0

Michelle Eva Morholt, WCSN

Westminster College
School of Nursing and Health Sciences
NURS 409- Nursing Leadership/Capstone
Position Paper
Elizabeth Harald PhD, RN
April 8, 2015

1
You must be the change you wish to see in world. Gandhi
The following position paper outlines my beliefs regarding many topics that guide nurses
in providing competent and appropriate nursing care.
Education
Baccalaureate-prepared nurses understand the necessity of being life-long learners who
are willing to explore and develop best-evidenced based practice. To provide quality health care,
nurses must continue to be self-motivated and value expanding their empirical knowledge and
clinical methodologies. It is my opinion that all practicing registered nurses in the United States
of America should be baccalaureate prepared. While the American Nurses Association has
recommended this transition, no official mandates have been approved through legislature.
Impact on quality of care: As a baccalaureate-prepared nurse with a minor in Mandarin
Chinese, I am best positioned, with the help of my future colleagues, to address barriers to health
care and assist people in realizing positive health outcomes. Undertaking a liberal education has
afforded me an all-inclusive lens to view the world, the ability to critically reason, provide
culturally competent care, and an understanding of the complex technologies. The quality of care
I am able to provide my future patients are enriched because of my education that focused
providing all-inclusive nursing care. Westminster College has prepared me not only with the
necessary empirical nursing knowledge, psychomotor skills, but also an awareness of the
professional nurses scope of practice, required ethical standards, competency, and
accountability. Baccalaureate prepared nurses will be vital to appropriately respond to and
evolve with the numerous changes in health care, not only here in the United States of America,
but worldwide.
Authority of the Professional Nurse

2
Legal: Here in Utah, nurses must be aware of and compliant with the Nursing Practice
Act. The Nurse Practice Act (NPA) clearly defines the nurses scope of practice, lawful, and
unlawful conduct (Nurse Practice Act, 2014). NCLEXRN is the National Council Licensure
Examination for Registered Nurses, developed by the National Council of State Boards of
Nursing (NCSBN) allows for appropriately prepared candidates to become licensed and lawfully
accredited to practice as a registered nurse. The Utah Division of Occupational and Professional
Licensing (DOPL) oversee the NCLEXRN licensure examination in Utah.
Organizational: The NPA allows for organizations to create job descriptions, policies,
procedures, and protocols. Legitimate authority is obtained and practiced by a licensed registered
nurse via the organization they are employed.
Roles of the Professional Nurse
A myriad of roles are assumed upon accreditation and employment as a professional
registered licensed nurse.
Various roles: Professional nurses change the world. As a caregiver, nurses offer
compassion and support to patients and their loved ones throughout significant chapters in their
lives. As a leader, nurses empower patients by guiding them to adopt healthy behaviors that
enable them to play an active, positive role in their recovery and overall health. As critical
thinkers and advocators, nurses utilize a solution-focused approach and evidence-based practice
to advocate for patient rights, develop healthcare policies, and continue to advance their
profession. When nurses advocate for their patients they are motivated by what is best for the
patient, their families, and their communities.
It is my opinion that the role of advocator is the most sacred and essential charge of a
professional nurse. Additionally, nursing continues to be ranked highest among innumerable
professions in terms of being the most trusted (Porter-O'Grady & Malloch, 2011). This earned

