Learning Objectives
By the end of this section, you will be able to:
- Review key concepts of professional nursing
- Describe the competencies for the Quality and Safety Education for Nurses and role of The Joint Commission
- Define the nurse’s role in providing patient-centered care
Nurses are an asset to their communities. The nursing profession is a calling for many, and it is an essential component of quality health care. Nurses take on many roles, from patient advocates to wellness educators, while also providing direct patient care. The nursing profession has evolved in recent decades so that evidence-based practice (EBP) is now the focus of patient care. Nurses also provide holistic care in a variety of specialized roles.
Professional Nursing Concepts
In the 1800s, hospitals typically comprised three primary units: medical, surgical, and obstetrics. In the mid-20th century, little distinction was made between surgical and medical nurses. However, by the 1960s, surgical nursing had become its own specialty; medical-surgical nursing became a more distinguished specialty around 1991, and the profession has continued to evolve. Today, medical-surgical nursing is one of the largest nursing specialties (Joseph, 2019; American Medical-Surgical Nurses Association, n.d.-b).
The Nurse’s Role
Nurses work on the front lines of health care. They assess patients’ symptoms and vital signs, document changes in condition, and evaluate the response to treatment. They also administer medications and operate medical equipment. The nurse is typically the first health-care worker to recognize when a patient is having a medical issue. It is their responsibility to immediately report the issue to the relevant provider to avoid adverse outcomes. The nurse remains with their patient during the patient’s course of treatment. The nurse follows the progress of each of their assigned patients and keeps their best interest at heart. Nurses may also serve as a patient’s case manager, taking the lead in coordinating medical care and advocating for the patient’s physical, emotional, mental, cultural, and spiritual needs.
Because nurses have many roles, they acquire deep knowledge in a wide range of fields. An individual nurse has many specific roles to choose from, including bedside nurse, health coach, nurse navigator, case manager, nursing supervisor, home health nurse, hospice nurse, health writer, and nurse consultant. Nurse leaders, or those who enjoy management, may choose a role such as unit manager, clinical manager, or director of health services. Roles for advanced practice registered nurses include nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist; these nurses have advanced training from a higher-level degree program such as a master’s or doctorate. Regardless of one’s focus, being a nurse opens the door to many opportunities in a variety of settings, including entrepreneurship beyond the health care industry.
The nursing scope of practice—the range of activities a licensed nurse is permitted to perform—is determined at the state level by a two-step process: (1) the state legislature passes a law, known as the Nurse Practice Act (American Nurses Association n.d.); and (2) regulatory bodies, such as the state nursing board, then create and implement rules and regulations intended to protect the public. Each state has its own rules and regulations. It is imperative as a licensed professional to be aware of the limitations of your practice in the state in which you work and where to find this information.
Link to Learning
The American Nurses Association articulates the nursing scope of practice explaining the areas in which each type of nurse can act. It is critical that a nurse understands their scope and role in the profession.
Professional Organizations
Nurses can choose to belong to a number of professional organizations. One of the most significant ones, with which most nurses are likely familiar, is the American Nurses Association (ANA). The ANA was founded in 1896 as the Nurses Associated Alumnae; it changed to its present name in 1911. Its goal is to advance and protect the profession of nursing. According to the ANA, “patients’ interests are best served by a health-care system in which many different types of qualified health professionals are available, accessible, and working together—collaboratively” (American Nurses Association, n.d.). Formal membership in any nursing organization generally requires membership fees that help fund the organization’s political lobbying activities to support the causes of nurses, expand research, collect and disseminate resources, and provide networking, and educational and specialty certification opportunities for its members.
Another important organization for medical-surgical nurses is the Academy of Medical-Surgical Nurses (AMSN), which was founded in 1990. The AMSN’s commitment is to “quality patient care through professional development, certification, scholarship, and advocacy” (American Medical-Surgical Nurses Association, n.d.).
Link to Learning
Specialties within the nursing profession have professional associations and organizations that support education and provide a subset scope of standards of practice. For example, the Academy of Medical-Surgical Nurses is the only professional association specifically for medical-surgical nurses. The role and mission of the organization is to support medical-surgical nurses throughout their professional careers.
