NUR 513 Topic 2 DQ 2 Compare two different advanced registered nurse roles with regard to ethical guidelines

Christians are held to a higher standard, and integrity should be a factor in all decisions. It’s doing the right thing even when no one is watching. I don’t understand how someone can cheat their way through school and receive their degree off someone else’s work.  Nursing is such a specialized profession with respect and trust from society.  Patient’s look to nurses for comfort, compassion and advice.  If the nurse cheats her way through school, how else will she cheat her patient’s?  Nurses also must have the knowledge to think critically.  It’s scary to think someone is providing care for you or your loved one who doesn’t fully understand the concepts and fundamentals of their profession.

My mother had a nurse in the hospital where she passed.  I have always wondered about her. She removed my mom’s central line like a peripheral IV.  She then turned her back and was preparing the 2×2 gauze with tape to apply it to the area.  By the time she turned around my mother had a huge knot where she removed the line, and she had an embolism hit her heart.  My sister and me panicked and told her she removed the line incorrectly.  My mom passed a few minutes later. I have often replayed this scene in my head, because removing central lines was taught very well in my program.  I am not sure if she cheated her way through school, or really did not know how to remove a central line. My mom had stage 4 lung cancer and was terminal, but none the less, that should have never happened.  The hospital formed a policy after that, that all central lines must be removed in radiology. (284 words)

From my understanding APA style format is crucial for college writing and research it adds readability, helps to keep the flow of the content and standardization to complex subject matter. it can also be said that APA style of writing makes the paper more organized. easy to read and understand without causing confusion or misinterpretation. Another important aspect of APA style of writing it gives credibility to the writing since the reader can cross reference citations to prove reliability of source. Finally APA style allows the writer to give credit and distinguish ones one idea from another writer thus avoiding plagiarism.

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I believe APA format is important because it demonstrates a general standard to keep writings concise, clean, and professional. Following a specific format helps to keep writings consistent, which results in an easier read with less chance of confusion. Additionally, APA format holds the writers accountable to give credit to the sources that were used. All sources that were used as in-text citations must be listed as a reference, thus giving credit to the author. Not only does this give credit to the author, but it also makes you more likely to use reliable sources, since they can be easily accessed through your references. Professionalism and proper grammar are very important in order to be viewed as an educated, trustworthy, and well-rounded individual.

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Beside of simplifying the work of editors by avoiding repetitive use of format for a given publication. APA Style makes it easier for readers to understand a text by providing a familiar structure they can follow. Also provide readers with cues they can use to follow the ideas more efficiently and to locate information of interest to them.APA Style provides fairly comprehensive guidelines for writing academic papers regardless of subject or discipline. However, traditionally, APA is most frequently used by writers.

To conclude APA style establish the credibility of the document provided. Also demonstrated clearly the source of information obtained ,minimizing plagiarism Amounts writer’s.

Reference:

https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_overview_and_workshop.html

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The importance of the APA writing style for professional communications is clearly demonstrated by its recognition as the primary writing style in scientific-based writings. Ideally, APA style is based on the principle of effective communication in the scientific field. Through this writing style, students, researchers, and other stakeholders in the academic sector have the opportunity to present their ideas and findings in a reliable manner. That is, the readers can scrutinize the writing for crucial information such as the authenticity of the sources. Therefore, APA writing style is important in professional communications because it is easy for the readers to understand the information provided. It provides the tools to ensure that the author presents effective communication.

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The APA style was created by American Psychological Association (APA) and used as a standard guide for education papers or professional communication. When writing an academic thesis, you’re sharing your masterpieces with your professor, peers, and other professionals. You want them to focus on the content of the papers and not be distracted by unfamiliar formatting. Another important in

the APA style is credibility, writers are allowed the use information from other writers or different sources, like web pages, journals, news, and book, but when you use the information from others, you must give credit to the source, the APA reference is the location for your show credibility to the authors. References should always be accurate, allowing your readers to trace back the origins of your information.

Reference:

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://doi.org/10.1037/0000165-000

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APA style and formatting provides a standard method that allows students and other professional writers to have a defined set of rules to follow. This ensures that references are correctly documented and credited with the research and knowledge used by the writer. The style guide provides a structure for professional writers to follow that gives a flow to the paper, transitions between topics, rules for formatting, and clearly organized. APA formatting is important for students to learn and follow if they continue academic research and submit articles for peer-review or publication, as these often require specific formatting and citation of sources or references. Appropriate references give credit to original research, negate plagiarism, and protect the integrity of the writer and research.

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APA (American Psychological Association) format gives a foundation for effective scholarly communication, and it helps writers present their ideas in a clear, precise, and inclusive manner. APA style is important to professional communication because uniformity and consistency help readers to focus on the ideas easily and scan works quickly for key points, findings, and sources. Style guidelines encourage authors to fully include essential information and readers to understand without any distractions.