3
trust, as I see it, has only come to fruition because of nurses individually and collectively as a
profession identifying patient advocacy as a guiding principle. The American Nurses
Associations (ANA) 2015 Code of Ethics for Nurses with Interpretive Statements Code outlines
in Provision two that the nurse's primary commitment is to the patient, whether an individual,
family, group, or community (p.8). Furthermore, ANAs Provision three states, the nurse
promotes, advocates for, and strives to protect the health, safety, and rights of the patient (p. 8).
Historically, from the time of when nursing care was directed by clerics, and continued
with influential nurses such as Florence Nightingale and Lillian Wald, the nurse has been the
person who has identified patient needs and sought ways to have these needs met. Today,
nursing advocacy requires critical thinking skills, appropriate assessment and intervention,
speaking for the patient within the context of the multidisciplinary team approach, and ensuring
that patient's wishes are honored and care is respectfully delivered. It will be interesting to be a
part of the conversation of how advocating for patients will evolve as more primary care
provider roles are being fulfilled by nurse practitioners and advanced practice registered nurses.
Future plans: I desire to reach underserved populations and diminish health disparities
through providing individualized care and by affecting policy level change. Attuning my future
practice as a nurse to actively developing and implementing equitable health care policy and
comprehensive health care to underserved populations globally and in the United States is timely
and appropriate. I plan on achieving these goals by working within my community here in Salt
Lake City as a professional clinical nurse by continuing to volunteer at the George Walden
Veterans Hospital and maintaining active memberships in Sigma Theta Tau International
Nursing Society, American Nurses Association, and the Utah Nurses Association.
Furthermore, I will maintain my proficiency in Mandarin Chinese and the relationships I
have forged on a service-learning trip to China. I plan on returning to China May 2016 to work

4
within hospitals throughout Xian and continue conversations with Chinese legislatures, doctors,
nurses, and community organizations regarding the integration of Western medicine and medical
technologies into the Chinese health care model and consequently the necessity for advanced
education and evolution of the scope of practice for Chinese nurses.
Scope of practice: As outlined above, the Nurse Practice Act defines the scope of
practice for nurses. It is my belief that interdependent care delivered by interdisciplinary teams
comprised of members hailing from all disciplines within health care offers the greatest
likelihood quality care will be provided. However, it is important to recognize that
interdisciplinary teams increase the complexity of interventions and treatment plans. With
increased members on an interdisciplinary team, communication is paramount to assure mistakes
are avoided and the patients best interest is sustained. As the complex care of interdisciplinary
teams is provided, adherence to individual scope of practices will allow realization of safe and
quality care to be delivered.
Delegation: Registered nurses accept primary responsibility for consequences of
delegation and shares legal accountability for consequences of delegations. To assure the NPA
and legalities are upheld, it is the responsibility of the nurse that the five rights of delegation are
employed with each task that is delegated to supportive staff. These rights include: right task,
right circumstance, right person, right direction and communication, and right supervision and
evaluation. All tasks that are delegated must be appropriate at the time delegated, and the
supportive staff being assigned a delegated task must be competent, knowledge, and within the
legal authority of the employing organization.
To assure positive patient outcomes are realized, the nurse directs the care provided.
Clear communication between the nurse and supportive staff is paramount and defines the
specific task that is delegated, sets clear expectations and prioritization, directions, and

5
timeframes for accomplishing the task. While the registered nurse utilizes the professional
judgment in the decision to delegate, under no circumstances can patient assessments and
evaluations, nor any part of the nursing process delegated to supportive staff members.
It is important nurses understand that consequences can relate to ones own actions in
delegating and also to the action or non-actions taken by the delegate. For all delegated tasks and
interventions, nurses are accountable for monitoring changes in patients status, noting and
implementing treatments, as well as assisting in prevention of complications. Ultimately, the
registered nurse is responsible and accountable for provision of nursing care.
Accountability
The key to maintaining accountability is accepting ownership for outcomes, whether
positive of negative. Accountability requires clinicians to be responsible and answerable for
actions or inactions of self and, in the instances of delegated tasks, others. Above all else,
professional nurses, achieve and maintain accountability by recognizing that nurses are
accountable to themselves, individually and collectively as a profession, their patients,
communities, and the world at large. It is paramount that competent nursing care be provided and
accessible to all people.
The call for the improving health care access and decreasing disparities in health care is a
long-standing ambition of health care clinicians. In 1978, the World Health Organization
declared in their Declaration of Alma-Ata:
The existing gross inequality in the health status of the people particularly between
developed and developing countries as well as within countries is politically, socially and
economically unacceptable and is, therefore, of common concern to all
countries...Primary health care is the key to attaining this target as part of development in
the spirit of social justice (p. 1).

6
I believe this call for increased attention to primary preventions and declared need for action by
governments, health care clinicians and all people of the world is still applicable today.
Over the past thirty years, nearly all of the developed nations of the world have
implemented systems to provide universal health care coverage to their citizens. However,
despite these efforts to increase access to quality health care services, the majority of the worlds
people are underserved. Barriers to health care include lack of resources and infrastructure,
geographic distances, cultural incompetency and intolerance, misdistribution of services, rising
costs of services, growing burden of personal out-of-pocket expenditures, prevalence of chronic
diseases and comorbidities, aging populations, and an overall negative global economic climate.
Many of these obstacles have made it difficult to collectively as a society and
individually improve peoples health and wellness. For example, according to DeNavas-Walt,
Proctor and Smiths 2008 U.S. Census Bureau report, an estimated 46 million people in the
United States were without health coverage (p.10). Furthermore, despite the implementation of
the Affordable Health Care Act, it is estimated in Smith and Medalias 2014 U.S. Census Bureau
report, In 2013,13.4 percent of people (or 42.0 million) were uninsured for the entire calendar
year (p.9). This conversation is appropriate to discuss within the context of nursing
accountability because if nurses are to accept accountability as claiming responsibility for action
and inactions, then it is the nurses charge as an advocate to promote accessible competent health
care to the worlds people.
Ethics
The American Nurses Association offers clear guidelines regarding nursing code of
ethics and professional standards. In the 2015 Code of Ethics for Nurses with Interpretive
Statements nurses are reminded the measures that must be satisfied to remain accountable and
ethical. Provision four outlines, The nurse has the authority, accountability, and responsibility

7
for nursing practice; makes decisions; and takes actions consistent with the obligation to promote
health and provide optimal care (p. 8).
I agree with the ANA that moral principles including fidelity, loyalty, veracity,
beneficence, respect for dignity, and self determination of patients as well as adherence to scope
and standards of nursing practice (p.15), is not only a responsibility of nurses but a requirement
for professional and personal accountability. Moreover, as technologies and political policies
develop that influence and evolve health care, I believe that for the professional standards of
nursing to remain paramount, stringent, and current, nurses will need to first be self-guided and
personally accountable. Nurses will not collectively be able to maintain a high standard of
accountability, if nurses are individually unaccountable and willing to compromise their personal
moral and ethical principles.
Conclusion
One sure thing is change. I strive to better myself and the world through honest selfassessment, use of new technologies, utilizing and advancing evidence-based practice, engaging
in teamwork, and advocating for appropriate health care polices that reflect the needs of all
individuals and populations. I align myself with the goals of the professional nursing community
to focus on quality health care, improve access to care, contain costs, and achieve better
outcomes for everyone. With these principles as a solid foundation to anchor to, I can remain
flexible and reactive to the rapid changes in the health care profession to offer my patients the
most ethical, current, and effective care possible. Ultimately, I am thankful for the opportunity to
be the change I wish to see in the world as a licensed registered nurse.

8
References
American Nurses Asssociation. (2015). Code of ethics for nurses with interpretive statements.
Web. Retrieved February 18, 2015.
http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/C
ode-of-Ethics-For-Nurses.html
DeNavas-Walt, C., Proctor, B.D. and Smith, J. (2008). Income, poverty, and health insurance
coverage in the United States: 2007. U.S. Census Bureau. Web. Retrieved February 18,
2015. http://www.census.gov/prod/2008pubs/p60-235.pdf
Nurse Practice Act (amended 2014). Utah state nurse practice act. Utah Code Title 58/Chapter
31b/Section 502. Retrieved April 1, 2015.
http://www.rules.utah.gov/publicat/code/r156/r15631b.htm
Porter-O'Grady, T., & Malloch, K. (2011). Quantum leadership advancing innovation
transforming healthcare, 3rd ed. Sudbury, MA: Jones and Bartlett Learning,
Smith, J., and Medalia, C. (2014). Health insurance coverage in the United States: 2013: current
population reports. U.S. Census Bureau. Web. Retrieved February 18, 2015.
http://www.census.gov/content/dam/Census/library/publications/2014/demo/p60-250.pdf
World Health Organization. (1978). Declaration of alma-ata. Web. Retrieved February 18, 2015.
http://www.who.int/publications/almaata_declaration_en.pdf