Quality and Safety Education for Nurses
The Quality and Safety Education for Nurses (QSEN) project focuses on preparing future nurses to promote the quality of care and safety of patients in health-care systems (QSEN Institute, n.d.-a). The QSEN is a framework that weaves best practices from the Joint Commission Accreditation Standards and the Magnet model. The QSEN aims to redesign the “what and how” of nurses’ delivery of care to ensure high-quality, safe patient care. QSEN’s vision is “to inspire health care professionals to put quality and safety as core values to guide their work,” with a focus on the following six main competencies:
- EBP
- informatics
- patient-centered care
- quality improvement
- safety
- teamwork and collaboration (QSEN Institute, n.d.-b)
Link to Learning
To learn more about the QSEN project and access their resources, visit the QSEN website that describes knowledge, skills, and attitudes for nurses.
Joint Commission Best Practices
The Joint Commission, formerly Joint Commission on Accreditation of Healthcare Organizations, is an independent, not-for-profit, peer-review organization that sets standards for quality care, quality improvement (QI), and patient safety for any organization and workers in the health-care industry. The standards set forth from the commission become the foundation for best practices in the health-care industry, including nursing standards of care. The Joint Commission has the power to accredit health-care facilities, ensuring their compliance with guidelines set by the Centers for Medicare and Medicaid Services and enabling them to receive federal reimbursement for services.
The Joint Commission believes nurses play an important role in health care and should be involved in developing safety and improvement initiatives. This belief led to The Joint Commission’s support and integration of the QSEN. Ongoing priorities of the nursing profession include, but are not limited to, improving standards and recommendations for infection prevention, workplace violence, suicide prevention, emergency management, environmental sustainability, and health-care equity for all, which are tied to the QSEN. Furthermore, each year, The Joint Commission gathers information related to emerging patient-safety issues. This information is used to create specific programs for the organization’s National Patient Safety Goals (NPSGs). NPSGs are critical organizational elements to reduce negative patient outcomes and improve delivery of overall quality of care. Examples of NPSGs include improving the accuracy of patient identification and improving the effectiveness of communication among caregivers.
Link to Learning
Read The Joint Commission’s National Patient Safety Goals on their website.
Patient-Centered Care
One model known as patient-centered care (PCC) is designed to promote optimal individual outcomes. The model requires listening to patients to understand what they value most, then using the information as the catalyst for health-care decisions. PCC encourages the patient and family to be a part of the health-care team, actively collaborating in the decisions that will formulate a customized plan of care and guide treatment decisions for the patient.
Scope and Attributes of PCC
PCC is essentially personalized care; providers work with each patient to develop and deliver a customized plan of care. Common elements of PCC include:
- collaboratively coordinating care by including the patient and family as essential team members
- encouraging the patient’s family, as defined by the patient, to be present in the care setting
- ensuring the organization’s mission and values are driven by patient-centered goals
- equally valuing the patient’s emotional well-being and physical comfort
- incorporating the patient’s emotional, mental, spiritual, social, and financial perspectives into their care
- promoting compassionate, quality care, and patient safety
- providing the right care at the right time in the right place
- respecting the patient’s and family’s values, culture, and socioeconomic status
- sharing information in a timely manner so the patient and their family can make well-informed decisions
PCC benefits patients as well as health-care providers and organizations. Overall, it improves patient satisfaction scores and enhances the reputation of health-care organizations, which, in turn, influences reimbursement rates. PCC boosts morale and productivity among providers because they share in their patients’ experiences and improves the efficient use of hospital resources, which subsequently provides improved, individualized patient outcomes (“What is patient-centered care,” 2017).
Examples of PCC in Nursing
Of all members of the health-care team, the nurse spends the most time with a patient; thus, they play the biggest role in PCC. The nurse’s role in PCC includes responsibilities such as
- ensuring the patient’s needs and concerns are at the center of health-care decisions and treatment plans
- inviting family members to become part of the care team by participating during rounds or shift changes
- including the patient and family in discussions and treatment decisions
- knowing what is most important to the patient and honoring their directives
- providing timely updates for the patient and their family