Running head: PDP: THE BSN AND BEYOND

Professional Development Plan: The Bachelor of Science Degree and Beyond Denise S. VanderWeele Ferris State University

PROFESSIONAL DEVELOPMENT PLAN: THE BSN AND BEYOND Abstract

Following the American Nurses Associations (ANA) Standards of Professional Nursing Practice is an expectation of all Registered Nurses (ANA, 2010). This document uses these standards as guideposts along the road to developing as a Bachelor of Science in Nursing (BSN)-prepared professional. Upon closer examination, the standards enable the nurse to evaluate their strengths and weaknesses as a professional nurse. It is through this process that I have seriously considered obtaining an advanced practice degree as part of my commitment to lifelong learning and professional growth beyond earning a BSN.

PROFESSIONAL DEVELOPMENT PLAN: THE BSN AND BEYOND Professional Development Plan: The BSN and Beyond Along the education path from Registered Nurse (RN) to Baccalaureate-prepared Registered Nurse (BSN), there will be a logical progression in the professional development of

the RN. This paper gives the background of my current practice as an RN and looks at the future goals I have to develop professionally. Using the American Nurses Association (ANA) Standards of Professional Nursing Practice as guideposts in this paper, I will outline my current practice as well as my five and ten year goals for developing as a BSN-prepared professional nurse and becoming an independent practitioner as a Certified Nurse Midwife. ANA Standards of Professional Nursing Practice Ethics The practice standard of ethics states simply that the registered nurse practices ethically (ANA, 2010, p. 47). This standard is further explained in The Code of Ethics for Nurses with Interpretive Statements (ANA, 2001), which is used to guide my practice. A nurse practicing ethically would respect the dignity of the person and treat them with compassion, knowing that each person is a unique human being with inherent worth (Provision 1). The nurses primary commitment is to the patient, family group or community that she is called to serve (Provision 2). The nurse is a patient advocate (Provision 3), accountable for his/her own practice (Provision 4), and charged with maintaining his/ her competence and professional growth (Provision 5). The nurse establishes, maintains and improves the health care environments and employment conditions to provide quality health care through her individual and professional organizations (Provision 6). A nurse advances the profession through her contributions to the practice, education, administration and knowledge development (Provision 7). The nurse is a collaborator

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with other health professionals in promoting health needs (Provision 8). The nurse is responsible for maintaining the integrity of the profession and for shaping social policy (Provision 9). With nearly 20 years in a clinical setting, I strive to uphold these ethics in my practice. When a patient is admitted to the Childbirth Center where I work, I establish a relationship with them (patient, significant other and extended family, if present) in which they are a participant in their care. I ask them if they have a formal or informal birth plan and we discuss what their vision is of their childbirth experience. I provide information where needed for them to make informed decisions involving their care, regardless of my personal bias. For example, I really enjoy helping patients have a drug-free delivery because I am able to use many non-invasive skills to promote patient comfort. However, I would never neglect to inform the patient of her options on pain control which include IV medications and/or an epidural anesthesia. It is their decision to make, and I facilitate that with information and support for the decision made. I am the patient advocate, making sure her wishes are followed, and to adjust my care if she changes her mind in the middle of her labor. It is also my duty to her to provide the best labor support, based upon her wishes. Sometimes, this means staying at the bedside for the entire 12-hour shift and doing interventions with her and her family so that she can avoid needing medication. Other times giving the best labor support means teaching her family how to massage her back or coach her and leaving the room so that they have as little intervention outside their family as possible, if their vision is to have strong family support with minimum intervention from nursing. Sometimes, it means having her ready to receive an epidural as soon as possible and then allowing her to sleep with minimal interruptions during labor because that is how she wants her experience to be managed. In all these settings, I maintain a safe environment and monitor her labor progress. When there is a procedure necessary that goes against the

