NR 449 Week 1 Discussion: Clinical Decision Making

NR 449 Week 1 Discussion: Clinical Decision Making

Student Name

Chamberlain University

NR-449 Evidence-Based Practice

Prof. Name:

Date

Introduction to Developing Self and Others

The nursing profession offers a range of career pathways that allow individuals to enhance their skills, grow professionally, and explore varied opportunities through structured career planning. The continuous acquisition of knowledge and alignment of personal goals with professional development are critical elements in the process of self-development. Moreover, nursing leadership plays a pivotal role in mentoring and supporting emerging nurse leaders. Effective career planning incorporates evidence-based practices, skill enhancement, the influence of mentors, ongoing education, and a dedication to lifelong learning.

This learning process enables individuals to:

• Explain strategies for self and peer development.
• Distinguish between leadership and management responsibilities in career planning.
• Explore the concept of professional identity and success planning.
• Apply developmental stages of nursing knowledge acquisition.

Professional Career Advancement

Career development in nursing is a shared responsibility between healthcare organizations and the individual nurse. While institutions offer resources and structure, each nurse must also take personal initiative in guiding their professional journey. Effective development includes goal setting, continual education, and active engagement in opportunities that foster growth.

Leadership and Management in Career Planning

Benner’s Novice-to-Expert Framework

Benner’s theoretical model outlines five stages of nursing experience:

• Novice: Beginners with no clinical experience, rigid adherence to taught rules.
• Advanced Beginner: Some exposure, but still rule-focused and requires guidance.
• Competent: Gains efficiency through experience, prioritizes tasks.
• Proficient: Sees situations holistically, improves decision-making.
• Expert: Intuitive understanding and deep clinical expertise.

Leadership Versus Management Roles

Leadership involves inspiring others, modeling best practices, and fostering innovation. Management, on the other hand, focuses on operational efficiency, policy enforcement, and staff support. Together, these roles create an environment conducive to professional development.

Professional Identity in Nursing

Professional identity involves the integration of ethical values, acquired knowledge, leadership capacity, and recognition of nursing as a lifelong vocation. This identity shapes how nurses view themselves and how they contribute to their teams and the profession at large (Rischer, 2021).

Career Stage Examples

Steps to Develop Self and Others

Succession Planning and Organizational Support

Succession planning entails identifying potential leaders and aligning organizational development with career aspirations. Evaluations, feedback, and access to job postings are critical. Training policies must support internal mobility and career advancement. Institutions should promote learning opportunities tailored to staff development.

Self-Development Framework

Self-development requires proactive planning:

1. Assess personal interests, strengths, and areas for improvement.
2. Set short- and long-term SMART goals.
3. Visualize future career direction.
4. Plan strategies to build skills, such as further education.
5. Execute the plan.
6. Reassess and adjust biannually to stay on course.

Transitioning to Practice

Transition programs help bridge the gap from education to employment. The American Nurse Credentialing Center’s Practice Transition Accreditation Program® (PTAP) is the recognized benchmark:

Success Tips for New Nurses

• Network with colleagues and attend professional events.
• Establish mentor relationships.
• Maintain open communication; ask questions.
• Verify clinical references and procedures.
• Embrace lifelong learning.
• Practice self-care and manage stress.

Nursing Orientation Success

• Accept that clinical orientation is overwhelming but necessary.
• Ask questions without hesitation.
• Observe varied nursing practices.
• Learn medication protocols and patient care routines.
• Communicate openly with preceptors and colleagues.
• Seek support networks inside and outside the workplace.

Case Reflection: New Nurse Experience

A new graduate nurse feeling overwhelmed due to inconsistent mentorship and leadership voids illustrates the challenges faced during transition. This scenario places the nurse in the “novice” category within Benner’s framework. Key concerns include unclear roles, inconsistent guidance, and inadequate preparation. Solutions include open communication, resource identification, and establishing clear reporting lines.

Recognizing and Analyzing Cues

Taking Action and Evaluating Outcomes

Effective actions for a new nurse:

• Clarify unit expectations with preceptors.
• Address concerns directly and professionally.
• Utilize the chain of command.
• Do not delay questions until after shifts.
• Advocate for support and learning consistency.

Recruitment and Retention in Nursing

Nurse leaders are responsible for attracting and retaining talent in alignment with the organization’s mission. Successful retention efforts involve career planning, professional development, and supportive management structures.

Role of Nurse Managers in Employee Hiring and Onboarding

Responsibilities in the Hiring Process

Nurse managers are crucial in recruiting, interviewing, and hiring new nursing staff. They collaborate with human resources to identify staffing needs, define job descriptions, and screen applicants. During interviews, nurse managers assess candidates’ skills, experiences, and compatibility with the team and workplace culture. Importantly, they also ensure that interview questions comply with employment laws, avoiding inquiries about age, religion, marital status, or other discriminatory topics. Once the candidate is selected, nurse managers help develop orientation plans tailored to unit-specific needs.

