Compare two different advanced registered nurse roles with regard to ethical guidelines.

Clinical Nurse Specialists and Certified Nurse Leaders are the two jobs I will compare (CNL). CNSs are APRNs who specialize in one or more medical specialties. Certified Nurse Leaders are not exactly APRNs. Both jobs require master’s degrees, but CNLs have fewer clinical requirements. The Clinical Nurse Leader (CNL) focuses on unit-level healthcare microsystems. The AACN says CNL focuses on care coordination, outcomes measures, transitions of care, inter-professional communication and team leadership, risk assessment, evidence-based best practices, and quality improvement. (Clavo-Hall et al., 2018).

Clinical Nurse Specialists (CNS) have advanced training in their specialty and can work in areas such as population (such as pediatrics, geriatrics, or women’s health), setting (such as critical care or emergency room), disease or medical subspecialty (such as diabetes or oncology), type of care (such as psychiatric or rehabilitation), or type of problem (such as pain, wounds, or stress) (Hatley Ralyea, Buttriss, & Rankin, 2019). The CNS works with cross-system multidisciplinary care teams.

CNL and CNS attempt to improve patient care and satisfaction. The two approaches differ greatly. The CNL focuses on one system problem at a time, while the CNS looks at the whole (Rettig, LaRue, & Pearson, 2017). If both positions cooperated together, healthcare ethics could improve.

Both jobs must follow the ANA Code of Ethics for Nurses. The nursing profession has an ethics code that describes member expectations and defines personal and performance standards. The nursing code of ethics outlines the nurse’s duties and interactions with patients and promotes health (Porter-O’Grady & Malloch, 2018). A healthcare provider’s responsibility is to reveal accurate medical, treatment, and prognosis information and engage in shared decision-making to empower the patient to make his or her own decision. By dismissing a patient’s wishes to cease treatment or decline treatment, a healthcare provider acts as if he or she does not appreciate the patient as a decision-maker.

Compare two different advanced registered nurse roles with regard to ethical guidelines.

Topic 2 DQ 2

Compare two different advanced registered nurse roles with regard to ethical guidelines. Are there any differences in the ethical guidelines that govern these roles? What situations might require one role to respond differently, depending on the ethical guidelines?

At GCU we hold Christian Values as a component of our educational foundation. Should this also be a factor in how students act and influence their decisions towards academic integrity? Answers are voluntary but do count towards one of your three substantive posts for the week if you meet the 200-word minimum requirement.

I think spiritual values do influence the decision to maintain academic integrity because otherwise, it would be hypocrisy. If one claims to be a spiritual being but cheats their way through life, then the question becomes who do we actually think we’re fooling? It is necessary to stay true to oneself and to choose the proper thing to do even when no one’s looking, to me, that’s the true definition of integrity. I also believe one must constantly work at or renew their spiritual beliefs because we’re all human without perfection so, at times will’s get weak and we envision success by taking the easier way out such as cheating on a test or taking credit where it isn’t due by putting our names on others’ work, committing infractions known to us as plagiarism but causing greater damage to the soul.

We must remember every good thing worth having requires putting in the work required to achieve those goals. The constant struggle within to always do the right thing is understandable but, if we nourish the positivity more than we nourish the negativity, making the appropriate decisions become second nature and the struggle to make the desirable choices are lessened. It’s a greater sense of appreciation to know the goals achieved were achieved honestly and through hard work. When one puts in honest work, the process is respected!

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Thank you for your response. This brings to mind King James Bible/New Living Translation 2005, Luke 8:17; For all that is secret will eventually turn to light. I was in Nursing school and happen to be tutoring a nursing student that was a class or two behind me. The student was prepared to take her med-surgical exam; we had reviewed the pathophysiology so that she would be able to look at, for example, be given a scenario regarding a patient’s lab values and know if the patient was in metabolic acidosis. We reviewed the ability to think critically.

Prior to her taking the test we, both felt confident that she would pass. Day later she called and asked to come over and when she arrived, she was distraught. I was dumb founded; she explained that she had taken the exam, but it did not go very well because she decided to cheat. A couple of her classmates reassured her that they had the answers to the exam; She did not even read the exam to use anything that we had reviewed as far a critically thinking and using pathophysiology, lab values, and so on to arrive at the answers.

I was upset that she had taken up hours and days of my time to prepare for an exam and she just totally threw everything out the window and just put down answers. The class prior to hers had aced the exam, but the instructor and the Director of the Nursing department reviewed the class trends and knew that the class prior to her class should not have scored that many A’s.

Therefore, the test was changed and the test that my friend took was different from the one the prior class had taken. On top of that she had to speak with the Director of the Nursing department and was expelled from the program. She needed to at least pass with a C to remain in the program. The class prior had students that were also expelled as well as the students that were in her class.