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patients wishes, I give them information to make the best decision possible, and then support the decision and adjust my care to their needs. Education The registered nurse attains knowledge and competence that reflects current nursing practice (ANA, 2010). My education is and will always be on-going. I participate in yearly hospital-wide competency evaluations, semiannual Skills and Drills Day where we practice emergency scenarios in my unit, reading professional journals, attending conferences and seminars, online learning activities and interaction with my colleagues. We have a nursing educator in our department who is an invaluable resource for expanding our knowledge base and provides us with monthly learning activities. Our Nurse Educator also prepares monthly fetal monitoring strip reviews, which are interdisciplinary and a great source of learning and feedback for actual events that have occurred in our unit. I am also pursuing my BSN as a means to expanding my education horizons, with the possibility of a Masters of Science in Nursing (MSN) degree or an advanced practice certification. I currently hold certification from the American Nurses Credentialing Center in Perinatal Nursing, which covers all aspects of childbirth from prenatal care to postpartum follow-up. It is my goal within the next year to obtain additional certification in Electronic Fetal Monitoring as further proof of my competence in caring for the laboring patient and her fetus. As part of these certifications, I have to maintain 25 hours of continuing education in my specialty over the next five years, or lose that credential. It is my plan to be able to renew these certifications until I retire or leave the perinatal nursing specialty.

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Evidence-Based Practice (EBP) and Research This standard requires the registered nurse to integrate EBP and research into their practice (ANA, 2010). This requires that I seek out knowledge based on current research and establish my practice based on these findings. I also need to share research findings with colleagues and peers and come alongside them when they institute new EBP procedures. I believe that most of my practice is based on evidence obtained in research studies. By reading journals and attending seminars, I become aware of new research that pertains to my practice. New policies or procedures based on recent research are presented to the Unit Based Council, our Nurse Educator and the Nurse Manager for consideration and possible implementation into practice. As chairperson of the Unit Based Council, I review policies and procedures for the Childbirth Center and recommend changes based on research that supports the practice, evaluate its effect on our patients, and suggest ways to make it work in our particular setting. I have actively participated in the Harvard Nurses Health Study for the past 20+ years. It is a data-gathering health assessment aimed at nurses because they can more accurately report lifestyle and nutrition choices and provide reliable data to the researchers. It is the longest running study of its kind. While the prevention of cancer is still a primary focus, the study has also produced landmark data on cardiovascular disease, diabetes and many other conditions. Most importantly, these studies have shown that diet, physical activity and other lifestyle factors can powerfully promote better health (Harvard, 2012). My hospital has a new nursing research department that is organizing nursing research projects throughout the hospital. Within the next five years, I would like to actively participate

PROFESSIONAL DEVELOPMENT PLAN: THE BSN AND BEYOND in a nursing research project, possibly after I finish my formal education at Ferris State University. Quality of Practice The registered nurse contributes to quality nursing practice (ANA, 2010). Quality care is an outcome of nursing competency and the use of the nursing process. In every situation, an assessment must be made, a plan of care is formed, goals are set, the execution of the plan takes place and the outcome is evaluated. To be sure that I am delivering quality care, I use the nursing process in all of my patient care situations. I maintain my competencies and certifications so that I am prepared to meet the needs of the patient and strive

to increase my skills in every way possible. Patient feedback, staff evaluations and my personal satisfaction with doing something well are all indicators that quality care is being delivered. A weakness in this area would be my documentation skills. I am currently working on improving them by bridging the gap in my education between paper charting and using electronic medical records. This has involved chart audits and unit-wide education and information gleaned from professional seminars. I will continually work on improving my documentation so that it is relevant, complete, succinct and timely. Communication The registered nurse communicates effectively in a variety of formats in all areas of practice (ANA, 2010). The standard of communication includes all forms of communication: verbal, written, and electronic. It also entails questioning the rationale of care processes and decisions that do not make sense to me or seem contrary to the patients well-being. This questioning of (usually) authority figures is still a learning process for me. I am developing a language that is non-confrontational that can diffuse the (perception) of the Residents judgment

PROFESSIONAL DEVELOPMENT PLAN: THE BSN AND BEYOND being questioned. Please help me to understand why you have chosen to do xyz.. This is a phrase that I have found takes the judgment out of a question and allows for some scholarly discourse. Because I am old enough to be the mother of most of the Residents, any question to them can be perceived as hostile or condescending, and I strive to have a stress-free work environment by avoiding confrontational language. Leadership

