Download Nursing Education: Preparing for a Rewarding Career and more Exams Clinical Medicine in PDF only on Docsity! Georgia Highlands College NURS 1000 - Introduction to Nursing (OER) - 2nd Edition: Chapter 8 Educational Preparation, Career Choices, Licensure and Certification Requirements, and Professional Organizations Ā āTheĀ rigorĀ ofĀ theĀ nursingĀ majorĀ shouldĀ beĀ understoodĀ andĀ appreciatedĀ byĀ theĀ nursingĀ studentĀ (Stabler-Haas,Ā p.Ā 17,Ā 2012) In this chapter, students will learn: ļ· Nursing education is a rigorous and rewarding journey of professional and personal growth ļ· Requirements for licensure and certification to ensure public safety ļ· Professional organizations that support lifelong learning and career success Educational Preparation and Career Choices Educational Preparation and Career Choices Nursing is an applied science and art which requires personal and professional growth and development (NLN, 2010). Knowledge, skills, and attitudes are learned through classroom, simulation, and clinical experience. Both theory and practice are necessary to develop competent nursing professionals as well as professional self-assessment skills. Maranon and Pera (2015) found that undergraduate students develop professional identities throughout nursing school and gain confidence in the ability to approach new situations. In this study, clinical mentors were crucial partners in the development of confidence and flexibility. The National League for Nursing (NLN) (2010) recognized that āā¦it is no longer sufficient to launch a newly qualified nurse into the workforce armed only with mastery of a body of knowledge. We must instead prepare individuals grounded in values and ethics, with an understanding that knowledge is continually evolving, and with the skills to evaluate that knowledge and apply it in situations where nurses touch the lives of others.ā This insight guides nurse educators to help students learn how to: ļ· provide safe, culturally sensitive care that is built on healthy relationships with patients, families and communities ļ· practice within a professional scope that is legal, ethical, and adheres to current standards of practice ļ· continually learn and grow professionally to remain current in evidence- based practice ļ· advocate for quality healthcare that is accessible for all persons (NLN, p. 7, 2010). Christine Tannerās (2006) model of clinical judgment in nursing is one way to understand the pre-licensure transformative journey. Nurses care for unique humans in varied settings under myriad conditions and must be able to adapt to psychology, and emotional intelligence to adequately care for patients. Therefore, a well-rounded application would indicate qualities such as caring, compassion, empathy, and personal resilience. Godfrey and Young (2021) encourage students to be accountable for their own learning, engage in reflection, build relationships, and develop habitual self- care practices. Students must also take control of their lives through adjustments to work, social, leisure, and study time with more focus on studies. These actions will assist in the development of professional identity. The decision to work while in a rigorous program of study should be considered carefully. Professional education takes many more hours of preparation beyond the classroom and clinical hours (Stabler-Haas, 2012). Working as a nurse tech where administrators are supportive of school hours could help increase confidence and build rapport with a future employer. Stabler-Haas (2012) recommends that the maximum amount of work per week for a student nurse should be 20 hours or less. Family expectations usually need adjustment during nursing school due to the number of clinical, classroom, and study hours required for success. An honest conversation about this temporary ātime awayā can help prepare loved ones for added responsibilities, limited ātogetherā time, and the change in relationship dynamics. The group can decide together how best to manage this commitment and plan for contingencies should crises emerge. Student nurses often expand their normal support group to include neighbors, friends, and extended family members as backup for childcare, meals, and other duties. Nursing school exams and success. One nurse educator reminds students that nursing school is different; memorization has its place but does not help a learner āfigure things out,ā solve problems, or make sound clinical decisions (Scott, 2009, p.81). Students must learn how to think critically and use information to solve complex problems. Scott also tells students to fortify themselves for a nursing career where instant decisions must be made based on evidence, experience, and patient preferences (Scott, 2009). To do this well, students must learn in various ways, not just with memorization. The change in learning methods and exams can take students by surprise. In the first semester, students who achieved high grades on general education exams can be shocked by the different types of testing in nursing school. Nurses