Self-Assessment of Nursing Standards of Practice Sarah Elser Ferris State University

2 SELF-ASSESSMENT Abstract The Academy of Medical-Surgical Nurses (AMSN) has outlined standards of professional nursing practice to guide the medical-surgical registered nurse in delivering quality nursing care. The sixteen standards of professional medical-surgical nursing practice are discussed in relation to my own professional practice. In this self-assessment of nursing standards of practice and professional development plan, I have demonstrated how I use the standards in my nursing practice; I have also used these standards to assist in developing goals. A plan to achieve these goals as well as means of evaluating the plan is outlined. Keywords: Academy of Medical-Surgical Nursing (AMSN), professional development goals, nursing scope and standards of practice

3 SELF-ASSESSMENT Self-Assessment of Standards of Practice Nursing is a profession requiring continual skill improvement, competence, and . In order to . The Academy of Medical-Surgical Nurses (AMSN) has outlined the Scope and Standards of Medical-Surgical Nursing Practice which can serve as a guideline for medical-surgical nurses. Using these standards to guide and reflect upon my practice will allow me to ensure I am practicing at the highest degree of professionalism of which I am able. It is essential to not only reflect upon these standards occasionally, but also to set goals that will enable me to strive for these standards. When goals are set, it is imperative to form a plan to determine how the progression of these goals will be evaluated and achieved. Throughout this paper, my selfassessment of the Scope and Standards of Medical-Surgical Nursing Practice as outlined by the AMSN will be discussed, as well as my current professional goals with an action and evaluation plan. Standards of Care The AMSN has established Standards of Care that guide the medical-surgical registered nurse in quality care. These standards “describe a competent level of nursing care as demonstrated by the nursing process, involving assessment, diagnosis, outcome identification, planning, implementation, and evaluation” (AMSN, 2012, p. 9). Standard 1: Assessment According to the AMSN (2012), collecting data from a wide variety of sources enables the medical-surgical nurse to establish a patient‟s plan of care. As the first step of the nursing process, it is potentially the most important. In my practice, I frequently perform many types of assessments to determine patient needs at any given time. From the initial admission assessment to the discharge or transfer assessment, I am constantly assessing the plan of care, interventions,

4 SELF-ASSESSMENT and if there is a need for changes to be made. A specific assessment that I feel is especially important is to understand the patient‟s home environment to determine if there are any referrals or help from which the patient may benefit. Standard 2: Diagnosis “Medical-surgical nurses analyze the assessment data in determining diagnosis” (AMSN, 2012). I am able to demonstrate competency of this standard by determination of appropriate nursing diagnoses based on my assessments, which generate nursing interventions to guide patient care. However, this standard may be one of my weaknesses, as I do not always update the electronic plan of care based on each assessment I perform. This task is very important and I know it is an area in which I can improve. Standard 3: Outcomes Identification “Medical-surgical nurses identify expected outcomes unique to the client” (AMSN, 2012). I am able to demonstrate this standard on a daily basis with my surgical patients, especially. For instance, I know that a patient in the immediate post-operative period will experience the best outcomes if they get up and ambulate soon and frequently after their surgery. By acknowledging this, I am able to identify „decreased post-operative complications‟ as an outcome that I want my patient to achieve. Standard 4: Planning In order to achieve the desired outcomes that I have identified for my patients, I must describe a therapeutic plan of care. I am able to effectively utilize the criteria as described by the AMSN (2012) to create an individualized plan of care, such as developing the plan with the patient, patient‟s family, and other healthcare providers involved with the patient‟s care. Whenever I admit a patient, I determine the patient‟s needs (such as pain control, peri-operative

5 SELF-ASSESSMENT care, respiratory care, etc.) and create a computerized care plan that is accessible by all of the providers caring for the patient during his stay. This plan of care is then transferred to the “Intervention Board” on my home screen so it is easily viewed each time I sign in; I also ensure that each patient‟s intervention board is up to date to the best of my knowledge every shift. I will write some highlights of this plan on the patient‟s board in his room so it is visible to all providers when they enter. Standard 5: Implementation of Care Each shift, I ensure that the plan of care is implemented adequately. For my surgical patients, I encourage and assist with ambulation as needed and as the physician has ordered. I check orders (both computerized physician order entry (CPOE) orders and hand-written orders in the chart) to be sure plan of care is accurate, and then I carry out the orders to the best of my ability. I always check to be sure that all consults have been addressed and implemented as necessary. Starting out each shift with an organized list of what each patient will need throughout the night (medications, treatments, dressings, ambulation, etc.) helps to ensure all care is implemented appropriately. Standard 6: Evaluation According to the AMSN (2012), the registered nurse evaluates and documents the effectiveness of the interventions in an effort to continually address the plan of care (p. 14). An example of this which I frequently do is reassessing a patient‟s pain level after implementation of pain relief efforts. I evaluate whether or not the medication, repositioning, or other pain relief efforts were effective after an adequate and established length of time has passed. All nursing interventions are evaluated towards the end of each shift and documented accordingly. By

6 SELF-ASSESSMENT evaluating these interventions and implementations, I will be able to ensure the goals are met or adjust the interventions as necessary. Standards of Professional Performance There are standards as described by the AMSN that can guide the medical-surgical nurse in professional nursing performance. “Standards of Professional Performance describe a competent level of behavior in the professional role – including activities related to quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization” (AMSN, 2012, p. 9). Standard I: Quality of Care “The medical-surgical nurse systematically evaluates the quality and effectiveness of nursing practice” (AMSN, 2012, p. 16). I demonstrate this standard by continuously assessing the effectiveness of a patient‟s plan of care. If an intervention is no longer appropriate, I will revise it so that it promotes the patient to the best possible outcome. My workplace has a Performance Improvement Project (PIP) to address an area of care that can be improved upon, and I frequently address this and implement it into the care I deliver to my patients. Standard II: Performance Appraisal The AMSN (2012) addresses that the medical-surgical nurse should reflect upon and evaluate her practice according to the professional standards (p. 16). I meet this standard in several ways; first of all, I participate in reflections such as this one in my educational efforts to obtain my BSN. Even the weekly discussion board posts enable me to reflect on issues and topics in my practice and how I uphold professional performance standards in relation to those issues. I also participate in annual performance reviews with my directors which allow me to see what areas of my job performance need improvement.

7 SELF-ASSESSMENT Standard III: Education The AMSN (2012) professional performance standard of education is met by formal education, continuing education, certification, and experiential learning (p. 17). I would consider this standard one of my stronger displays of professional performance. Furthering my education by working towards my BSN is one of the many ways that I meet this standard; I also complete continuing education hours on a monthly basis for my employer. It is important to me to stay updated on the educational articles that are posted at my workplace on new evidenced-based practices related to our specialized practice. I am very aware of the benefits that a good education has provided to me in my career thus far, and it is something that I value deeply. Standard IV: Collegiality According to the AMSN (2012), the medical-surgical registered nurse enhances the professional growth of others as demonstrated by contributing to the learning experiences of nursing students and to a healthy work environment, among others (p. 17). I meet these criteria to exhibit that I practice collegially. Nursing students are often assigned to work with our surgical patients under the supervision of a registered nurse; I invite the students to work with me and also bring them into learning experiences if any arise. I am always sure to point out the rationale behind any interventions, as this enables the student to learn better. Working with a positive attitude and always willing to help a coworker demonstrate that I facilitate a collegial work environment, which is also very important to me. Standard V: Ethics “The registered nurse practices ethically” (ANA, 2010, p. 47). A profession can have their own code of ethics, and the ANA has written a Code of Ethics for Nurses which provides the nurse with guidelines to care for patients unbiased and without regard to any outside factors.