In APA style, ideas flow logically, sources are credited appropriately, and papers are organized consistently. Tables and figures present data in an engaging, consistent manner. APA style promotes consistency in writing in an organized way. APA format has detailed description about how to format the references and in- text citations. It is extremely useful for students, professors, and researchers

There are many avenues available for Registered Nurses within different types of Masters Programs. Advanced Nursing Practice Roles uniquely identify within different specialties. The two types of APN roles I have decided to compare includes Nurse Educator and Nurse Practitioner (Liaison International , 2022). 

The Nurse Educator, whether it be college instruction or hospital bedside guidance, has a very important responsibility. Teaching and guiding nursing students, new grads and experienced nurses through gentle but firm instruction is an important balance (American Nurses Association, 2022). Ethical considerations can include providing constructive communication techniques for all facets of learning styles, maintaining confidentiality and anonymity, and recognizing potential of harm so the issue can be swiftly revised and improved. The nurse educator is an important resource for all areas of nursing, and performing this role with compassion and confidence directly influences healthy growth and success within all levels of nursing practices (DeNisco & Barker, 2019).   

The Nurse Practitioner involves direct patient care and can span all types of specialties in medicine. Diagnosis and treatment as well as counseling in preventative care helps to create a healthy balance between the actual management of care and strategies needed for long term success. (American Nurses Association, 2022).  Nurse Practitioners do not just treat the present problem but also the patient’s future health and happiness. Ethical considerations include voluntary participation of the patient, confidentiality, and informed consent (DeNisco & Barker, 2019). 

There are many ethical differences within these two APN roles. The scope of practice highly differs between the two, which directly influences the associated ethical guidelines. One huge difference is the population served. Nurse Educators directly serve the nurses and institutions, while Nurse Practitioners directly serve the patients and institutions. Both roles utilize evidence-based practice and definitive ethical standards. The response to an ethical situation differs in the fact that the educator may identify and correct situations by improving knowledge gaps and training while the Nurse Practitioner may have to adjust the plan of care accordingly and follow up with different treatment modalities. 

For example: A Jehovah witness patient is diagnosed with sickle cell crisis who is dangerously anemic and needs a blood transfusion. Ethical guidelines remain in place for respecting spirituality and religion. The hospital educator may consider addressing this situation with cultivating awareness by teaching the institutions employees, which leads to building understanding and acceptance for this patient population. The Nurse Practitioner will need to adapt the plan of care to this specific situation but also directly educate the patient on the high level risks associated with the denial of the blood transfusion. The NP can help the patient define personal limits and wishes associated with the plan of care without encroaching on the validity of the religious belief. 

American Nurses Association. (2022). Advanced Practice Registered Nurse (APRN). https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn 

DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124 

 Liaison International (2022). Explore Health Careers. https://explorehealthcareers.org/field/nursing/ 

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The two different advanced registered nurse roles that I am going to compare is a nurse midwife and a nurse educator. Although all nurses need to abide by similar ethics there are additional guidelines to consider for these very different roles.  Nurse educators have many responsibilities but one of the most important things that they must do is promote and encourage students to exercise around clinical judgement, practice using ethical standards, and support and respect their colleagues (National League for Nursing, 2012). Nursing educators need to treat all students fairly and stray away from racism. On the other hand, nurse midwives have a whole new world of ethical guidelines that need implemented. Midwives provide care to women at some of the most vulnerable times of their lives. They are responsible to keep women healthy as well as making sure their babies arrive healthy. What a huge responsibility that has a lot of moving parts.

One unique ethical guideline to midwives is that they must develop a partnership with the woman that they work with and shares relevant information to help women make informed decisions, consent to an evolving plan of care, and acceptance of responsibility for the outcome of their choices (American College of Nurse-Midwives, n.d.). Respect for autonomy is basic to midwifery care and is foundational to a partnership that fosters open communication between a midwife and a woman (American College of Nurse-Midwives, n.d.). But all nurses whether that be an advanced registered nurse, or not should all have the goal to respect basic human right and dignity of all people, this is an important principal when caring for people. 