use information to solve problems every day, so application and analysis questions test the studentās ability to use data, to think through problems, and make good clinical decisions in various settings. Many students face feelings of inadequacy during the transition to nursing student. Two forms of self-care can help: Use learning techniques that apply or analyze facts and keep a passionate statement visible on why nursing is a chosen career. Learning techniques should include asking questions that address dilemmas in patient-centered care, priorities, safety, and evidence-based clinical decisions: ļ· What would a nurse do with these facts at the bedside for thisĀ patient and situation? ļ· What would a nurse do first in this situation? ļ· Is there a safety issue? ļ· What other data does the nurse need to make a good decision? Students should not only comprehend the knowledge but also possess the ability to apply and analyze the knowledge that is gained. Study groups can help with application of knowledge through discussion and questioning while working on clinical problems together. This form of education and ātraining the brain to think like a nurseā becomes easier each semester and prepares nurse graduates for the licensure exam. A major goal of nursing faculty is to: Prepare graduates who can think critically, make sound clinical judgments, and integrate best evidence into practice (NLN, 2010, p.67). Preparation for clinical experiences. Student nurses learn nursing care at the bedside of patients in various settings with increasingly complex health conditions. Clinical facilities such as hospitals and nursing homes require clinical credentialing and verified skill demonstrations to ensure patient safety. These facilities also require that anyone caring for their patients must have certain physical and psychosocial skills. Clinical credentialing processes are the responsibility of the nursing program, and each student must comply with requirements prior to caring for patients. Common items include annual drug screens, criminal background checks, health insurance, proof of immunization from communicable diseases, cardiopulmonary resuscitation (CPR) certification, signed confidentiality agreements, and successful completion of healthcare facility safety procedure quizzes (i.e., infection prevention, fire and disaster procedures, and healthy body mechanics). Additionally, clinical uniforms, shoes, and personal appearance standards must be met. Students are reminded that all school paperwork related to patients should omit identifier information such as age, ethnicity, name, etc. and that hallway and mealtime conversations must never violate confidentiality laws. Skills verification sessions are held at the school prior to clinical experiences where the skills will be used. For example, students practice administering medications and injections, initiating intravenous infusions, and insertion of urinary catheters prior to performing these skills on patients. Additionally, students are monitored by an instructor or registered nurse during performance of these tasks at the facility. Students must maintain skill in tasks previously verified and are required to prepare for each clinical experience through study, practice, and critical thinking prior to arrival. Instructors often quiz students about readiness to practice so that patients are safe and care standards are met. Preparation for clinical education at clinical facilities requires certain physical and psychosocial skills (Stabler-Haas, 2012). Good assessment skills require the ability to see, hear, smell, and feel changes in the human body and in mental and emotional states that might not be expressed. Most nurses who work in hospitals and nursing homes need physical stamina to sit, stand, lift, move equipment, and assist others with eating, bathing, toileting, standing, walking, and transfers to and from bed. They also need to hear and read prescriptions, medical records, procedure guidelines, and other communication to make good clinical decisions. Finally, healthcare workers are expected to possess a certain level of emotional intelligence, control over behavior and affect, and professional restraint when stressful situations occur. Student nurses learn two crucial personal and professional skills during school ā flexibility and critical thinking. Every clinical instructor is different as is each clinical facility. How things are done at one facility and with one instructor, might not be how things are done at another facility or with another instructor. However, the principles of excellent nursing care guide each task and every patient-student nurse encounter. For additional thoughts on preparation for nursing school, go to: ļ· Nurse Awesome - What I Wish Someone Told Me About the First Month of School o https://www.youtube.com/watch?v=z9HXv568jN4 ļ· Nurse Awesome - 1st Semester Habits That Will Help You Be Awesome! o https://www.youtube.com/watch?v=L10MfLNpQ5Y Becoming a successful registered nurse of school or before, and the student should