My most recent employment included working as a Rehabilitation vocational nurse in an in-patient Rehabilitation hospital. Typically I cared for 6-8 patients at a time, providing total care for each. I am IV certified with much experience in the field, particularly within pediatrics. I have worked with professional nurses, physical and occupational therapists, social workers, dietitians, physicians and more as part of a collaborative and comprehensive health care team.
Issues and Concerns Surrounding Transition For Practical/Vocational Nurse
A licensed practical or vocational nurse (LPN or LVN) is often the first step in one's career toward becoming a certified professional nurse. The role of a vocational nurse differs significantly from the role of a professional nurse. Most nurses trained at this level have one year of study experience at a vocational or community college. A vocational nurse is used to working under the supervision of a licensed RN or professional nurse or physician (Quan, 2004).
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There are multiple issues and concerns surrounding the transition to the role of professional nurse, none the least of which is the shortage of qualified nurse educators to provide guidance to LPN's desiring a career as an RN (Quan, 2004). There are also multiple levels of education one may pursue as a professional nurse that must be considered (Quan, 2004). For example, while many hospitals in the past have offered three year courses allowing students to live in the hospitals, few of these programs still remain (Quan, 2004). Most vocational nurses now desiring a professional career must pursue their Bachelor of Science in Nursing or an associate's degree in nursing. This requires much time, effort and of course, acceptance into a qualified nursing programs.
A vocational nurse must also have the ability to effectively transition to the role of a supervisor or leader, capable of making complex decisions and delegating tasks to others as part of their job responsibilities as a professional nurse.
Clinical Judgment in Autonomy and Accountability of Professional Nursing Practice
Professional nursing practice affords RN's a relatively large amount of autonomy and accountability on the job. Professional nurses are often called on to use their own technical expertise and judgment to help manage and oversee patient care as part of members of a collaborative health care team (Shanbhag, 2002). They are accountable for the results of any decisions they make regarding patient care, even when those decisions involve delegating tasks to others.
In cases where professional nurses supervise the work functions of others, professional nurses must also be held accountable for patient outcomes and the outcomes of their underlings. Professional nurses are often afforded the ability to delegate tasks as they see appropriate to underlings including vocational nurses (Shanbhag, 2002). This requires not only a great deal of decision making ability but also the ability to differentiate among underling's skills, qualifications and abilities. This will help them remain accountable for the actions of each member of their health care team.
A professional nurse is also more likely to be held accountable for patient's outcomes as they often supervise the care of other nurses or health care assistants involved in patient care (Shanbhag, 2002). Most are expected to exercise "independent judgment" reserving the right to direct care in certain circumstance (Shanbhag, 2002). Professional nurses are also more likely to be held accountable for patient outcomes as well as the performance of those working under their direct supervision.
How Professional Nurse Collaborates with Others To Achieve Effective Patient Care
The best possible outcome for patients is only realized when professional nurses work as members of a multidisciplinary team, collaborating to ensure the best patient outcome. A professional nurse does not work alone but rather as a member of a comprehensive patient care team whose goals include optimizing patient outcomes. Members of this comprehensive health care team may include nursing assistants, professional nurses, primary care physicians, social workers, patients and family members (Coombs, 2004). For collaboration to work in the health care team it must often be defined in a non-hierarchical or cooperative manner based "on shared power and authority" assuming that each member of the team holds a certain level of knowledge, responsibility and influence that directly influences patient outcomes (Coombs, 2004).
Professional nursing requires many of the same leadership skills required of doctors or other management professionals. The primary leadership skills beneficial to the field include (1) the ability to establish, maintain and promote communication and interpersonal relationships, (2) the ability to delegate work tasks and oversee the work of others (3) the ability to make decisions based on one's knowledge, skills and expertise (4) the ability to work as members of a collaborative team and (5) the ability to help create interdependency and promote knowledge sharing among all team members (Coombs, 2004). The ability to work collaboratively is a fundamental skill required of effective leaders (Miccolo & Spanier, 1993).
A professional nurse must first be able to provide coworkers, supervisors and underlings with clear communication and insight regarding his or her goals, methods, policies and programs. A professional nurse like any other member of a health care team is responsible for knowledge sharing. Anyone responsible for knowledge sharing within an organization must have the ability to develop communication skills among team members. Further, a leader knows how to delegate work tasks to ensure they aren't overburdened by administrative or nursing tasks at any one point in time. This helps reduce burn out and promotes a more efficient and product team environment. A nurse must also rely on their own education, experience and knowledge to help make directed and responsible decisions within the health care environment. This will help the nurse work as an effective leader within the health care team, and promote cooperation among all team members.
Management of Nursing Care and Delegation
Professional nurses must act as managers, working to help build, create, maintain and manage effective partnerships or teams of workers within the health care environment. The management of nursing care involves identifying what members of the health care team are capable of carrying out certain roles, and assigning them those roles accordingly to ensure the patients basic needs are met, and to ensure a positive health outcome for patients treated under a professional nurses care.
Delegation of tasks is an autonomous task requiring independent decision-making capability. Since professional nurses tend to work in a role that requires leadership, independent thinking, decision making and accountability for patient outcomes, it naturally follows that professional nurses must learn how to delegate tasks appropriately. Proper use of delegation within the health care environment will also free up time for professional nurses to work with multiple patients and to address the many administrative functions and tasks that come along with the role of a professional nurse in today's health care environment (Coombs, 2004).
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