I only knew about this as she confided in me regarding the situation; otherwise, the was emphasis in my class to make sure that all the concepts were understood; if not ask questions during/after lecture and because in clinical we were taking care of patients and need to know why we were administering some as simple as a vitamin E and the side effects. In my practice I have been conscientious regarding patient care. In the Neonatal Intensive Care everything we gave during the time I worked in the unit was doubled checked. If it did not fit into a 1cc syringe it was triple checked.  

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Reference

• King James Bible/New Living Translation. (2005). Tyndale House Publishers Inc. Https:/www.tyndale.com 

Interestingly, I have found over the years that there does not seem to be any difference between Christians and non-Christians when it comes to cheating. They either do or they don’t and their religious beliefs or lack thereof do not seem to make any difference. It is the integrity of the student that determines whether or not they will cheat or attempt to cheat. If they get away with cheating, they are hurting not only themselves but also the patients that they care for.

I believe that as a Christian I am held to the standards set forth in the bible, and if I don’t live my life by these standards, I disappoint God. I spent a lot of time involved in women’s ministry, and my director called me a Silent Evangelist, meaning that while I have a hard time vocally discussing my faith at times, not wanting to offend people or come across as self-righteous, I do evangelize by living my life with integrity, I am a reflection of my faith.

I believe that all people should act with integrity, whether they have beliefs or not, but Christians especially have a responsibility to act in a way that not only pleases God, but that reflects to others what they believe. In the bible, 1 Chronicles 29:17 says, I know, my God, that you test the heart and are pleased with integrity (NIV, n.d.).  We are constantly tested. It is often easier to cheat, to take a short cut or use material that is not ours, but those are opportunities to do what is right. One of my favorite Psalms, 62:12 reminds us, “and with you Lord, is unfailing love, and you reward everyone according to what they have done” (NIV, n.d.).

The Clinical Nurse Specialist (CNS) and Nurse Practitioner (NP) positions are two advanced registered nurse roles that are similar. They both require master’s level training in the field of nursing, but the clinical nurse specialist responsibilities tend to be more administrative with a strong focus on staff and patient education, research, and program development. The nurse practitioner’s role is more focused on assessment, diagnosing and management of disease processes. Nurse practitioners also tend to have more autonomy and work as an independent care provider. Depending on the regulatory laws of the state in which they practice, nurse practitioners can function under the supervision of a physician or unsupervised. Clinical nurse specialists’ approach tends to be more collaborative, and team centered (Gains, 2022). A Nurse Journal article sums up the differences between the two roles by stating that the nurse practitioner provides direct patient care, and the clinical nurse specialist manages patient care (Nurse Journal, 2022). 

There are four Principles of Ethics for nurses. They are autonomy, beneficence, justice and nonmaleficence (Gains, 2021). The role of nurse practitioner is faced with a higher potential for ethical dilemmas due to the differences in duties from the clinic nurse specialist, especially regarding the principles of autonomy and nonmaleficence. One example is prescriptive authority of controlled substances. Nurse practitioners have prescriptive authority in 50 states and the authority to prescribe controlled substances in 49 states, clinical nurse specialists have no control substance prescriptive authority (Gains, 2022). Prescription drug abuse is currently a crisis in America and with the authority to prescribe controlled substances, comes the added responsibility that the medication is being prescribed safely and ethically.  

References:

Gaines, K., (2021, July 22). What is the nursing code of ethics?. Nurse.org. https://nurse.org/education/nursing-code-of-ethics/ 

Gaines, K., (2022, June 9). The differences between a clinical nurse specialists (CNS) vs nurse practitioner (NP). Nurse.org. https://nurse.org/articles/cns-vs-cnp-which-career-path-is-right-for-you/ 

NurseJournal. (2022, June 13). NP vs. CNS: What’s the difference?. Retrieved August 15, 2022 from https://nursejournal.org/resources/np-vs-cns/

Hi Melanie, thanks for your response. I was involved in a case just last week that involved ethics, informed consent, and patient rights. We had scheduled a procedure for a prison inmate to have a feeding tube placed. When the patient arrived for his procedure, he was adamant about not having any tube placed, refused to give consent, and also stated he would pull the tube out as soon as he was able. He threatened staff members that were part of his care and anyone that attempted to force the tube on the patient. The NP at the prison facility was contacted and questioned about why the procedure was ordered with the patient’s refusal of placement. The NP said her ethics were too called into question, however the prison had a court order to place the tube against the patients wishes. The facility sent us a copy of the court order, which our supervisor had to contact the hospital ethics committee and verify we could perform the procedure. The court order was kept and filed with the patient’s chart as the CRNA on the case also wanted to refuse anesthesia for the patient due to lack of consent, however as an inmate with a court order, we had to do the procedure and place the tube. Multiple nurses including RNs, APRNs, physicians, and ethics committee members were consulted in this situation, and unfortunately even though many of us considered this an unethical procedure, we had to follow the court order which was also explained to the patient prior to beginning the procedure. It was documented the medical record of the patient’s refusal and also the court mandate to perform the procedure anyway.