References 

 American College of Nurse-Midwives. (n.d.). Code of ethics with explanatory statements. https://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000293/Code-of-Ethics-w-Explanatory-Statements-June-2015.pdf 

National League for Nursing. (2012, January). Ethical principles for nursing education national league for nursing. https://www.nln.org/docs/default-source/uploadedfiles/default-document-library/ethical-principles-for-nursing-education-final-final-010312.pdf?sfvrsn=4b49d00d_0 

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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/ 

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Agree to your discussion about the role of the Clinical Nurse specialists and the Nurse Practitioners role as regards to ethical guidelines. i would like to share an experience that i personally had during my time when I practiced as a Certified Wound Nurse in a 22 bed Surgical Intensive care unit. There was a situation where the patient was intubated, sedated with no living will or power of attorney. This patient was homeless. The nurse practitioners quest of contacting the family or a friend was of no avail, as no one would respond or take any interest in this particular patient’s condition. Since the Advance care practitioner is focused on a specific patient, the unique situation was handled independently by the Advance Practice nurse. But experiencing this situation in an ICU, the Clinical Nurse specialist identified a process problems in the unit specific to this patient population & initiated a guideline/ protocol for end of life situations for patient who were indigent. The CNS identified a process issue seeing the chaos that it created for the providers and assisted the unit as a whole for the future for any kind of situations such as these, that the nurses or providers who would encounter in the future. 

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Week 2 DQ 2 

Ethics involves understanding the moral rules and the system that they are made of such as the nature of purposes and justifications. One of the major challenges that nurses encounter is the ethical dilemmas and it is vital that nurses establish good ethical practices to ensure that there are better patient outcomes. Nurse practitioners are responsible for the provision of primary, acute, and specialized care across the lifespan (Fraze et al., 2020). They perform their role by assessing, diagnosing and treating illnesses and injuries. One of the major ethical issues that nursing practitioners encounter is having to deal with difficult patients and their family members. Behavioral issues and hopelessness can arise because of the complex nature of a patient’s problem which can also result in emotional and psychological problems. Despite the various challenges that may arise, nurse practitioners are responsible for catering to the patients need by fulfilling their ethical standards in their practice. 

Psychiatric clinical nurse specialists are responsible for the provision of care to patients suffering from psychiatric issues. These nurses utilize evidence-based practice and standards of best practice in ensuring that they offer the highest quality of care to the patients. Caring for patients in this area may be challenging because of the diagnosis of mental illness (Mohr & Coke, 2018). Nurses need to be patient and empathetic to ensure that they can practice ethically without any form of bias. It is important for these nurses to be objective and contain their emotions when dealing with patients and not allow them to prevent them from effectively caring for the patients. Nurses should attempt to be neutral and provide patients with the highest quality of care. 

References 

Fraze, T. K., Briggs, A. D. M., Whitcomb, E. K., Peck, K. A., & Meara, E. (2020). Role of nurse practitioners in caring for patients with complex health needs. Medical Care, 58(10), 853–860. https://doi.org/10.1097/mlr.0000000000001364  

Mohr, L. D., & Coke, L. A. (2018). Distinguishing the clinical nurse specialist from other graduate nursing roles. Clinical Nurse Specialist, 32(3), 139–151. https://doi.org/10.1097/nur.0000000000000373 

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“Ethical values are universal rules of conduct that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued. Ethics are moral principles that govern how the person or a group will behave or conduct themselves.” (Haddad & Geiger, 2022) Ethical values are at the core of humanity. We are blessed that our healthcare profession holds to ethical values as strongly as they do. No matter what area of the healthcare field you choose to pursue, you will encounter them. And rightly so. The field of caring for diseases, acute injuries and administering medications, safety issues abound. Most especially, in the nursing field you will put ethics to use in practice every single day. 

Advanced Practice Registered Nurse (APRN) is defined as a registered nurse who has additional knowledge and skills gained through an advanced formal education program. There are four roles that consist of certified registered nurse anesthetist (CRNA), certified nurse–midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). CNP may then be educated in another sub-specialty, Adult-Gerontology. I want to compare the CNM and the CNP with Adult-Gerontology training. As stated previously, in every area of life we should be striving to act in an ethical manner, but what differences does that mean for healthcare at different places in the spectrum of life? The CNM has training and strives to bring new life into the world with minimal complications while the CNP Adult-Gerontology is met with people on the other end, where people are living their last days. To let a young life go without life sustaining procedures would be unthinkable, and yet when a 90-year-old grandmother has a life-threatening disease, cancer for example, we do no curative treatments. Yet, both situations, opposite in the kind of care that’s offered, is considered ethical. To die with dignity, to be comfortable while death overtakes the body is ethical. 

 Haddad LM, Geiger RA. Nursing Ethical Considerations. 2021 Aug 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30252310. 

APRN Joint Dialogue Group Report, July 7, 2008, Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education, https://ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008 

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A code of ethics within nursing is imperative to maintain the dignity of the patient and the integrity of the APRN no matter what population or patient one may be providing service to. When an RN decides to seek further education and advance their practice into an APRN practice, they dive into more specialized patients and populations. Although the foundation of the code of ethics for APRN’s may be the same, this divergence into specialties means applying those ethics to each role very differently.   