8 SELF-ASSESSMENT The AMSN (2012) states that “the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (p. 18). I think this is an important part of ethical nursing practice. As the front line of defense for patients, so to speak, nurses often know the needs of the patient and are able to implement the best interventions to promote increased health. I am consistently reassessing my patients‟ needs and ensuring they are receiving the care they need to heal. I recently cared for a patient admitted for complications after an outpatient laparoscopic cholecystectomy. The patient was being aggressively hydrated, but did not have much output. Upon assessment, she denied the urge to urinate but her bladder was severely distended. Using the bladder scanner, it became clear that her bladder was very full. By now, it was the end of my shift but I wanted to take care of this issue for my patient before I reported off for the day; I called the physician and received an order for a Foley catheter which made the patient much more comfortable and safer. I advocated for my patient as opposed to passing off the information in report and not knowing for sure if the issue was taken care of. Standard VI: Collaboration “Medical-surgical nurses collaborate with the client, family members, significant others, and health care providers in providing care” (AMSN, 2012, p. 19). I meet this standard in my current practice, but I consider it to be one of my weaknesses. I inform the respiratory therapy department when I have a patient that needs a respiratory treatment. I also collaborate with the telemetry nurse when I am caring for a patient on telemetry to verify there have been no cardiac changes, or what measures need to be taken if there have been cardiac changes. However, I would consider it to be one of my weaker areas; working on the night shift, I do not have as much contact with other disciplines, physicians, family members, and significant others as do

9 SELF-ASSESSMENT dayshift nurses. I do utilize our patient communication board, but I feel like I am often “passing on” or leaving messages for others involved in a patients care. Standard VII: Research “Medical-surgical nurses use research findings in practice” (AMSN, 2012, p. 19). This standard may be one of my weaker standards, as the facility at which I work does not participate in research projects. However, I do utilize the research that I complete for classes in the BSN program and implement it into my practice. This also can prove to be problematic, as some of the research findings contradict current policy and procedure at my workplace; in these instances, I have provided my directors with the research findings and in a proposal for modifying our present procedures to reflect current evidence-based practice. Standard VIII: Resource Utilization “If medical-surgical nurses assign or delegate tasks, it is based on the needs, age, and condition of the client; the potential for harm; the stability of the client‟s condition; the complexity of the task; and the predictability of the outcome” (AMSN, 2012, p. 20). Working with patients who have recently had surgeries requires many tasks and monitoring to ensure they get back to their baseline level of functioning as quickly as possible; I rely on the help of my support staff for the completion of certain tasks which I delegate after my initial, thorough assessment of these patients. For example, I will assist the patient to get up and out of bed for the first time after their surgery so I can assess their progress and level of functioning. If they are stable and doing well, I will ask my support staff to help them the next time as long as they are comfortable with the task. Standard IX: Communication

10 SELF-ASSESSMENT Effective communication is essential in any profession, but it is especially crucial in a healthcare environment. According to the AMSN (2012), criteria of meeting this standard includes conveying information to patients, families, the interdisciplinary team, and others in communication formats that promote accuracy and assessing communication format preferences of patients and families (p. 20). I adequately and efficiently use our unit‟s SBAR form of communication to pass on vital information in the shift to shift report. I also keep in mind a patient‟s cultural considerations when planning care and communicating, as we have many Amish, Hispanic, and Muslim patients for which we care; these cultures all communicate very differently and implementing this is an important part of delivering quality care. Standard X: Leadership “Medical-surgical nurses use leadership skills to enhance client outcomes and foster a healthy work environment within the practice setting and profession” (AMSN, 2012, p. 21). While I may consider this to be one of my weaker areas, I do demonstrate behaviors that meet the criteria. I have recently been trained and qualified to orient new nurses on our floor, and being of higher seniority than many on my shift, I am often sought out for advice, questions, or guidance. I believe that I „lead by example‟ by always performing to the best of my ability with a positive attitude and helping others in any way I am able. In an effort to improve my leadership skills, I plan on joining a professional organization, which is later described in further detail. Professional Development Plan In order to continually practice at a high level of professional excellence, one must set goals to be challenged and strive for that increased level of commitment and quality care delivery. When setting goals, it is essential to also develop a plan of action of the necessary steps to achieve those goals. Establishing a specific and measurable evaluation plan will allow for

11 SELF-ASSESSMENT adequate assessment to determine the effectiveness of the goals, and the potential need to revamp the goals or action plan. Goals I have set several goals which I believe will help me to continue my journey as I evolve into a professional nurse of highest standards and quality. The first goal that I have set for myself involves becoming a member of a professional nursing organization by the time I finish this BSN program; after the last few weeks of studying topics like shared governance, collective bargaining, and professional organizations, the importance of becoming involved in this aspect of our profession is very evident. I also have a goal to be oriented to other departments in my hospital in order to gain a more diverse view of nursing and its many opportunities. I would like to complete this goal within the next six months. Looking towards the future, I aspire to continue my education and become a nurse practitioner within five years of finishing my BSN. Action Plan Once a goal is established, a plan of action must be formed to maximize successful completion of the goals. I plan to join the Michigan Nurses Association (MNA) and become more familiar and involved with their actions, which will allow me to gain a better understanding of my role in a professional nursing organization. I also plan to start regularly attending the meetings of the union to which I belong through my workplace. In order to achieve my goal of being oriented to other departments in my hospital, I will submit my application to volunteer for floating orientation. This will inform my manager and the managers of other departments in my interest to be oriented, and allow them to coordinate my training. I plan on making a final decision on my choice of university to pursue a Master‟s Degree by the time I finished this

12 SELF-ASSESSMENT program, and then enroll to start as soon as possible; immediately continuing my education without a break will give me the best chance of achieving my goals. Evaluation Plan It is important to evaluate an action plan occasionally to ensure more likely success or completion of the goals. In August 2014, I will acknowledge both my attendance of union meetings and MNA membership status in order to evaluate that goal. In regards to the goal of being oriented to other units at my workplace, I will evaluate that goal on a weekly basis to determine what units I may be able to schedule myself for orientation with consideration to my regular unit‟s schedule. I will evaluate the progress of my long term goal of becoming a nurse practitioner at intervals after each of the next two semesters of the BSN program to ensure I am on track to be able to start immediately upon completion of this degree. Conclusion The AMSN has outlined standards for professional nursing practice to guide the registered nurse in the medical-surgical setting. By following these standards, I can ensure that I deliver quality care to my patients. I will continue to reflect upon my practice and these standards regularly to ensure the care I give is always of highest quality. Reviewing my current practice in conjunction with the standards set by professional organizations such as the AMSN and ANA will allow me to reflect on my practice and ensure that I am consistently practicing within the highest standards of nursing.

13 SELF-ASSESSMENT References Academy of Medical-Surgical Nurses (AMSN). 2012. Scope and Standards of Medical-Surgical Nursing Practice (5th ed.). Retrieved from: http://www.amsn.org/sites/default/files/documents/practice-resources/scope-andstandards/AMSN-Scope-Standards-MS-Nursing.pdf American Nurses Association (2010). Nursing: Scope and Standards of Practice (2nd ed.) Washington D.C.: Author.

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1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)] 2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2” from the top of your title page? (Should be a few words from the title of your paper). [p. 229 and example on p. 40] 3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract and know what to find in your paper. [p. 25 and example on p. 41] 4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use „Introduction‟ as a heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and example on p. 42] 5. Margins: Did you leave 1” on all sides? [p. 229] 6. Double-spacing: Did you double-space throughout? No triple or extra spaces between sections or paragraphs except in special circumstances. This includes the reference page. [p. 229 and example on p. 40-59] 7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229] 8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions. 9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a person‟s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 87-88] 10. Typeface: Did you use Times Roman 12-point font? [p. 228] 11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106111] 12. Plagiarism: Cite all sources! If you say something that is not your original idea, it must be cited. You may be citing many times…this is what you are supposed to be doing! [p. 170] 13. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this: “The variables that impact the etiology and the human response to various disease states will be explored” (Bell-Scriber, 2007, p. 1). Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p. 170-172] 14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172] 15. Paraphrase: A paraphrase citation would look like this: Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007). It may also look like this: Bell-Scriber (2007) found that……

[p. 171 and multiple examples in text on p. 40-59] For multiple references within the same paragraph see page 174. 16. Headings: Did you check your headings for proper levels? [p. 62-63]. 17. General Guidelines for References: A. Did you start the References on a new page? [p. 37] B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often they are not and must be adapted. Make sure all fonts are the same. C. Is your reference list double spaced with hanging indents? [p. 37]