ādress for success when interacting with potential employers. ļ· Talk with nurse recruiters from several facilities. ļ· Attend job fairs and career days. ļ· Read job postings in professional publications, bulletin boards, and the internet. ļ· Attend networking events and professional meetings. ļ· Tell preceptors, friends, and family about your career plans. ļ· Investigate nurse residency programs to assist in integration into the healthcare field Obtaining the first RN position. Final comments about finding the āperfectā job include creating a professional portfolio. First on the list is a brief resume that highlights education, work, and volunteer service. Use an online format with instructions on how to create a professional resume. Obtain reference letters from nursing professors and clinical instructors. Write a cover letter that summarizes professional goals with an emphasis on knowledge, skills, and attitudes that match the job description and facility mission. Update this portfolio each year with new knowledge, skills, and abilities to be ready for the next career advancement. Advancing education and career opportunities Many registered nurses pursue a masterās and/or doctorate degree in a chosen nursing specialty. There are several paths to higher education in nursing that deepen expertise in a selected area of interest: nursing administration, advanced practice, and nursing education (NLN, 2010). There are many advanced practice options. These include nurse anesthetist (CRNA), clinical nurse specialist (CNS), nurse midwife (CNM), nurse practitioner (APRN), and nurse educator (AACN, 2022). Nurses who practice in these advanced roles obtain additional education in pathophysiology, pharmacology, and physical assessment to practice at higher levels of independence (AACN, 2022.). Most advanced practice nurses can prescribe medication, perform minor procedures, and practice independently. For more information on graduate programs in nursing, go to the AACN website: https://www.aacnnursing.org/Nursing-Education-Programs/Masters- Education. These graduate programs may require a Masterās degree or doctoral degree (AACN, 2022). Some nurses prefer to specialize in nursing care for specific populations or conditions. For example, a clinical nurse specialist (CNS) might care for communities or persons with diabetes, heart failure, or mental illness. Most graduate programs in nursing require a BSN as part of the admissions process. Some bridge programs are available which teach the core BSN content prior to graduate school courses. The application process is like other college admissions requirements and could include items from the professional portfolio (letters of recommendation, cover letter, and current resume). Applicants might also be required to take an entrance exam called the Graduate Record Exam (GRE). This exam tests skills and knowledge in writing, math, and verbal communication (Burckhardt and Irwin, 2008). For more information on the GRE, go to Educational Testing Service (ETS), the organization that creates, and proctors the exam: https://www.ets.org/gre/? WT.ac=etshome_gre_flagship_180417 At the doctoral level, nurses can choose a practice-focused doctorate (DNP), a research doctorate (PhD, DNS, DSN, DNSc), or a doctorate in nursing education (EdD). The DNP has two possible tracks: Advanced practice for nurse practitioners or a population and systems focused degree, however both tracks prepare nurses for doctoral-level evidence-based practice (American Association of Colleges of Nursing [AACN], 2006). Nurse scientists and scholars (PhD, DNS, DSN, DNSc) are prepared to conduct research and scholarly activities (AACN, 2006). The EdD in nursing focuses on the art and science of nursing education, research, and scholarly endeavors. Once a career path and degree are selected, the nurse chooses a nursing program that matches career goals and personal and professional interests. There are over 500 nursing schools nationwide and over 2,000 graduate programs. For help in determining a career path, go to the AACN website at www.aacnnursing.org (AACN, 2006). Continuing education requirements. Most professions require continuing education to ensure that current best practice is provided to the public. For example, a physician attends conferences to learn about updated treatments, and an engineer attends a continuing education workshop on how to use new technologies safely. The same is true for nurses. Each state board of nursing determines the number of continuing education units (CEU) that a nurse must complete prior to licensure renewal every two years. Additionally, hospital nurses are often required to participate in CEUs on a regular basis. Most nurses focus on updating knowledge and skills in a chosen specialty, however, broadening interest in general nursing and other specialties can enhance nursing practice. Exemplars The following examples describe various paths from pre-licensure education to practice at entry and advanced levels of nursing practice. The stories are fictional but based in