Professional standards for the advance practice nurse
Needleman and colleagues, 2002 investigated the influence of nurse staffing levels on the quality of care in hospitals and inferred that there is a correlation between higher level of staffing by registered nurses and reduced rates of unfavorable patient outcomes. Nurse-staffing principles are patient management unit related; i.e. depends on analysis of particularized and summative patient needs in a given care unit. It is also staff related (the specific needs of a specific patient population establish the skills required), and, finally, it is organization related, i.e. depends on signs of organizational appreciation to the role of nurses (Gallager and Kany, 2000).
The practice of advanced nursing practice is defined by Arkansas Board of Nursing (<http://www. arsbn.org>) as the deliverance of healthcare services for reimbursement by professional nurses who have developed supplementary knowledge and expertise gained by the completion of a structured program of nursing education that qualifies and certifies nurses for advanced practice specific functions.
Standards of practice express a skilled level of clinical nursing practice, while a professional standard is the experienced knowledgeable stage of performance of the professional role (SGNA Practice Committee, 2005). As expressed by Sox, 2002, professional standards are the operational levels of ability, efficiency and holding to principles. They are simply the fundamental commitment of medicine to society (Sox, 2002).
Hook and White, 2001, categorized the professional standards for the advance practice nurse into three main categories namely, basic commitments of the nurse, limits of duty and dedication and duties towards the larger community.
1-Basic commitments of nurses: Primarily, all nurses have the responsibility of patient’s well being through continuous devotion to the quality of healthcare service provided. No reason social, administrative or market force pressures should compromise this duty. The obligation of practicing professional nursing to patients is essential and not a subset maintaining patients’ welfare (Sox, 2002). Honoring the patient’s dignity, privacy and confidentiality are of prime importance (Hook and White, 2001). The obligations to honesty with patients and maintaining proper relations with patients includes considering the inherent weakness, susceptibility, and reliance of patients in the relationship between nurses and patients. There should be no financial gain or sexual exploitation (Sox, 2002). Commitment to improve the quality of nursing care does not only mean to maintain nursing efficiency but also to cooperate with other healthcare professionals to reduce medical error, ensure patient safety and enhance prospects of healthcare (Sox, 2002).
2- Limits of Duty and loyalty: This standard addresses self-respect and respect to colleagues (of the medical profession or otherwise, senior or junior). The aim is that nurses’ efforts would result in the creation of a working environment aware of and practicing these ethical duties (Hook and White, 2001). The ethical standard of social justice implies continuous work to reject discrimination in healthcare at any level and for any reason. Advance practice nurses should also contribute in managing conflicts of interest with medical equipments, pharmaceutical or insurance companies (Sox, 2002).
3- Duties towards the larger community:
Among the duties of the advance practice nurse is the commitment to participate actively in professional nursing associations as a prime duty towards the larger community of nurses (Hook and White, 2001). Advance practice nurse should be committed, also, to cooperate with other health professional and the public to the duties of initiatives in medical and social reform. An example to such initiatives is to renew the human based cultural qualities (rekindle humanistic qualities) in the practice of the profession of medicine. As members of the still larger community, advance practice nurses should work in harmony with other members to boost patient care, and contribute in the process of self-regulation (Welling, 2003). Advance practice nurses have commitments to the broad human community in the general concern related to human rights through leadership activities and the ability to make a difference through their professional organizations (Hook and White, 2001).
Medicine is an occupation (not a trade) that requires extensive education, knowledge and training (i.e. a profession). All members of the medical profession, including advance practice nurses, have a commitment to teach as they learn and by the code of ethics, their prime duty is to put patient care and welfare before self-interest. They should practice the benefit of self-regulation settled by society (Snyder and Leffler, 2005).
Needleman, J, Buerhaus, P, Mattke, S. et al. "Nurse-Staffing Levels and the Quality of Care in Hospitals”. The New England Journal of Medicine 346, no. 22 (2002): 1715-1722.
Gallager, R. M and Kany, K. A. Principles for Nurse Staffing With Annotated Bibliography. Washington, DC: American Nursing Association, 2000.
Arkansas State Board of Nursing. "Nurse Practice Act. Title 17: Professions, Occupations and Businesses. Subtitle 3. Medical Professions. Chapter 87- Nurses. Subchapter1: general Provisions." Arkansas Board of Nursing. http://www.arsbn.org/advanced_practice.html.
SGNA Practice Committee. "Standards of Clinical Nursing Practice and Role of Delineation Statements." Society of Gastroenterology Nurses and Associates. http://www.sgna.org/Resources.
Hook K G. and White G B. "Code of Ethics for Nurses With Interpretive Statements: An Independent Study Module." American Nursing Association Continuing Education. http://www.nursingworld.org/mods/mod580/cecdefull.htm.
Sox H C. (Editor). "Medical Professionalism in the New Millennium: A Physician Charter." Annals of Internal Medicine 136, no. 3 (2002): 243-246.
Welling R E. "Professionalism”. Arch Surg 138, (2003): 262-264.
Snyder L. and Leffler C. "Ethics Manual: Fifth Edition." Annals of Internal Medicine 142, no. 7 (2005): Research Library pg. 560-582.