing diagnosis, managing care, assessment, maintaining patient safety, setting goals, collaborating with other healthcare members, supervising and delegating care to qualified individuals.
Professional Nurse Role
An extensive nursing experience plays a critical role in the success of RN practitioners. As opposed to solely discharging care and safety to patients, RN practitioners also serve as primary health care providers much like a physician. They are entitled to carry out other responsibilities such as diagnosing illness and prescribing medication. Because they can serve as sole primary health care providers for the patients, this category of nurses are permitted to operate their own private practices. Therefore, their work performance is directly influenced by professional nursing experience.
The nursing profession ought to utilize nursing experience as a critical factor to consider when registering and giving licensure to a nurse practitioner. Nurses with less clinical expertise are more likely to hinder the provision of best outcomes and safety to patients. Experienced nurses possess high intuitive ability to effectively give critical clinical decisions while putting every single step in its entire perspective. A higher degree of expertise enables nurses to provide proper quality care and clinical judgment which determines whether a nurse has successfully integrated both the practical and theoretical knowledge in actual clinical situations (Moccia & Moss, 2011).
Several nursing studies propose that experience alongside proper education guarantee RN an important advantage in the provision of quality care. It is reported that a new graduate or novice nurse lacks the appropriate clinical experience to run their own private practice. As opposed to expert nurses, novice nurses encounter significant errors when responding to individual needs of patients (Moccia & Moss, 2011). For instance, current data shows that hospital-acquired pressure ulcers and incidence of patient fall occur mostly under the care of novice nurses. These poor incidences of health care services are much reduced with an increased level of clinical expertise.
Due to the increasing demands of nursing practice delegation of duties to assistive personnel has been adopted to solve the problem of nurses’ shortage. The practice of delegation in nursing practice was first ratified in 2005 by the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) (Corazzini at al., 2013). As envisaged in these organizations the concept of the delegation was deemed an important aspect that must be integrated into nursing practice. The RN Scope of Practice elaborated how to manage the delegation practice as part of the role of nursing competencies and accountabilities.
The usage of delegation practice in nursing has been received with considerable variation but the definition advanced by NCSBN and ANA has been widely used. It essentially refers to the process with which a nurse directs other personnel outside the profession to undertake nursing duties and operations. According to NCSBN, it implies that a nurse transfers their authority to other assistive personnel or delegatee. On the other hand, ANA describes it as the practice that a nurse transfers the responsibility to other unlicensed individuals (Schluter & Griffith, 2009). In essence, a registered nurse is expected to delegate nursing duties to another individual to perform what normally would not be accepted to perform.
Studies indicate that effective implementation of evidence-based practice in health care sector improves the patient’s care and treatment considerably. Quality practice is achieved because nurses incorporate a conscientious use of best practice derived from a clinician’s expertise, well-designed research studies, preferences and patient values (Barnsteiner et al., 2010). Nurses are expected to play a key role in mobilizing and supporting the management to streamline its policies and organizational culture to facilitate timely implementation of the evidence-based practice.
Nurses should constantly replace their traditional knowledge with the latest research studies that champion the best evidence-based practice in clinical settings. Besides, nurses should initiate the changes themselves instead of constantly complaining of organizational barriers.
For nurses to fully disseminate the evidence derived from evidence-based practice research, they need to improve their understanding of how to use research processes and how to critique research studies. Moreover, nurse leaders and enlightened nurses should support and train other nursing staff to adopt newly found evidence into their day-to-day practice. In this way, nurses would disseminate their findings effectively from latest research studies and consequently improve their quality of practice.
Salary Ranges
The salary range of RNs is usually based on three factors; the level of experience, the revenues generated by the hospital and the degree of worthiness RN demonstrates in the nursing practice. The salary usually varies from state to state. For example, in the state of Texas, the RNs earned an average annual salary of $ 65,000 according to the Bureau of Labor Statistics (BLS) in May 2013. In California, the third largest state, the annual average salary of RNs was $71, 000 as of May 2013 according to BLS. And in New York, the average annual salary of RNs as of May 2013 was $75, 470. This salary ranges largely depends on different percentile levels in which RNs are categorized.
Summary and reflection
For effective implementation of evidence-based practice, the health organization ought to adopt the best models needed to promote evidence-based practice. These models include the organizational excellence model, the embedded research model, and the research-based practitioner model (Barnsteiner et al., 2010). The research-based practitioner model will work well in my current workplace because this model empowers the practitioners to keep up-to-date with new research and consequently apply them in their day-to-day practice without the need for organizational interventions and policies.
By adopting this model, nurses will find it easy to address a problem by researching the latest studies, appraising the evidence they find and incorporating this evidence with their practice-based knowledge to establishing a lasting solution. Because of organizational barriers, embedded research model and organizational excellence model would not work well in the organization
The practice of delegation has made it possible for the licensed nurses attend to more complex needs of the patients. This will only be achieved when the RN evaluates properly the practice of nursing by employing professional judgment and nursing knowledge to their daily duties and functions. They must be aware of the established nursing regulations to discharge maximally their duties and thus be in a position to address the prevailing shortage of nurses facing the healthcare sector.
Only a licensed nurse is allowed to transfer duties to a delegatee upon a thorough examination and considerations of many parameters. These parameters include assessment of delegatee skills, the established policies within a given state and the legitimacy of delegatee skills to the patient needs and setting. Licensed nurse are expected to assess the potential patient safety risks that are linked to the activity considered for delegation. The RN is expected only to delegate duties that unlicensed personnel have the capacity to undertake safely at the given conditions of the patient.
References
Barnsteiner, J. H., Reader, V. C., Palma, W. H., Preston, A. M., & Walton, M. K. (2010).
Promoting evidence-based practice and translational research. Nursing Administration Quarterly, 34(3), 217-225
Corazzini, K. N., Anderson, R. A., Mueller, C., Thorpe, J. M., & McConnell, E. S. (2013).
Licensed practical nurse scope of practice and quality of nursing home care. Nursing Research, 62, 5.)
George, J. B. (2011). Nursing theories: The base for professional nursing practice. Upper Saddle
River, N.J: Pearson Education.
Moccia, P., & Moss, L., (2011). Nursing theory: A circle of knowledge. New York, N.Y: Insight
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Schluter, J. E., & Griffith University. (2009). Delegate, undertake or negotiate: Understanding
nursing scope of practice in the acute environment. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