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PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE 18. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out where you addressed each section.) MB 11/29/13 19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you become breathless or it doesn‟t make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did you do this? MB 11/29/13 20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit? MB 11/29/13 21. Conversational tone: Don‟t write as if you are talking to someone in a casual way. For example, “Well so I couldn‟t believe nurses did such things!” or “I was in total shock over that.” Did you stay in a formal/professional tone? MB 11/29/13 22. Avoid contractions. i.e. don‟t, can‟t, won‟t, etc. Did you spell these out? MB 11/29/13 23. Did you check to make sure there are no hyphens and broken words in the right margin? MB 11/29/13 24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.? MB 11/29/13 25. Stay in subject agreement. When referring to 1 nurse, don‟t refer to the nurse as “they” or “them”. Also, in referring to a human, don‟t refer to the person as “that”, but rather “who”. For example: The nurse that gave the injection….” Should be “The nurse who gave the injection…” Did you check for subject agreement? MB 11/29/13 26. Don‟t refer to “us”, “we”, “our”, within the paper…this is not about you and me. Be clear in identifying. For example don‟t say “Our profession uses empirical data to support ….” . Instead say “The nursing profession uses empirical data….. MB 11/29/13 27. Did you check your sentences to make sure you did not end them with a preposition? For example, “I witnessed activities that I was not happy with.” Instead, “I witnessed activities with which I was not happy.” MB 11/29/13 28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck? MB 11/29/13 29. Did you have other people read your paper? Did they find any areas confusing? MB 11/29/13 30. Did you include a summary or conclusion heading and section to wrap up your paper? MB 11/29/13 31. Does your paper have sentence fragments? Do you have complete sentences? MB 11/29/13 32. Did you check apostrophes for correct possessive use. Don‟t use apostrophes unless it is showing possession and then be sure it is in the correct location. The exception is with the word it. It‟s = it is. Its is possessive. Signing below indicates you have proofread your paper for the errors in the checklist:
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__________Sarah G. Elser_____________________________DATE:_____11/27/13______ A peer needs to proofread your paper checking for errors in the listed areas and sign below: ________Melissa Burleson ________________________________DATE:___11/29/13______
Revised Spring 2010/slc

16 SELF-ASSESSMENT Grading Rubric for Self-Assessment of Competency regarding Standards of Practice
Accomplished Points Range: 9-10 Describes standard of practice with supportive evidence Proficient Points Range: 6- 8 Provides limited or unclear supporting details or evidence Needs Improvement Points Range: 3- 5 Provides a general summary of standard of practice without supporting details or evidence Points Range: 3 - 5 Goals are general and/or undeveloped Not Acceptable Points Range: 0- 2 Discussion is weak, inaccurate, and/or includes no details

Description and Analysis of Current Behaviors

Professional Developmental Plan

Analysis: Action Plan and Evaluation Plan

Points Range: 9 - 10 Articulates clear professional goals which reflect a plan to attain and maintain competency in each standard. Goals are measurable and specific Points Range: 9 - 10 Action plan for goals include actions and timelines that is consistent with the goal statements. Provides specific and measurable evaluation plan Points Range: 9-10 Presented Analysis & Plan with accuracy, precision, clarity, relevance, depth, breadth, logic and personal significance.Sentence structure, paragraphing, headings, spelling, typing, grammar, neatness Points Range: 0 - 5 1 point deducted for each error up to 5 points. Points Range: 0 - 5 APA check list was submitted with name of peer who proof -read the paper. Valuable feedback provided on a peers APA checklist 1 point deducted for information not provided.

Points Range: 6 - 8 Provides limited or unclear professional goals that are not specific and measurable

Points Range: 0 2 Discussion is sparse, almost no details

Points Range: 6 - 8 Provides limited action plan without specific measurable evaluation plan

Points Range: 3 - 5 Action and evaluation plans are general and/or undeveloped

Points Range: 0 2 Discussion is sparse, almost no details

Critical Thinking/Writing

Points Range: 6- 8 Provides limited or unclear supporting details or evidence

Points Range: 3- 5 Provides a general summary of analysis and plan without supporting details or evidence

Points Range: 0- 2 Discussion is sparse, almost no details


Points Range: 0 - 0

Points Range: 0 - 0

Points Range: 0 0 Points Range: 0 0

APA Checklist

Points Range: 0 - 0

Points Range: 0 - 0

Total Point 50