Registered Nurse Practice for Safe, Competent, and Compassionate Care

Nursing Informatics

The term “registered nurse” was keyed in with subject headings relating to nursing standards, ethics and practice evaluation. 56 peer-reviewed articles with these words and phrases within the US and Canada on the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database resulted from this search. An article from the Alberta RN Journal by Debra Allen RN MN, Debbie Phillipchuk RN MN and Donna Harpell Hogg RN MS offered incredible insight to the requirements that would help a nurse deliver “…safe, competent and ethical nursing care” (Allen, Hogg & Phillipchuk, 2013, p. 6). According to LinkedIn, Debra Allen “remains a magnate in Canadian nursing with over 2 years of experience as a senior manager in the Regulatory and Practice department of the College and Association of Registered Nurses of Alberta (CARNA)”. Hogg is in CARNA and the United Nurses of Alberta. She serves a key role in the Uniquely RN initiative (United Nurses of AB, 2015). Phillipchuk is a featured in a number of reputable peer-reviewed publications across Canada. Her publications provide incredible insight into nursing practice. Together, they authored an original research article that looks into the challenges that professional registered nurses face. Their findings were based on the recorded logs of consultations provided by provided by CARNA to Registered Nurses (RNs). Conveniently, this database is specifically dedicated to information on Alberta nurses; therefore, it suited their context to the latter as they are all members of CARNA.

This information made Alberta RNs passive participants to a useful study. The theoretical framework of the data analysis in the article was sourced almost entirely from CARNA publications with only two sources taken from other sources. Such would be a significant cause for concern as the audience might be exposed to bias with a one-sided research that fails to seek insight from other sources. However, CARNA in itself covers most of the stakeholders of the research making it a convenience rather than bias using their own resources to analyze their common profession.

An Effective Professional Registered Nurse

As a professional registered nurse (RN), there are numerous expectations from the patients as well as the healthcare institution to fill a much-demanded niche within healthcare. However, there are numerous dilemmas in the professional tenure of RNs. Regulatory bodies and legal provisions demand that their standards of practice remain within provided frameworks. These stipulations assist RNs to work towards achieving their roles effectively. From the analysis of numerous publications, accountability, the application of knowledge and ethics are among the primary characteristics that an RN should embody throughout their practice. There is limited room for flexibility in these constructs of nursing practice within Ontario.

Accountability

The professional standards of practice published by the College of Nurses of Ontario (CNO) hold every nurse accountable for their actions and their consequences, and the nursing profession’s respect. Such a character portrays itself through identification and explanation of the role of an RN to a patient and the provision of best available care for patients while advocating for them too. The Regulated Health Professions Act, 1991 (RHPA, 1991) also maintains their accountability in reporting sexual abuse of patients by other health professionals. Contention might arise over the ambiguity of the roles of nurses spanning different fields of nursing. However, Registered Practice Nurses’ (RPNs’) accountability was ruled as ineffective by Lankshear and Rush (2014); moreover, such misconceptions on accountability for others causes underutilization of RPNs and of disarray in the role of RPNs (p. 26). For RNs, accountability only goes as far as the decisions they make personally or on behalf of others (patients or staff). Accountability creates autonomy for RNs that was shown to have direct correlation to work engagement. According to Keyko et al. (2016), the intensity of decisional input directly correlates with work engagement (p. 155). These characters build on each other to develop an accountable and responsible RN who engages sufficiently with their work.

Application of Knowledge

The application of professional knowledge remains a continuing skill that RNs have to maintain. Processes, theories and frameworks privy to RNs should be optimal to ensure the exhaustion of relevant information and interventions achieve favorable outcomes and client needs (CNO, 2002). This standard of practice also demands an RN to be capable of discerning unusual client reactions. Evidence-based practice comes to life thanks to this skill. Application of knowledge precedes an evaluation of updated research-based or theoretical frameworks for best nursing practices. Clinical knowledge underscores correct medication protocols that predispose patients to relatively less or non-severe medication errors (Parry, Barriball & While, 2015, p. 417). Application of knowledge on assessment, intervention, and medications is a delicate process that requires accuracy and sensitivity to presenting clinical features (Allen, Hogg & Phillipchuk, 2013). The proper application of knowledge in various scenarios makes an RN a valuable member of any healthcare team.

Ethics

Finally, ethics define the role of an RN in numerous ways by ensuring the decisions that are taken always cause the least harm to the patient and are made without discrimination or unfairness. The CNO is one of the regulatory bodies charged with creating ethical guidelines for practicing RNs. RNs should have the insight to identify ethical issues as they present and communicating them to the attending health care team (Canadian Nurses Association (CNA)). Moreover, solutions for ethical dilemmas should be analyzed aptly followed by the evaluation of the interventions to mitigate the ethical issue. Personal perceptions of ethical issues should not contravene with those set for professional practice by the various regulatory bodies (Allen, Hogg & Phillipchuk, 2013). Autonomy, benevolence, non-maleficence and justice are the principles of ethical practice; however, they conflict each other frequently in real practice. Burke (2009) describes numerous instances within which attending RNs saw to mitigate arising challenges in patients even as they are in the waiting room (p. 7). Ethical considerations remain client-centered throughout nursing practice and efforts to mitigate ethical dilemmas should follow the patient’s preferences. Keyko (2014) describes work engagement in its ethical form as being relational, meaning that RNs have various interactions with and in their work that surpass the existing framework of ethical reasoning and decision-making (p. 4). The nature of professional practice calls for relational engagement such that mutual respect thrives across different cultures and perspectives. The work environment should also be conducive for ethical practice to ensure the delivery of “safe, compassionate, competent, and ethical care” as demanded by the CNA (2015, p. 11).

Conclusion

In conclusion, a professional RN has to embody all the values necessary to provide “safe, compassionate, competent, and ethical care” to their patients. Based on the research, the main characteristics are accountability, the application of knowledge and ethical practice. The CNO (2002) dictates these standards in a comprehensive publication on professional standards. Many researchers have studied the characteristics that relate to effective RN practice that make an RN reliable in their work. Indeed, a professional RN has to muster accountability, application of knowledge and ethical practice to practice effectively.

References

Allen, D., Hogg, D. H., & Phillipchuk, D. (2013). Frequently asked practice questions: 2012 summary of CARNA practice consultations. Alberta RN, 69(1), 6-8.
Canadian Nurses Association. Framework for the practice of registered nurses in Canada. Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/framework-for-the-pracice-of-registered-nurses-in-canada.pdf?la=en.
College of Nurses of Ontario (2002). Professional standards. Retrieved from https://www.cno.org/globalassets/docs/prac/41006_profstds.pdf.
Burke, J. (2009). BPSOs transform care, nursing. Registered Nurse Journal, 21 (3), 7.
Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing ethics, 21(8), 879-889.
Keyko, K., Cummings, G. G., Yonge, O., & Wong, C. A. (2016). Work engagement in professional nursing practice: A systematic review. International journal of nursing studies, 61, 142-164.
Lankshear, S. & Rush, J. (2014). It’s all about synergies. Understanding the role of the registered practical nurse in Ontario’s health care system. RPNAO.
Linkedin. Debra Allen. Retrieved from https://ca.linkedin.com/in/debra-allen-810108101
Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), 403-420.
United Nurses of AB (2015, September 19). UNA’s Jane Sustrik and @AlbertaRNs Donna Harpell-Hogg talk with central Alberta Nurses about Uniquely RN initiative [Tweet]. Retrieved from http://www.easybib.com/guides/citation-guides/apa-format/tweet/.