Organizational Assessment During Job Search

When nurses relocate and explore job opportunities at different hospitals, it’s important they assess several organizational elements to determine workplace suitability. Below are essential questions and what they evaluate:

These questions are valuable for assessing the overall atmosphere, policies, and safety culture of a prospective workplace.

Recruitment and Retention

Distinction Between Recruitment and Retention

Recruitment is the process of attracting and selecting individuals best suited for specific roles. Retention involves strategies to maintain staff engagement and minimize turnover. Below is a comparison:

Role of Human Resources in Staffing

Human resources (HR) play a key role in both recruitment and retention. They ensure that staff are hired according to policies and legal standards, verify credentials, screen applicants, and manage transfers and promotions. In collaboration with nurse managers, HR ensures that the nursing staff are competent and compliant with the facility’s standards.

Recruitment Strategies

Effective recruitment involves both internal and external approaches:

• Internal postings and staff referrals
• Job advertisements (online and print)
• Professional organization job boards
• Social media outreach
• Broadcast media (radio, TV)
• Recruitment agencies

Retention Strategies

To retain nurses, organizations must provide support and incentives. According to Kelbach (2020), successful strategies include:

• Hiring the right people: Ensuring a good match between nurse and unit.
• Offering meaningful benefits: Competitive compensation and benefits.
• Recognizing staff contributions: Involving them in decisions and showing appreciation.
• Providing welcome packages: Personalized gestures such as coffee gift cards and lanyards.
• Adding a personal touch: Managers regularly checking in with staff.
• Identifying ways to help: Being visible and supportive on the unit.

Addressing the Nursing Shortage

Causes of Nursing Shortages

The shortage of nurses stems from multiple factors:

• Aging workforce and retirements
• Poor work-life balance
• Family and caregiving responsibilities
• Cost-cutting and understaffing
• High workloads and stress
• Limited educational capacity

Solutions Proposed by Future of Nursing 2020-2030

According to the National Academies of Sciences, Engineering, and Medicine (2021), addressing nursing shortages requires:

• Increasing the number and geographic distribution of nurses
• Supporting diverse and culturally competent workforces
• Addressing barriers to workforce capacity
• Assessing long-term effects of the COVID-19 pandemic

Supply and Demand Outlook

The U.S. Bureau of Labor Statistics (2021) projects a 9% growth in registered nursing positions from 2020 to 2030. However, educational bottlenecks such as limited faculty, clinical sites, and classrooms threaten the supply of qualified nurses. Faculty salaries are often lower than clinical salaries, further exacerbating the issue (AACN, 2019).

Impact of Retention on Quality of Care

Poor retention negatively affects quality of care. For instance, higher turnover has been associated with increased pressure ulcer rates in hospitals (Buchan et al., 2018). On the other hand, Magnet hospitals report higher job satisfaction and lower mortality rates (Smith, 2014).

Legal Aspects of Interviewing

Nurse managers must avoid questions about personal and protected characteristics such as religion, age, and sexual orientation during interviews. Acceptable questions focus on experience, goals, and competencies, such as:

• “Why did you apply for this position?”
• “What are your career goals?”
• “Have you passed the NCLEX?”

Orientation and Onboarding

Phases of Onboarding

Responsibilities

Evaluating Onboarding Outcomes

Lifelong Learning and Career Development

Lifelong learning is essential in nursing. Nurses should continuously seek updated, evidence-based knowledge. For example, if uncertain about a treatment plan, a nurse should consult reputable evidence-based sources before acting.

Adult learners bring unique strengths and challenges. Self-directed motivation, prior experience, and proven learning ability are assets. Time constraints, personal distractions, and low self-confidence are common obstacles.

Preceptorship and Skill Acquisition

During orientation, new nurses should actively communicate with preceptors about the need for hands-on learning. Demonstrating competence and enthusiasm can help build trust and support skill development. Reporting preceptors without cause or bypassing the chain of command is not recommended.

References

Respecting the Chain of Command

New nurses are advised not to bypass their preceptor by approaching other nurses or the nurse manager directly. This behavior may be interpreted as a lack of respect for the established chain of command within the clinical setting. Conversely, taking no action at all may hinder the nurse’s learning and professional development.

Nurse Residency Programs

Structure and Purpose

Nurse residency programs, also referred to as transition-to-practice initiatives, typically span from eight months to one year and serve as a complementary component to preceptorships. These programs aim to foster the development of critical thinking, clinical reasoning, and clinical judgment in novice nurses.