common facts. Diploma program education After three years of training in a diploma nursing program, Nancy was hired to work in a 100-bed rural hospital. Her education was from a hospital-based program that allowed much on-the-job training as she progressed through school. She would learn a skill and apply it that same week. Her fund of knowledge grew deeply because she was able to care for patients with the same conditions that she had learned each semester. Most of the nurses were graduates from the same program and helped her know what to expect next. They gave her assignments that matched what she was learning. These nurses told her to keep learning and to finish her core classes for the Bachelor of Science in Nursing (BSN) as soon as possible. The hospital was being purchased by a larger hospital system that required at least an ASN but preferred BSN nurses. They reminded her that a BSN was required, not a bachelorās degree in another field. Nancy realized this program had prepared her well for hospitalized patient care, but she eventually wanted to become a homecare nurse which required a BSN. Her diploma program was associated with a community college, so some of her courses counted toward a BSN degree. One year after graduation from the diploma program, she completed her core courses and shopped around for an online RN-BSN program that matched her learning style and work/family schedule. Working full time and going to school full time for four years had taken a toll on her family, so she worked on her BSN part time. After graduating from the BSN program, Nancy was hired as a home care nurse in her rural community to provide nursing care to people she had known all her life. The job was immensely fulfilling, and she grew in knowledge, skills, and confidence while helping her community strive for better health. Associate of Science in Nursing (ASN) education process of BSN-level education had also prepared him for graduate school ā where even more papers are required. Master of Science in Nursing (MSN) education Sally had worked as an RN in her hospital for three years. She had a BSN from a four-year college and was ready to advance her career. There were several role models on her unit who she admired but was unsure which path to take. After the BSN, nurses have many, many options for practice. Some nurses continue to work in hospitals after graduate school, others work in community agencies, start their own clinics, or teach in nursing programs. She talked with each of her role models and investigated several schools, specialties, and work settings. After a self-assessment that included her strengths and weaknesses, family and social life, and her career goals, Sally knew what she wanted to do. Her favorite type of patient was a person who needed acute care stabilization in the intensive care unit (ICU). She also loved to teach other nurses how to best care for each patient. She had excellent scholarly writing skills and a 3.9 GPA. She also enjoyed working with and learning more from physicians, physical therapists, and pharmacists. Sally had a reputation for being one of the best ICU nurses and was admired by staff and other disciplines as a good leader, a great clinician, and a helpful teammate. To advance her career and better care for ICU patients, Sally decided to become an advanced practice registered nurse (APRN) with a specialty in acute care for adults. She researched schools and found the best fit for her work-life balance, location, educational rigor, and school mission. After two more years of full-time study (yes, the family took a back seat for another two years, but they cheered her on), Sally graduated from an accredited nurse practitioner program. She passed the national certification for her nurse practitioner (NP) specialty and applied to the state board of nursing for an NP license. The application process was like obtaining an RN license and renewal was set at every two years. She decided to keep her RN license, too, so she could work as an RN in other states that might not recognize her NP license. Sally continued to work in the ICU but was now a nurse practitioner who worked alongside doctoral prepared physicians, nurses, pharmacists, and physical therapists to plan and direct care. She wrote prescriptions for medication and treatments and mentored RNās on best nursing practices. Sally felt fulfilled in her new position and reaped several other benefits. The pay was much better, she could make higher-level clinical decisions with her patients and their loved ones, and she was able to mentor other nurses toward career goals and best patient outcomes. The work had paid off. Sally had a job she enjoyed at a salary that reflected her level of expertise and in a setting where she thrived. She and her family agreed that school had been worth the effort. Doctoral level education: A DNP and PhD comparison At the doctoral level, nurses have several choices in career path and Justin and Anna were aware that it would be rigorous. Justinās main strength and joy in work came from finding