Domain 9: Professionalism

Domain 9: Professionalism 

Descriptor: Formation and cultivation of a sustainable professional identity, including accountability, perspective, collaborative disposition, and comportment, that reflects nursing’s characteristics and values. 

Contextual Statement: Professionalism encompasses the development of a nursing identity embracing the values of integrity, altruism, inclusivity, compassion, courage, humility, advocacy, caring, autonomy, humanity, and social justice. Professional identity formation necessitates the development of emotional intelligence to promote social good, engage in social justice, and demonstrate ethical comportment, moral courage, and assertiveness in decision-making and actions. Nursing professionalism is a continuous process of socialization that requires the nurse to give back to the profession through the mentorship and development of others. 

Professional identity, influenced by one’s personal identity and unique background, is formed throughout one’s education and career. Nursing identity flourishes through engagement and reflection in multiple experiences that is defined by differing perspectives and voices. As a result, nurses embrace the history, characteristics, and values of the discipline and think, act, and feel like a nurse. Professional identity formation is not a linear process but rather one that responds to challenges and matures through professional experiences as one develops confidence as a nurse. 

9.1 Demonstrate an ethical comportment in one’s practice reflective of nursing’s mission to society. 

9.1h Analyze current policies and practices in the context of an ethical framework. 

9.1i Model ethical behaviors in practice and leadership roles. 

9.1j Suggest solutions when unethical behaviors are observed. 

9.1k Assume accountability for working to resolve ethical dilemmas. 

9.2 Employ participatory approach to nursing care. 

9.2h Foster opportunities for intentional presence in practice. 

9.2i Identify innovative and evidence-based practices that promote person-centered care. 

9.2j Advocate for practices that advance diversity, equity, and inclusion. 

9.2k Model professional expectations for therapeutic relationships. 

9.2l Facilitate communication that promotes a participatory approach. 

9.3 Demonstrate accountability to the individual, society, and the profession. 

9.3i Advocate for nursing’s professional responsibility for ensuring optimal care outcomes.

9.3j Demonstrate leadership skills when participating in professional activities and/or organizations. 

9.3k Address actual or potential hazards and/or errors. 

9.3l Foster a practice environment that promotes accountability for care outcomes. 

9.3m Advocate for policies/practices that promote social justice and health equity. 

9.3n Foster strategies that promote a culture of civility across a variety of settings. 

9.3o Lead in the development of opportunities for professional and interprofessional activities. 

9.4 Comply with relevant laws, policies, and regulations. 

9.4d Advocate for policies that enable nurses to practice to the full extent of their education. 

9.4e Assess the interaction between regulatory agency requirements and quality, fiscal, and value based indicators. 

9.4f Evaluate the effect of legal and regulatory policies on nursing practice and healthcare outcomes. 

9.4g Analyze efforts to change legal and regulatory policies that improve nursing practice and health outcomes. 

9.4h Participate in the implementation of policies and regulations to improve the professional practice environment and healthcare outcomes. 

9.5 Demonstrate the professional identity of nursing. 

9.5f Articulate nursing’s unique professional identity to other interprofessional team members and the public. 

9.5g Evaluate practice environment to ensure that nursing core values are demonstrated. 

9.5h Identify opportunities to lead with moral courage to influence team decision-making. 

9.5i Engage in professional organizations that reflect nursing’s values and identity. 

9.6 Integrate diversity, equity, and inclusion as core to one’s professional identity. 

9.6d Model respect for diversity, equity, and inclusion for all team members. 

9.6e Critique one’s personal and professional practices in the context of nursing’s core values. 

9.6f Analyze the impact of structural and cultural influences on nursing’s professional identity. 

9.6g Ensure that care provided by self and others is reflective of nursing’s core values. 

9.6h Structure the practice environment to facilitate care that is culturally and linguistically appropriate. 

9.6i Ensure self and others are accountable in upholding moral, legal, and humanistic principles related to health. 

(American Association of Colleges of Nursing, 2021, pp.49-52)

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. AACNnursing.   https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

Related Evidence

            For the NURS 71163: Roles and Professional Practice for Advanced Practice Registered Nurses (APRNs) course, I was given an assignment to select a procedure or practice related to my field of study, which is psychiatric mental health, and then use the Arkansas State Board of Nursing’s (ASBN) APRN Decision Making Model to create a concept map of my process of interest to determine if it is within the scope of practice of my specialty.

 Once the concept map was completed, I created a five-minute PowerPoint presentation to share my findings with classmates. Because attention deficit hyperactivity disorder is a common disorder leading many patients to seek outpatient behavioral healthcare management, I chose to answer the question, “In the State of Arkansas, do psychiatric mental health nurse practitioners have the authority to prescribe stimulants?” For this assignment, I completed a significant amount of research on laws governing APRNs’ prescriptive authority within the state of Arkansas. I found that Arkansas remains a collaborative practice state with the option to apply for a certificate of full independent practice once the APRN achieves specific milestones (Arkansas Code, n.d.). I also learned that APRNs with prescriptive authority are authorized to prescribe drugs, medicines, and therapeutic devices that are appropriate to the APRN’s specific area of practice. However, the APRN’s prescriptive authority only extends to drugs listed in Schedules III-V with limited and specific exceptions. The Arkansas APRN with prescriptive authority may prescribe stimulants, a Schedule II class of medication, only if a physician originally initiated the prescription, the physician has evaluated the patient within the six-month period prior to the APRN issuing the prescription, and the APRN’s prescription is providing treatment for the same condition as the physician’s original prescription (Arkansas Code, n.d.).

In the NURS 71163 course, I was also assigned to develop a one-slide PowerPoint infographic that presented essential information regarding APRN regulations and practices dictated by the State Board of Nursing for the state where I intend to practice. Because my family and I will be relocating to the state of Washington following my graduation from UAMS, I conducted extensive research regarding Washington’s laws and regulations governing APRN practice and incorporated this information into my infographic. I discovered that Washington grants APRNs full practice authority with no requirement for physician involvement (AMA, 2017). To obtain prescriptive eligibility in Washington, the APRN must (a) hold an active Washington State APRN license free of sanctions and restrictions; (b) provide evidence of 30 contact hours of education in pharmacology; (c) and submit a completed application, the required fee, and evidence of completed pharmacology education  (Washington State Legislature, n.d.).

Additionally, I learned that the APRN with prescriptive authority may prescribe Schedule II drugs through Schedule V and Legend drugs without restriction if these medications are within the APRN’s scope of practice (Washington State Legislature, n.d.).

Reflection

            I found both the presentation assignment, utilizing the ASBN’s APRN Decision Making Model to determine if Arkansas APRNs with prescriptive authority are authorized to prescribe stimulants to patients, and the infographic, detailing key information pertaining to laws regulating APRN’s practice in the state of Washington, to be extremely beneficial. Until this point in my academic career, my focus has been entirely on patient care. This course and these assignments provided my first opportunity to familiarize myself with laws and regulations regarding my future practice. Both these assignments greatly enhanced my knowledge of the laws, policies, and regulations surrounding APRN practice, enabling me to achieve the critical Domain 9.4, “Comply with relevant laws, policies, and regulations" (American Association of Colleges of Nursing, 2021, p. 51). Additionally, I feel that I benefited from both these assignments because they forced me to examine the differences in Arkansas and Washington legislation, which contributed to my understanding of the importance of my involvement in professional organizations that advocate for needed policy and legislative changes. Although, I have not yet achieved Domains 9.4g, “Analyze efforts to change legal and regulatory policies to improve nursing practice and health outcomes,” and 9.4h, “Participate in the implementation of policies and regulations to improve the professional practice environment and healthcare outcomes" (American Association of Colleges of Nursing, p. 51), I am now highly motivated to pursue achievement of these domains.

References

 American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. AACNnursing.   https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

American Medical Association. (2017). State law chart: Nurse practitioner practice authority [PDF]. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-practice-authority.pdf

Arkansas Code. (n.d.). Arkansas code of 1987 (2023) :: Title 17 - professions, occupations, and businesses (§§ 17-1-101 — 17-107-311) :: Subtitle 3 -medical professions (§§ 17-80-101 — 17-107-311) :: Chapter 87 - nurses (§§ 17-87-101 — 17-87-808) :: Subchapter 3 - licensing (§§ 17-87-301 —17-87-316) :: Section 17-87-310 - prescriptive authority. Justia Law. https://law.justia.com/codes/arkansas/title-17/subtitle-3/chapter-87/subchapter-3/section-17-87-310/

Washington State Legislature. (n.d.). WAC 246-840-410: Application requirements for ARNP

prescriptive authority.