The registered nurse demonstrates leadership in the professional practice setting and the profession (ANA, 2010). Leadership is not just being a member of the staffing hierarchy but can also be demonstrated by participating in professional organizations, mentoring new hires, being a preceptor, developing conflict resolution skills and seeking ways to advance nursing autonomy and accountability. Besides being a mentor and resource to new nurses entering practice and working with student nurses who rotate through our unit, I am the chairperson of our Unit Based Council. This council represents over 90 RNs and Nurses Aides who work in our unit. We meet monthly to deal with issues involving practice, policy or equipment in our department. We frequently spearhead projects that will improve both the employee and the patient experience on our unit. I also hold a position on the hospital-wide Professional Nursing Council. The matters addressed by this council are hospital-wide issues such as policies, procedures, quality improvement initiatives, patient satisfaction or promoting hand hygiene. As a member of our professional organization (the Association of Womens Health, Obstetrics and Neonatal Nurses), I encourage others to join and attend conferences and seminars.

PROFESSIONAL DEVELOPMENT PLAN: THE BSN AND BEYOND I also perform the duties of relief charge nurse. I recently applied for a position as Clinical Coordinator, a title similar to permanent charge nurse. The position was offered to a

nurse with similar experience as I have with the main difference being that she possessed a BSN. Within the next five years, I will continue to look for leadership opportunities in both a formal role and in informal ways such as supporting or advancing a patient safety initiative on my unit. Collaboration The registered nurse collaborates with the healthcare consumer, family and others in the conduct of nursing practice (ANA, 2010). Each labor patient on our unit has a primary care nurse. The remainder of our care team includes the Nursing Techs (Nurses Aides), attending physician, resident, intern, medical student and student nurse. It is my responsibility to not only be a patient advocate and educator but to coordinate the care that all these people give to the woman in labor and her support team. Communication within the health care team is vital to meeting the needs of the patient at any given time during her labor and delivery. By keeping the care team coordinated and current with the care being given, we are able to respond to emergencies more efficiently and in a timely manner. Resolving conflict is the biggest challenge I have with this standard. Most of the time, there is a spirit of camaraderie among the healthcare team where I work. When conflict arises, occasionally the chain of command has to be instituted to resolve the issue when a compromise cannot be reached. Every July, when new interns are starting and the former interns are now residents, there is a shift in the power dynamics of the unit. This is where most of the conflicts originate. New residents want to show their authority and some become arrogant and confrontational in front of the new interns. It is my job to diffuse these situations and work amicably to maintain patient safety and a spirit of collaboration.

PROFESSIONAL DEVELOPMENT PLAN: THE BSN AND BEYOND Professional Practice Evaluation

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The registered nurse evaluates her or his own nursing practice in relation to professional standards and guidelines, relevant statutes, rules and regulations (ANA, 2010). Patient outcomes, post-discharge evaluations, feedback from doctors, fellow nurses and ancillary personnel all give me a sense of when good care is being given and when things need improvement. If I am in an emergency situation and do not know what I am doing or have doubts about the quality of care given, I am able to ask my colleagues (doctors, nurses, nurses aides) after the fact what could have been done better or differently in that situation. These informal debriefings are a great learning tool as they provide real-time feedback and can spark further research and/or learning opportunities. I am constantly evaluating myself: am I doing the best that I am able? What else could I learn that might improve the care of my patients? How are my patients responding to the care that I provide for them? These questions also lead me back to school to obtain my BSN. There is so much more to learn and apply to my practice! My annual review is tied to a self-evaluation that I submit before the formal evaluation. I have been consistently classified as a high performer, which gives me the security of knowing I appear to be doing a good job. I demand a great deal from myself, and sometimes this leads to feelings of frustration; will I ever get this concept? Why is it always such a struggle to give quality care? Will there be a time when I feel that I have finally arrived at the peak of my capacity to do a good job? I doubt it. There are always areas of growth to be pursued. I believe this is what helps me achieve excellence constantly striving to do better, examining what is going on and looking for ways to improve the processes. Everything in nature is organic it is in the process of becoming something else. Professional practice is just like the rest of nature: you grow or you die. I choose growth.

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Resource Utilization The registered nurse utilizes appropriate resources to plan and provide nursing servi ces that are safe, effective and financially responsible (ANA, 2010). This standard includes advocating the use of technology that enhance nursing practice and referring patients to social work consults, Welcome Baby home visits, and breastfeeding support groups when needed. Our doctors initiate referrals for infants who need more than basic care to the Level I Neonatal Intensive Care Unity in town and also initiate referrals of high-risk maternity patients to the high risk perinatology group at a neighboring hospital.

Cost-effective care is giving the best care possible while using the resources that we have wisely. We are all held accountable for the resources that we use and are encouraged to share cost-saving innovations. An idea that I had was to provide the patient menus on the television instead of printing them for each room and then discarding them upon discharge. This saved the cost of printing the menus, the time to distribute the menu, and decreased overall waste produced by the hospital.

Environmental Health The registered nurse practices in an environmentally safe and healthy manner (ANA, 2010). I work at a Leadership in Energy and Environmental Design (LEED)-certified hospital. We do everything the green way, right down to having recycling bins in the operating room and patient rooms. Our tableware is sugar-based so that it dissolves in the environment, unlike styrofoam and petroleum-based products. We are constantly trying new ways to conserve resources and save money for our organization and the patient.

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As a nurse, I actively participate in the recycling effort. We have a hospital-wide quiet zone initiative that cuts down on unnecessary noise in the hallways. We use natural light to illuminate the rooms if it is available. This all contributes to a healthy environment outside and inside the hospital. I think I am a team player and that I contribute to a healthy work environment. I look for ways to encourage my coworkers and to share the workload evenly. Sometimes, my assignment can be lighter than that of a coworker (RN or NA) so I will offer to help in whatever way is needed, even if it is just emptying the linen bag. When I am the one with a busy assignment, I keep my complaints to myself and ask for help when I need it, and express thanks when I get it. The overall environment that I work in is positive and supportive, where learning and sharing knowledge is encouraged. The exchange of medical information, new procedures, tips and ideas flows easily within the care team and makes going to work an event to anticipate. Five and Ten Year Goals My five-year goals include maintaining and improving competence in perinatal nursing, finishing the requirements for a BSN, obtaining a formal leadership role at the facility where I work, and/or continuing on to graduate school. In five years, I will be 61 years old, and in ten years I will be 67. Many of my peers are planning their retirement at this stage in their lives. I am not. I do not plan to retire, but to finally realize what I want to be when I grow up. As children, we are asked this question and encouraged to dream big. Dreaming big is the choice I am making for my older years. I do not plan to exit this planet quietly, but to be doing something meaningful and in service to my fellow human beings. It is my dream to care for mothers and infants in a tropical location with people who do not have access to quality care.

PROFESSIONAL DEVELOPMENT PLAN: THE BSN AND BEYOND During my service learning project in Haiti this past June, I participated in providing prenatal clinics to women in rural mountain areas. I also assisted with labor and delivery in a primitive (by western standards) hospital and assisted in the teaching of nurse midwives. This experience has proven to me that I can do this type of work and that I love interacting with

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different cultures while providing care and instruction to them. I do not know if this would be a full time endeavor, or if it would take the shape of frequent short-term mission trips. I feel that the skills that I possess right now are not enough to provide the level of care needed in places like Haiti, so I am in the process of deciding how I am going to prepare for this role. I am leaning toward becoming a Certified Nurse Midwife. I also am drawn to teaching and could be influenced into teaching the next generation of nursing students. I enjoyed doing all these things when I was in Haiti and felt a sense of purpose and fulfillment in performing these duties. I am open to what my life and my God have in store for me in the years ahead. Being in school at my age is already an act of faith in that I trust that I will have many more years to use the knowledge I am gaining. My first step toward realizing these goals is to continue to pursue excellence in all that I do and to listen to my heart and my life and see where it leads me. In the meantime I will continue on the path I have started and prepare for what looks like will be my next step. I am constantly learning new ways to be a patient advocate and to communicate well with the medical team. I will continue to work on my communication, collaboration and conflict-resolution skills. Evaluation I am on my way to achieving the first part of my dream. My BSN is only 30 credit hours away. If I continue taking two classes each semester, I will graduate by May of 2014. I am

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currently looking at options that will allow me to take 12 credits this fall and spring semesters. I would then finish my BSN by then end of next summer. I am in the process of finding affordable health insurance that will enable me to work less at the hospital and concentrate more on my studies. This is the only thing that is truly holding me back at this time. I have the full support of my husband and children to become a full time student and pour all my energies into finishing school. With either timeline, I know I will be finished with my Masters in Midwifery (becoming a CNM) within the next five years. Prior to my final semester, I will apply to the Frontier School of Midwifery to begin work toward becoming a CNM (Frontier, 2012). The Frontier School of Midwifery is the oldest midwifery program in the United States and is designed for distance learning, with CNM preceptors arranged in the students community for the later part of their training. The need for nurse midwives is best articulated by the World Health Organization: About 1000 women and almost 10, 000 newborns die every day due to largely preventable complications during pregnancy, childbirth and the immediate postnatal period. In addition, every year, nearly 3 million babies are stillborn. Many of these lives could be saved if every birth were attended by a midwife (WHO, 2012). Seventy-six percent of the births in Haiti are not attended by qualified health care professionals. Haiti has the highest maternal/infant mortality rate in the western hemisphere (Midwives for Haiti, 2012). These numbers are what drew me to Haiti for my service learning project. I am also looking at government grants for advanced practice nurses who are willing to exchange education for a commitment to an underserved area either in the USA or the Caribbean (Human Resources, 2012). This would help finance my education and place me in a location of greater need than if I looked independently for somewhere to practice as a midwife.

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As I continue my undergraduate classes, I am choosing to take pathophysiology for one of my elective classes. I also plan to take world folk literature and French culture classes. I hope that these classes aid in preparing me to realize my dreams by increasing my technical knowledge and expanding my world view. The weakness of my plan is the possibility of the circumstances of life interfering with what I have laid out. I recognize that life circumstances can alter plans rapidly. I am realistic enough to know that any number of things could change the trajectory of my career. At present, my spouse and I are healthy and active, and my elderly mother cares for herself independently. I know that this could all change in a heartbeat, so I am reluctant to have hard and fast goals for the next ten years. Conclusion By following the nurses Code of Ethics and striving for excellence in all areas of my professional life, I am moving toward the goals I have set in my professional development plan. Determining five and ten year goals has given me an opportunity to think beyond obtaining my BSN degree and moved me closer to my professional goals. The inner need in my life to become an advanced practice nurse so that I can achieve more in my professional life than is possible for me now has sparked a new enthusiasm for my education. My service learning project has fueled that need and created a determination to complete these plans sooner instead of later. I have nurtured the goal of obtaining my BSN for over 35 years, and now it is becoming a reality. If that is any indication of how tenacious I can be, I know that if my heart is committed to a course of action then I will get there eventually. I may not get there on the path that I see at this moment, but the destination is on the horizon and I am aiming toward it. As part of the process of growing professionally, I am becoming a better nurse in all areas of my practice.

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PROFESSIONAL DEVELOPMENT PLAN: THE BSN AND BEYOND References American Nurses Association [ANA]. (2001). Code of Ethics for Nurses with Interpretive Statements. Retrieved on 7/18/2012 from:

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www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/C ode-of-Ethics.pdf American Nurses Association [ANA]. (2010). Nursing: Scope and Standards of Practice (2nd Ed.). Silver Spring, MD: Author Ferris State University, (n.d.) Ferris Catalog. Retrieved from http://catalog.ferris.edu/programs/ 558/ Retrieved on February 13, 2011 Frontier Nursing University, School of Midwifery (n.d.) Catalog. Retrieved on 3/1/2012 from www.frontier.edu/academics/nurse-midwifery Harvard University (2012). The Nurses Health Study II. Retrieved on 7/18/2012 from www.channing.harvard.edu/nhs/ Author:

Human Resources Service Administration, US. Department of Health and Human Services (2012). Advanced nursing education. Retrieved 2/29/2012 from http://bhpr.hrsa.gov/nursing/grants/ane.html Midwives for Haiti (n.d.) Who we are. Retrieved 3/26/2012 from www.midwivesforhaiti.org Author: World Health Organization [WHO]. (2012). Ten facts on Midwifery. Retrieved on 7/22/2012 from www.who.int/features/factfiles/midwifery/en. Author: