Grand Canyon University: NUR-430V-O505
Contemporary Nursing Practice: The Evolution of Nursing Practice Over Time
Women were always viewed as homemakers and caretakers, so it was only natural that an expansion of that role would be to become a nurse. When the role of nursing started, it wasn’t viewed as a profession or highly respected and was just regarded as a position made for women to fill. The scope of nursing practice used to be very reminiscent of a household chore list. The progression of a nurse’s scope of practice originates from the evolving perceptions of women, an increased need for medical professionals, and broader, more complete training. When schooling and a broader scope of education was developed, nurses were taught the responsibilities originally specified for physicians, allowing nurses more authority in decision-making for their patients. The advancement of women from caretakers to becoming more respected with the ability to earn degrees in nursing, was the starting point of a changed perception of nursing. In the past, the experience of patient care was dehumanizing because medical professionals had no tact and were not concerned with a patient’s self-worth or cognizant of the effects that experiencing painful disease processes or medical procedures had on their patients. Present day, ethical patient care has become a key focus and crucial aspect of the medical field and for all medical professionals alike. “The advancements in technology have created an environment that makes patient care more efficient and helpful for the patient” (Ranard, 2015). These technological advancements have decreased patient mortality rates, evoked more positive patient experiences and outcomes, and helped facilitate tasks for nurses. Now, the nursing profession has completely rectified this archaic approach to treating the individual. Nurses are specifically educated in humanistic skills and represent themselves as patient advocates. Therapeutic communication is also a highly valued trait nurses possess that is vital in providing optimal, whole patient care. The nursing profession has progressed rapidly and maintains the ability to adapt to the ever-changing world around it.
The American Nurses Association defines competency as “an expected level of performance that integrates knowledge skills, ability and judgment”. BSN nurses can apply clinical judgment and critical thinking to patient care. For example, a patient is calling the nurse because they are writhing in pain post procedure from a cardiac catheterization. Instead of just medicating the patient with PRN pain medication as ordered by the physician, a BSN prepared nurse has the superior clinical judgment and critical thinking skills to understand the importance of assessing the patient and their level of pain, discovering the cause of pain, and performing any necessary interventions. It is that exceptional level of critical thinking that the ADN prepared nurse is not regularly versed in or prepared to apply. BSN prepared nurses can think critically on the spot without the guidance of a doctor or other medical professionals. This not only saves precious time in emergent situations but fosters more efficient care and promotes positive patient outcomes. ADN’s perform a basic level of standard patient care, providing the ordered PRN pain medication in accordance with the physician’s orders. BSN’s have the education and aptitude to apply complex nursing care to their patients. BSN nurses have shown to produce improved patient outcomes, provide a higher caliber of interventions and render skilled and competent diagnoses. Research has shown that better acute care outcomes are executed when a larger ratio of the nurses staffed hold a BSN degree. An ADN nurse’s practice is centered around their clinical skills, whereas BSN nurses are proficient in not only their clinical practice but management and leadership skills, critical thinking and problem-solving skills, communication and nursing theory, as well as nursing informatics, allowing them to be proficient in utilizing modern workplace technology. Rosseter (2015) states that “research has shown that lower mortality rates, few medication errors, and positive outcomes are all linked to nurses prepared at the baccalaureate or graduate degree levels”.
Evidence based practice, EBP, is an interdisciplinary method to patient care. It is the practice of nursing care grounded upon concrete research that follows exceptional standards for safety and quality, while concurrently focusing on the requirements of patients. EBP permits the nursing profession to uphold a regulated and corroborated foundation for practice. “The essential value of evidence-based practice is the emphasis it places on rational action through a structured appraisal of empirical evidence, rather than the adherence of blind conjecture, dogmatic ritual, or private intuition” (Trinder & Reynolds, 2000). When the care received from a BSN prepared nurse is questioned, EBP supplies the research to defend and back the nursing practice utilized. The research assists by verifying the decisions made under the leadership position. As healthcare continues to move from quantity-based to quality-based, EBP is becoming progressively more important. The expectation of baccalaureate prepared nurses is becoming increasingly stringent. The standards for problem-solving skills as well as their practice of care to support optimal patient outcomes and safe and effective nursing care, are continually increasing. A BSN prepared nurse helps assimilate research into patient care. The function of EBP in nursing can be attributed to starting during nursing school, where the baccalaureate students are commanded to apply clinical knowledge, critical-thinking skills, and professional accountability to their patient care. Utilizing evidence-based practice is beneficial to BSN level nursing because it provides concrete evidence of improvements and accomplishments in healthcare (Oh et al., 2010).
The position of registered nurse requires the nurse to be an integral part of an interdisciplinary team, IDT, and work as peers with other healthcare workers that have higher levels of education than themselves, namely master’s degrees or doctoral degrees. The other members of the interdisciplinary team may include but are not limited to physicians, nurse practitioners, speech pathologist, pharmacists etc. These healthcare professionals are versed in the intricacy of providing patient care and appreciate the worth and necessity for achieving higher levels of education. Dean (2018) defined collaboration as “how well a person is able to work with others to achieve a common goal or result”. The goal of using an interdisciplinary team approach to patient care is to outline a plan of care to produce the best outcomes for the patient. The interdisciplinary teamwork approach is an effective communication and collaboration technique because all members of the teams’ attributions are recognized, and a common ground is reached. Nurses communicate and integrate their clinical expertise within an interdisciplinary team with their stellar knowledge of humanistic and critical thinking skills and their superior clinical judgment.
American Nurses Association. (n.d.). Competency model. Retrieved from https://www.nursingworld.org/~4a0a2e/globalassets/docs/ce/177626-ana-leadership-booklet-new-final.pdf
Dean, J.K. (2018). The Dynamics of nursing. Practice and competency development. Retrieved from https://lc.gcumedia.com/nrs430v/dynamics-in-nursing-art-and-science-of-professional-practice/v1.1/#/chapter/3
Fesler-Birch, D. M. (2005). Critical thinking and patient outcomes: A review. Nursing Outlook,
53, 59-65. Retrieved from https://doi.org.lopes.idm.oclc.org/10.1016/j.outlook.2004.11.
Oh EG, Kim S, Kim SS, Cho EY, Yoo J, Kim HS, … Lee H. (2010). Integrating evidence-based practice into RN-to-BSN clinical nursing education. Journal of Nursing Education, 49(7), 387–392. Retrieved from https://doi-org.lopes.idm.oclc.org/10.3928/
Ranard, C. (2015). Minority nurse. How nursing has changed over time. Retrieved from https://minoritynurse.com/how-nursing-has-changed-over-time/
Rosseter, R. (2017). The impact of education on nursing practice. Retrieved from https://www.aacnnursing.org/Portals/42/News/Factsheets/Education-Impact-Fact-Sheet.pdf
Trinder, L., & Reynolds, S. (2000). Evidence-Based Practice: A Critical Appraisal. Oxford:
Wiley-Blackwell. Retrieved from https://lopes.idm.oclc.org/login?url=https://