Hospitals offer varied formats for nurse residencies. Some programs are intensive and cater to high-acuity units such as critical care, while others emphasize specialized skills training. For instance, oncology residencies may include instruction in chemotherapy administration and the use of port-a-caths. Prospective nurses should familiarize themselves with the structure and focus of these programs before accepting a position.

Example: Dominique’s Nurse Residency Experience

Dominique completed a year-long nurse residency that ran concurrently with her preceptorship. During the first three months, she worked two unit shifts per week and spent an additional 12 hours engaging in simulations and online modules. The remaining nine months included a monthly class alongside her three weekly unit shifts.

First Three Months

Last Nine Months

Monthly interdisciplinary classes were held with all new ICU and hospital-wide nurses. Topics included:

• Ethics
• Medication administration
• Restraints
• Quality improvement
• Incident reporting

Final Requirements and Outcome

Each residency group presented a quality improvement (QI) project. Dominique’s team focused on preventing ventilator-associated pneumonia, which helped her understand the practical application of evidence-based care. She credited the residency with providing strong support in her initial year as a cardiac ICU nurse.

Quality Improvement Projects

Dominique was tasked with presenting a QI topic relevant to the ICU. Appropriateness of various QI topics is summarized below:

Mentorship, Role Models, and Coaching

Dominique is considering furthering her career and seeks guidance through mentorship or coaching. She reflects on different types of professional relationships:

Committee Involvement and Reflection

Following advice from her charge nurse, Dominique joined two hospital committees: Policy & Procedure and the Wound Care Initiative. This involvement helps her explore areas of interest and promotes personal growth.

Reflection prompts:

• What are your post-orientation plans?
• Which nursing topics interest you most?
• Are there committees aligning with your specialty?

Evidence-Based Practice (EBP)

Dominique becomes an advocate for piloting a client turn team in her unit to prevent pressure ulcers. Her process involved:

• Reviewing recent EBP literature
• Evaluating systematic reviews
• Consulting multiple databases
• Presenting findings to leadership for implementation consideration

The EBP model includes:

• Ask
• Acquire
• Appraise
• Apply
• Act

Confirmation bias—using evidence that only supports a preexisting belief—is discouraged in favor of balanced and validated sources.

Continuing Education and Professional Associations

Ongoing education is essential for maintaining licensure and staying current in practice. Nurses are encouraged to prioritize CE courses based on role relevance.

Prioritization of CE Topics for an Oncology Nurse Manager

Professional Certifications

Dominique aims to strengthen her qualifications for a leadership role by pursuing a Critical Care Registered Nurse (CCRN) certification. Certification enhances professional standing and requires both an examination and ongoing CE.

Emergency Department Case

Among several candidates, a nurse with 7 years of experience and multiple certifications (BLS, ACLS, PALS, TNCC, CEN, TCRN) stands out due to demonstrated commitment and expertise.

Personal Development and Self-Care

Dominique experiences burnout six months into her assistant manager role. She is encouraged by leadership to take early vacation and read self-care literature. Recognizing the need for self-care is key to sustaining long-term professional effectiveness.

Reflection prompts:

• How do you meet personal needs?
• Have you neglected self-care before?
• How did you realize you needed a change?

Formal Education and Lifelong Learning

Three years into her leadership role, Dominique considers pursuing a master’s in nursing. She understands that lifelong learning encompasses formal education, EBP, CE, certifications, and professional experience.

Steps to Secure Support While Pursuing Education

Attributes of Lifelong Learning

Behaviors that indicate successful mentorship and a lifelong learning mindset include:

• Seeking evidence-based information
• Valuing different learning styles
• Educating peers
• Participating in committees
• Completing relevant CE courses
• Pursuing independent research

Relying solely on personal experience is not indicative of effective lifelong learning.

Case Study: Pursuit of Nurse Manager Position

An assistant nurse manager with 4 years of ICU leadership experience and enrolled in an MSN program applies for a med-surg ICU manager role. The candidate lacks the preferred certification and two additional years of supervisory experience but meets all minimum requirements.

Prioritizing Lifelong Learning for Nurse Managers

Advancing Leadership Credentials

Dominique, now a seasoned nurse manager with a completed master’s degree, seeks further recognition by:

• Planning for Clinical Nurse Leader (CNL) certification
• Enrolling in a Doctor of Nursing Practice (DNP) program in executive leadership

These credentials align with her leadership trajectory and demonstrate continued commitment to growth.

Certification and Lifelong Learning

While certifications such as the NIH Stroke Scale (NIHSS) and Medical-Surgical Registered Nurse (MSRN) hold value and professional credibility, they may not align with a nurse manager’s current phase in their ongoing learning journey. For an experienced professional, acquiring certifications appropriate to their advanced leadership role can more effectively demonstrate commitment to lifelong learning. Delegating tasks that others can perform independently does not foster their development or reinforce the nurse manager’s role as a mentor.

Evaluating Outcomes of Lifelong Learning

Reflecting on a five-year journey as a nurse manager, several accomplishments can illustrate continued commitment to learning:

• Developing an orientation program for assistant nurse managers
• Publishing a case study on nurse retention
• Earning a Doctor of Nursing Practice (DNP) in executive leadership
• Co-authoring a chapter in a nursing management book

Each of these actions represents either acquisition or dissemination of knowledge, which are essential traits of a lifelong learner. Recognition through awards or achievements like saving the organization money may indicate competence, but they do not specifically reflect educational growth or knowledge sharing.

Introduction to Career Development

The nursing profession offers a broad range of career pathways that support education, skill development, financial growth, and leadership opportunities. However, transitioning between roles can be both exhilarating and challenging. Nurses—whether new to the field or seeking advancement—must understand leadership and management roles to align their career progression effectively.

Objectives of the learning module include:

• Identifying reasons for career development
• Differentiating personal and organizational responsibilities in career planning
• Exploring leadership paths in nursing
• Applying career planning concepts in the pursuit of management roles

Justifying Career Development Programs

Several factors underscore the need for structured career development in healthcare settings:

• Encouragement of evidence-based practices
• Enhancement of employee growth opportunities
• Improvement in quality of work life
• Boosting organizational competitiveness
• Ensuring equal employment access for underserved populations

When healthcare professionals feel stagnant or mismatched with their roles, productivity can decline. Career development provides structured pathways for professional growth and satisfaction, making organizations more attractive to highly skilled candidates.

Showcasing Expertise

A professional portfolio is a critical tool in a nurse’s career. Unlike a resume, which offers a brief snapshot, or a curriculum vitae, which details academic history, a portfolio contains evidence of competencies and accomplishments. This document supports self-reflection and demonstrates long-term growth.

Career Development Goals

Career development supports both individual and organizational goals:

Individual and Organizational Roles

Both individuals and organizations play pivotal roles in career advancement.

Career Coaching and Services

Career coaches help new nurses and professionals with:

• Resume and portfolio preparation
• Interview practice
• Career planning and goal setting
• Transitioning into leadership roles

Nurses are encouraged to keep portfolios that demonstrate their evolving competencies. Career coaches support internal growth rather than advising employees to seek roles outside the organization.

Case Study: Pat’s Career Development

Background: Pat has served as a charge nurse and team leader at Chamberlain Health Center for five years. Feeling unchallenged, Pat wishes to pursue leadership roles but is unsure where to begin.

Key Issues Identified:

• Job stagnation and reduced motivation
• Desire for career advancement
• Supportive work environment but lack of guidance

Recommended Actions:

Development Progress:

Nurse Manager Responsibilities

Nurse managers hold clinical and administrative responsibilities such as:

• Overseeing nursing teams
• Managing patient care
• Making budgetary decisions
• Coordinating meetings
• Setting work schedules

Career Pathways in Management

Leadership progression generally follows this structure:

Educational Pathways

Education plays a crucial role in management roles. While bachelor’s degrees are often sufficient for entry-level leadership, middle and upper-level roles typically require a graduate or doctoral degree. Nurses should align educational pursuits with desired career outcomes.

Promoting Self-Care

The World Health Organization (2021) defines self-care as individuals’ ability to maintain health and manage illness with or without healthcare support. For nurses, practicing self-care is essential in preventing burnout and promoting job satisfaction.

Core Self-Care Activities Include:

• Healthy diet and exercise
• Rest and sleep (7-8 hours/night)
• Leisure and spiritual engagement
• Maintaining personal relationships

Self-Care and Professional Standards

According to the American Nurses Association’s Code of Ethics (2015), nurses have a duty to themselves to:

• Maintain health and safety
• Preserve integrity and character
• Pursue personal and professional growth
• Maintain competence

Self-care is critical for sustaining motivation and performance in clinical and leadership roles.

Organizational Support for Self-Care

Organizations play a vital role in promoting self-care by:

• Prioritizing ergonomics
• Offering wellness benefits
• Providing nutritious meal options
• Supporting flexible work schedules
• Hosting stress management and mindfulness sessions

Conclusion

Career development and self-care are intertwined components of professional nursing. Effective career planning, ongoing education, and workplace support not only enhance individual job satisfaction but also contribute to high-quality patient care and organizational success.

References

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

National Council of State Boards of Nursing. (2015). Welcome to the nursing profession.

The Workforce Institute. (2017). Practical strategies to promote employee wellness.

NR 449 Week 1 Discussion: Clinical Decision Making

World Health Organization. (2021). Self-care interventions for health. https://www.who.int/news-room/fact-sheets/detail/self-care-health-interventions