A clinical nurse specialist in a pediatric setting may respond to ethical dilemmas very differently than a Family Nurse Practitioner (FNP) . One such example would be one of non-maleficence, the avoidance of harm to a patient (Haddad & Geiger, 2022). Although practitioners that work in pediatrics in some capacity know they are not only treating the patient but supporting the family as well, a pediatric CNS may see a problem specific to how to it affects just the patient whereas an NP may see the greater picture as to how the health problem affects the whole family unit. The CNS and the FNP may make different choices or suggest different directions of treatment because of their different training and experience.   

An FNP may make a treatment suggestion knowing the family unit or because of the knowledge of the barriers or strengths in the community as they are often located in primary care. A CNS may make a treatment suggestion or plan to the healthcare delivery system of all those patients that present with that issue as they often serve as “expert consultants” to nursing staff or work to improved delivery of care within the healthcare system (Explorehealthcarecareers.org, 2022).   

One such example could be with controller medications in a pediatric patient with asthma. The FNP may take into consideration the abilities of the parents to adhere to 20 minute nebulizers everyday in a two year old and may suggest a less effective but more complied with treatment plan of metered dose inhalers if the benefit outweighed the cost. A CNS may suggest a change to the system of asthma management and/or advise this family/patient to figure out a way to adhere to best practice of inhaled nebulized mediation. In either case, the primary goal is in respect to Provision 2 of the nursing code of ethics, “the fundamental commitment of nursing to the uniqueness, worth, and dignity of the patient” (American Nurse’s Association, 2015). APRN’s in this situation is to maximize the treatment plan for a child with asthma.   

 References 

 American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/  

  Explorehealthcarecareers.org. (2022). Clinical Nurse Specialist. https://explorehealthcareers.org/career/nursing/clinical-nurse-specialist/   

  Haddad, L. M., & Geiger, R. A. (2022, January). Nursing Ethical Considerations. StatPearls (Internet). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK526054/  

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The two advanced practice registered nurse roles regarding ethical guidelines I plan to discuss here are the Nurse Administrator and the Public Health Nurse. 

The American Nurses Association (ANA) code of ethics states that “The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledgment” (Hain, 2009 as cited by Weberg et al., 2019, p. 83). The nurse administrator is responsible for ensuring a standard of care for patients and employee satisfaction and upholds the code of ethics as a standard of judgment in hiring, training, and conducting performance reviews (What is a nurse administrator, 2022). The administrator has the task of focusing on improving quality in the health care system and reducing costs. (DeNisco & Barker, 2021). Nurses ranked the highest according to Gallup’s annual poll on honesty and ethics 2020. The survey also revealed that the nursing profession exceeded 89% of all Americans, giving nurses very high scores for their honesty and ethics (Saad, 2020). To maintain the public trust, the nurse leaders/administrators have the highest obligations to safeguard the ethical guidelines. 

  The Public Health Nurse engages in disease prevention and health promotion at the community level (DeNisco & Barker, 2021). The American Nurses Association (ANA) code of ethics states that nurses should work with varied health professionals and the public to advance and strengthen national, community, and international endeavors to meet health demands. The public health nurse is responsible for validating the code of ethics while practicing in the community. The ethical foundations of the ANA code describe the nurses’ individual and collective action in relation to individual and community health. The code further emphasizes the issue that advances the health needs of the society, expectations of nurses regarding how they serve the public, and advance the social good (Weberg et al., 2019). 

     The main difference in these two roles is that the nurse administrators directly and indirectly shape and guide the complex health care system. For example, the nurse administrator plays a vital role in the advancement of the profession through contributions to practice, education, administration, and knowledgement (Weberg et al., 2019). She is the first line of contact for nurses who practice in various fields, including public health nursing. However, the public health nurses function as leaders and administrators in their own regard and are directly responsible for serving the public and advancing the social good (Weberg et al., 2019). 

  During the last three years, COVID-19 pandemic changed many of our roles with an increased demand for nursing and health care needs. The pandemic taught all nurses how nursing is unique and how the advanced practice nurse should be prepared to function in complex and changing health care demands yet uphold the ethical principles of nursing. Nurse leaders and administrators not only had to learn the public health nursing principles, but also had to accommodate the community’s health care challenges. Similarly, the public health nurses on the field and in the community learned to exercise administrative roles in terms of utilizing and allocating resources such as vaccination, COVID testing, surveillance, documentation, and reporting. 

  Reference: 

DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124 

Weberg, D. R., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2019). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Jones & Bartlett Learning. ISBN-13: 9781284146530 

What is a nurse administrator? (2022). Blog https://www.elmhurst.edu/blog/what-is-nurse-administrator/#:~:text=Nurse%20administrators%20supervise%20nurses%20and,schedules%20and%20conducting%20performance%20reviews.