out what worked best at the bedside for each patient on each unit. He was frustrated, however, with the lack of connection between new research and getting that evidence to the bedside in a timely manner. He knew that as a masters prepared clinical nurse specialist (CNS), his fund of knowledge was excellent, but he did not have the power to make changes to policies and procedures. He wanted to learn how changes are made in the healthcare system and have the authority to make that happen. Anna wanted to teach nursing. She was already an adjunct clinical instructor who took pre-licensure BSN students to clinical facilities. There, she taught them the art and science of nursing care in her specialty ā adult psychiatric nursing. She worked in a community crisis stabilization unit as an APRN and had enjoyed the work for many years. But lately, she knew that teaching was becoming her passion. She would end up taking a pay cut to teach but knew that it was the right move at this stage of her career. A Ph.D. in nursing would help her obtain a nurse faculty position at the university, and it would help her advance through the promotion and tenure process. As an older nurse, Anna was interested in working if she could influence nursing in the right direction. Research was going to be the way to demonstrate the evidence that nurses needed to make improvements in healthcare outcomes. After interviewing several recruiters from the Doctor of Nursing Practice (DNP) and Doctor of Philosophy (Ph.D.) programs, Justin and Anna found the perfect fit for their career goals. Through several phone conversations, they learned that Ph.D. nursing programs take about four years to complete, and Anna would have skills in conducting research. Justin knew that he enjoyed staying close to bedside nursing, so he chose to work on a DNP degree that prepared him to bring evidence-based practice to the bedside ā in two years. He would also learn how healthcare systems work, how financial decisions are made, and how evidence-based changes can be implemented throughout a healthcare system. They also learned that nurses with a Doctor of Nursing Practice (DNP) degree focus on the clinical setting, whereas nurses with a Doctor of Philosophy (Ph.D.) in nursing focus on research. The Ph.D. nurse scientists and DNP nurses work together to bring evidence-based practice to the bedside (NLN, 2010). Justin and Anna were taking different paths toward a doctoral degree in nursing to further advance their careers and the nursing profession. They would be joining other leaders in nursing to guide and direct the profession toward improved healthcare outcomes. Despite the differing foci of each pathway, both terminal degrees serve a vital function for the nursing profession and assist in bringing best practices to patient care. Licensure and Certification Requirements Licensure and Certification Requirements The sense of achievement and joy that comes with obtaining a nursing license can be deeply satisfying. The registered nurse (RN) license requires hard work, dedicated study, and a strong support system. Licensure opens doors to a wide array of career possibilities. RNs can also obtain an advance practice registered nurse (APRN) license after additional education. This section describes the process for obtaining and maintaining an RN and APRN license and certifications that recognize specialty expertise. Licensure for registered nurses Graduates from diploma, associate, or baccalaureate nursing programs must apply for permission to take a national exam as part of the licensure process. The graduate chooses a state in which to sit for the National Council Licensure Examination for Registered Nurses (NCLEX-RN). This state becomes the āhomeā for the RN license and is granted by the state board of nursing (BON), which sets testing requirements (National Council State Boards of Nursing (NCSBN), 2022). Candidates for the exam provide a background check, proof of identification, and professional name for the license. The nursing program director provides proof of completion from an accredited nursing program to the board of nursing. Once all requirements are met, candidates sit for the exam at a proctored testing center. ļ· Psychosocial integrity ļ· Physiological integrity o Basic care and comfort o Pharmacological and parenteral therapies o Reduction of risk potential o Physiological adaptation For more information on the NCLEX-RN, go to https://www.ncsbn.org/nclex.htm and click on the links for application, registration, testing locations, what to expect on exam day, and much more. Also check out these videos: https://www.ncsbn.org/8243.htm and https://www.ncsbn.org/356.htm fo r specific information about preparation and what to expect at the exam. Specialty Certifications Nurses at any practice level (RN, Advanced Practice) or with any nursing degree (Diploma, ASN, BSN, MSN, DNP, DNS, PhD) may choose to obtain a specialty certificate that indicates expertise in an area of nursing practice. For example, a nurse leader might become a Certified Nurse Executive (NE-BC) or a nurse educator might become a Certified Nurse Educator (CNE). A nurse who has dedicated a career to mother/baby care would study for and pass the exam for Inpatient Obstetrics (RN-C). As part of the application process, the professional portfolio will be updated to include a personal statement that highlights career goals, experiences, continuing education in the specialty, and philosophy or thoughts about nursing care. Letters of recommendation are needed and should come from nurses who completed the certification successfully. Professional organizations Professional organizations offer support, guidance, policy statements, standards of practice, and networking opportunities that promote excellence in nursing practice. Nurses are often called to coordinate many aspects of patient care that lie outside the usual nurse responsibilities and membership in professional organizations fosters (NLN, 2010). Student nurse organizations The National Student Nurses Association (NSNA) was founded in 1952 to bring students together with mentors to prepare for initial licensure as registered nurses. The organization promotes development of skills in advocacy, leadership, caring, and professionalism that convey the standards and ethics of the nursing professions. Membership in NSNA prepares students to play active roles in the nursing profession and bridges the gap between education and practice. The networking opportunities equip future nurses with skills to serve as leaders within the profession. Membership allows students an opportunity to participate at the local, state, and national level. Each school of nursing has a local chapter that is part of the state organization. Members of the state organization are also members of the national organization. These organizations help students build knowledge, skills, and attitudes related to professionalism, leadership, service, diversity, and teamwork. Participation in conferences offers career development opportunities, scholarships, networking, and a look into the legislative process as it pertains to the nursing profession and nursing education. For more information on the national organization go to https://www.nsna.org/. American Nurses Association and state associations The professional organization for nurses is the American Nurses Association (ANA). When nurses join this organization, they are automatically enrolled as a member of their home state organization. The ANA improves patient care through the support of nurses and organizations to advance the nursing profession. Advocacy occurs through work with the federal and state legislatures and in collaboration with global and national healthcare organizations. For more information on the organization, resources, and membership go to: ļ· https://www.nursingworld.org/ ļ· https://www.nursingworld.org/resources/ ļ· https://www.nursingworld.org/membership/joinANA/ Specialty organizations Nurses who want to deepen specialized knowledge and skills often join a specialty organization. For example, a nurse midwife might join the American College of Nurse Midwives (https://www.midwife.org/) while a behavioral health nurse might join the American Psychiatric Nurses Association (https://www.apna.org/i4a/pages/index.cfm?pageid=1). Nurses who work with special populations also join professional organizations to further the specialty and promote high quality care. For example, nurses who work with veterans or persons with HIV/AIDS might join these organizations: ļ· Nurses Organization of Veterans Affairs (https://www.vanurse.org/default.aspx) ļ· Association of Nurses in AIDS Care (https://www.nursesinaidscare.org/i4a/pages/index.cfm? pageid=4693&pageid=1) Some professional nurse organizations focus on skills such as infusion or wound care. ļ· Infusion Nurses Society (https://www.ins1.org/default.aspx) ļ· Wound, Ostomy, and Continence Nurses Society (https://www.wocn.org/default.aspx) Other organizations support nurses who work in special settings. ļ· International Association of Forensic Nurses (https://www.forensicnurses.org/default.aspx) ļ· National Association of School Nurses (https://www.nasn.org/home) These organizations usually offer evidence-based literature, conference discounts, continuing education units, certification preparation courses and exams, and networking opportunities. Over 40 organizations support professional growth and development within the nursing profession. For a list of organizations recognized by and partnering with the ANA, go to https://www.nursingworld.org/ana/org-affiliates/. Sigma Theta Tau Nursing Honor Society Sigma Theta Tau is an international organization of nurses who meet criteria for excellence in academia and/or community service. These nurses are known for their efforts to change lives and advance healthcare for local, state, national, and global populations. The organization provides numerous resources to enhance and further nursing careers including opportunities for education, publication, and leadership. For more information, go to https://www.sigmanursing.org/.