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Professional Role Development Plan

Kiana Olea

College of Nursing, University of Houston

NURS 3310: Professional Role Development and Practice Issues

Professor Tracy McManaman-Bridges

November 16, 2020

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Professional Role Development Plan

The complexity of today’s health care environment has altered the way the nursing profession

responds to health promotion and the prevention of diseases. In response to this transformation, the

Texas Board of Nursing (BON) developed the Declaratory Essential Competencies (DECs) as a method to

guide the preparation of graduate nurses as providers of safe, high-quality health care. These

competencies highlight the knowledge, clinical behaviors, and clinical judgments that are needed for the

nurse to fulfill their roles within the health care system. The four roles of the baccalaureate-prepared

nurse include being a member of the profession, provider of patient-centered care, patient safety

advocate, and member of the health care team (Texas Board of Nursing, 2010, pp. v-vii).

Member of the Profession

The baccalaureate nurse, as a member of the profession, acts under professional standards of

practice and a code of ethics to provide quality nursing care to their patients through advocacy and

leadership (Texas Board of Nursing, 2010, p. 11). According to the American Nurses Association Code of

Ethics, “the nurse promotes, advocates for, and protects the rights, health, and safety of the patient”

(2015). The nurse serves to represent the interests of their patient; therefore, the nurse should identify,

recognize, and put forth the patient’s values even if they differ from the nurse’s own. The nurse may

face many ethical dilemmas as a patient advocate; however, the nurse needs to recognize their

professional commitment to providing the highest quality of care to their patient (Masters, 2017, pp.

335-337).

The professional nurse can demonstrate that they are a member of the profession through

advocacy. For example, the nurse can publicly support the rights of LGBTQ+ populations. Discrimination

is a major contributor to the increased rates of morbidity and mortality in LGBTQ+ populations. In this

case, patient advocacy can take on different forms and can be done at different levels, whether that be
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within the patient’s family, the medical facility the nurse is employed at, or within the legal system.

Within the patient’s family, the nurse can serve as a mediator, ensure visiting privileges, and provide

education on the LGBTQ+ population health. Within the nurse’s place of employment, the

baccalaureate-prepared nurse can identify strategies to provide education to peers about internal and

external biases that could influence their approach to care. At the legislative level, the nurse can work to

advance certain policies that aim to change and improve access to quality care for LGBTQ+ populations

(American Nurses Association, 2019).

A baccalaureate nurse is not only responsible for providing quality care and promoting the

health of individuals and families, but they must also take accountability for the care that is delivered to

certain groups and populations, unlike a licensed vocational nurse (LVN) or associate degree nurse

(ADN). Additionally, the baccalaureate nurse must be able to use their skills to further the practice of

professional nursing via leadership and advocacy activities that the LVN and ADN contribute to and

participate in. Overall, the key differences that set apart the baccalaureate nurse from the LVN and ADN

as a member of the profession include using their leadership and accountability skills to work outside of

patient care (Texas Board of Nursing, 2010, p. 13).

Provider of Patient-Centered Care

The baccalaureate nurse, as a provider of patient-centered care, uses their knowledge and

clinical reasoning skills to determine their patient's needs. The knowledge from the baccalaureate

program of study allows the nurse to thoroughly apply the nursing process when providing nursing care.

To provide the most comprehensive care, the nurse should be aware of cultural, ethnic, and social

differences when assessing the individual needs, values, and preferences of the patient (Texas Board of

Nursing, 2010, pp. 11-12).

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The professional nurse can demonstrate that they are a provider of patient-centered care by

developing and delivering individualized care. Given the uniqueness of each patient, it is important to

consider the patient’s preferences, education level, emotional support, and health care needs. To

address these issues, the professional nurse can, on the admission of the patient, use therapeutic

communication to determine their response to each concern (Masters, 2017, pp. 268-274). For example,

on the admission of a patient, the professional nurse can respectfully ask the patient their preferred

name and pronouns. The nurse can make note of this information, inform others in the interprofessional

health care team who will also be providing care for the patient, and ensure that for the remainder of

the patient’s stay that they use the correct name and pronouns for the patient to maintain and provide

respectful quality care.

The baccalaureate-prepared nurse, compared to the LVN and ADN, uses the knowledge from

their baccalaureate degree program and research studies as a guide to provide patient-centered care.

Also, the baccalaureate nurse uses this knowledge and applies it to identify the unique needs of

patients, families, populations, and communities, unlike the LVN and ADN that utilize the knowledge

gained from their respective program of study to patients and their families. Lastly, when developing,

implementing, and evaluating plans of care for patients, families, populations, and communities, the

baccalaureate-prepared nurse also considers risk reduction to provide the most comprehensive care

(Texas Board of Nursing, 2010, pp. 13-15).

Patient Safety Advocate

The baccalaureate nurse serves as a patient safety advocate by giving special attention to the

welfare of their patients and acting under the safety rules and mandatory reporting requirements of the

Texas Nursing Practice Act (NPA) and Texas BON (Texas Board of Nursing, 2010, p. 12). Ensuring patient

safety is of the utmost importance in the nursing field; the nurse’s responsibility is towards their patient.
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In the health care setting, safety is known as the minimization of harm to patients through

organizational and individual provider performance. Therefore, it is important to be able to identify and

correct issues within the health care system to create an optimal environment for providing quality care

(American Association of Colleges of Nursing, 2008, pp. 13-14).

The professional nurse can demonstrate that they are a patient safety advocate by reporting

misconduct by a nurse that poses a risk to patient safety. According to the Texas NPA, misconduct that

should be reported includes violations of Texas Board of Nursing rules that leads to serious injury or

death of a patient, abuse, exploitation, violation of professional boundaries, or conduct that signals a

lack of knowledge, skill, or judgment that would pose a risk to a patient’s safety if the nurse continued to

practice (Texas Board of Nursing, 2019, pp. 25-26). An example of a situation that would require

mandatory reporting would be if the professional nurse found out that a colleague nurse restrained a

patient and administered medication against the patient's wishes. This example would fall under the

category of intentional battery, given that the colleague’s action of restraining the patient was

intentional and unreasonable, and administering the medication was a violation of the patient’s

autonomy and posed a significant risk to their safety (ATI Nursing, 2019, p. 15).

The baccalaureate-prepared nurse, unlike the LVN and ADN, is accountable for serving as a

patient safety advocate for populations and communities, not just an individual patient. Additionally,

the baccalaureate nurse is responsible for delegating the appropriate tasks to members of the health

care team, such as the LVN and ADN, taking into account not only the skill and educational level of the

delegatee but the patient’s safety as well (Texas Board of Nursing, 2010, p. 16).

Member of the Health Care Team

The baccalaureate nurse, a member of the healthcare team, effectively communicates and

collaborates with other members of the health care team (Texas Board of Nursing, 2010, p. 12).
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Delegation and supervision are considered critical competencies for the professional nurse who works in

an interprofessional team. The nurse needs to be aware of the laws and regulations of their state

regarding delegation of tasks, in addition to the policies of their employing institution, to provide safe,

high-quality care (National Council of State Boards of Nursing & American Nurses Association, 2016).

The professional nurse can demonstrate that they are a member of a health care team through

appropriate delegation. The nurse is accountable for assigning proper tasks to other members of the

health care team concerning their skill and education level that also follow the laws and regulations of

the state that they are working in. For example, the nurse can assign a certified nursing assistant (CNA) a

task pertaining to activities of daily living, such as bathing or dressing a patient. Nevertheless, there are

tasks that the professional nurse should never delegate to other members of the healthcare team that

does not have the necessary skills or education required to correctly and safely complete the task. These

tasks include patient education and assignments that require nursing judgment or the use of the nursing

process. For example, the nurse should not assign the CNA a task that is outside of their scope of

practice, such as administering medications through intravenous therapy (ATI Nursing, 2019, p. 27).

The baccalaureate nurse is responsible for supervising the care provided by other members of

the health care team that they are responsible for using proper management, leadership skills, and

evaluation techniques, unlike the LVN and ADN who, although can supervise others, do not have the

needed leadership skills. Another key difference between these groups lies in the scope of

communication and collaboration that the nurse is responsible for. The LVN and ADN are accountable

for the promotion and maintenance of the health of their patient and their family, meanwhile, the BSN

is accountable for the patient and their family, in addition to different population groups and

communities (Texas Board of Nursing, 2010, pp. 17-18).

Conclusion
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The roles of the nurse, as outlined in the DECs, reflect the expected knowledge and abilities

from graduate nurses as members of the profession, providers of patient-centered care, patient safety

advocates, and members of the healthcare team. The nurse, as a member of the profession, works

under a code of ethics and a set of professional standards to protect the rights, health, and safety of the

patient which can be demonstrated through advocacy. When providing patient-centered care, the

professional nurse utilizes their knowledge to apply the nursing process to best identify and adequately

address the unique needs of their patient. On top of that, the nurse also serves as a patient safety

advocate, acting accordingly to address any safety risks that could harm the patient. Additionally, as a

member of the healthcare team, the baccalaureate nurse participates in interprofessional collaboration

and is accountable for delegating the appropriate tasks to other members of the healthcare team (Texas

Board of Nursing, 2010).

The basis of the difference between the baccalaureate nurse from the LVN and ADN can be

found in the educational preparation for each role. The baccalaureate program allows the nurse to

develop leadership and management skills that enable them to provide direct and indirect care for

patients, families, populations, and communities (Texas Board of Nursing, 2010).

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References

American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for

professional nursing practice.

https://www.aacnnursing.org/Portals/42/Publications/BaccEssentials08.pdf

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.

https://www.nursingworld.org/coe-view-only

American Nurses Association. (2019). ANA position statement: Nursing advocacy for LGBTQ+ populations.

Online Journal of Issues in Nursing, 24(1), 1-6.

https://www.nursingworld.org/~49866e/globalassets/practiceandpolicy/ethics/nursing-advocacy-

for-lgbtq-populations.pdf

ATI Nursing. (2019). Fundamentals for nursing (10th ed.). Assessment Technologies Institute, LLC.

Masters, K. (Ed.). (2017). Role development in professional nursing practice (5th ed.). Burlington, MA: Jones

and Bartlett.

National Council of State Boards of Nursing, & American Nurses Association. (2016). National guidelines for

nursing delegation.  Journal of Nursing Regulation,  7(1), 5-14. https://10.1016/S2155-

8256(16)31035-3

Texas Board of Nursing. (2010). Differentiated essential competencies of graduates of Texas nursing

programs. https://www.bon.texas.gov/pdfs/publication_pdfs/delc-2010.pdf

Texas Board of Nursing. (2019). Nursing practice act, nursing peer review act, and nursing licensure

compact. [Texas Occupations Code and Rules Regulating the Practice of Nursing]

https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf