First let me say I'm not a lawyer, nor do I play one on TV.

What horseshit. First I went through all the flicker pictures of your emails. While it is hard to do, I did it. I do hope that you included all of them. I would say that what you posted leans your way.

Next, I would say that there is not way I would let them into my computer. No way, no how. If there is something on your computer that goes against you then who ever you sent it to would have a copy. Just because you wrote it, doesn't mean you sent it. If you didn't send it, it has no bearing on what happened.

I do like the cease letter the college sent you. Did you do, say or post something other than the emails that you were sent? If not what do they want you to quit doing? So unless you did something else, or these are great photoshops, I see nothing you did to harm the college. They sent you the letters so the truth rule would apply.

Let me know the out come.

Harold

BTW, I have never asked my health care provider what their sexual orientation was. I never asked because I don't care!

Frankly if someone is able to fix what ails me, I could care less if they find me attractive. After all, are we talking about regular, normal people who happen to be gay? Or are we talking about sexual predators? Or does the original question presume that one equates to the other?

Several points for consideration:

The American Nurses Association publishes both the Code of Ethics for Nurses with Interpretive Statements and Nursing's Social Policy Statement, which serves as a formal mechanism of the profession's social contract with its attendant obligations. The nurse's sexual orientation and gender identity are decidedly not a basis by which to select and evaluate professional nursing care.

Moreover, the status of the nursing school is significant. If it receives government and public funding, it must adhere to policies and practices of non-discrimination.

I tried to post a comment which was much too long, so am going to comment in shorter bites. The ANA Social Policy Statement will be coming to you in sections, so you can use it as a tool.
The Social Policy Statement draft is cut and pasted because the ANA put it back behind its firewall again. This draft was just closed to public comment two weeks ago, and it is probably going to be accepted as presented: (next comment)

http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards.aspx

http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/EthicsStandards/CodeofEthics/CodeofEthics.aspx

I will email you separately in case this is too long to go through.

DRAFT Nursing's Social Policy Statement - American Nurses Association Part I

DRAFT

Nursing’s Social Policy Statement:
The Essence of the Profession

ANA’s Congress on Nursing Practice and Economics

December 15, 2008

Draft for Public Comment

Nursing’s Social Policy Statement: The Essence of the Profession

“Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill and caring in improving the health status of the public and ensuring safe, effective, quality care.” (Nursing’s Agenda for the Future, 2001)

This revision of Nursing’s Social Policy Statement describes the essence of the profession by incorporating and building upon earlier thinking and writings. This social policy statement serves as a resource to assist nurses in conceptualizing their practice and provides direction to educators, administrators, and researchers within nursing. This statement also informs other health professionals, legislators and other regulators, funding bodies, and the public about nursing’s social responsibility, accountability, and contribution to health care. The description of the social context of nursing creates the foundation for understanding the definition of nursing, appreciating the purpose and use of the scope and standards of nursing practice, and valuing the elements of professional, legal, and self regulation.

Social Context

Nursing, like other professions, is an essential part of the society out of which it grew and within which it continues to evolve (See definition of nursing in Box 1). Nursing is responsible to society in the sense that nursing’s professional interest must be perceived as serving the interest of that society. The mutually beneficial relationship between society and its profession has been expressed as follows:

…professions acquire recognition and relevance primarily in terms of needs, conditions, and traditions of particular societies and their members. It is societies (and often vested interests within them) that determine, in accord with their different technological and economic levels of development and their socioeconomic, political, and cultural conditions, and values, what professional skills and knowledge they most need and desire. By various financial means, institutions will then emerge to train [educate] interested individuals to supply those needs.

Logically, then, the professions open to individuals of any particular society are the property not of the individual, but of the society. What individuals acquire through training [education] is professional knowledge and skill, not a profession or even part ownership of one. (Page, 1975, p. 7)

Social Concerns in Health Care

Health care continues to be a major focus of attention in the United States and worldwide. Public and political determinations are being made in six major areas, in each of which nursing has a leadership role:

1. Organization, delivery, and financing of health care.
Quality health care is a human right for all (ANA, 2008c). Increasing costs of care, health disparities, and the lack of accessible, available, and acceptable healthcare services and resources are complex issues that must be addressed to improve the quality of care.

2. Provision for the public’s health.
Increasing responsibility for basic self-help by individuals, families, groups, communities, and populations complements the use of health promotion, disease prevention, and environmental measures.

3. Continued expansion of healthcare knowledge and appropriate application of technology.
Research and evidence-based practice help inform the selection, implementation, and evaluation processes associated with the generation and application of knowledge and technology solutions.

4. Further development of healthcare resources and health policy.
These efforts include expanding facilities and workforce capacity for personal care and community health services, while increasing basic self-help resources for individuals, families, groups, communities, and populations.

5. Definitive planning for health policy and regulation.
Collaborative planning is responsive to consumer needs and provides for best resource use in the provision of health care for all.

6. Duties under extreme conditions.
Health professionals will weigh their duty to pro¬vide care with obligations to their own health and that of their families during disasters, pandemics, and other extreme emergencies. (ANA, 2008a)

Regulatory bodies set institutional standards for mandated quality of care. Other healthcare entities provide guidelines and protocols to attain higher quality care and better outcomes. The goal to provide quality, while addressing the costs and quantity of available healthcare services, will continue to be social and political priorities for action.

Authority for Practice

The authority for nursing, as for other professions, is based on social responsibility, which in turn derives from a complex social base and a social contract.

There is a social contract between society and the profession. Under its terms, society grants the professions authority over functions vital to itself and permits them considerable autonomy in the conduct of their own affairs. In return, the professions are expected to act responsibly, always mindful of the public trust. Self-regulation to assure quality and performance is at the heart of this relationship. It is the authentic hallmark of the mature profession. (Donabedian, 1976)

Facets of contemporary society, including depersonalization, apathy, minimal physical contact, and a growing globalization, can lead individuals to overlook the social contract that underlies their profession. Nursing’s social contract reflects the profession’s longstanding core values and ethics which provide a grounding point for health care in society. Society validates the existence of the profession through licensure, public affirmation, and legal and legislative parameters while nursing’s response is to provide care to all who are in need, regardless of their social or economic standing.

The nursing profession fulfills society’s need for highly educated individuals who embrace and act according to a strong code of ethics, especially when entrusted with the health care of individuals, families, groups, communities, and populations. Polls reflect this mutual relationship in the ranking of “nursing” within the top few most trusted professionals. This trusted position in society is interpreted by the nursing profession as the responsibility to provide the very best health care. The provision of such health care relies on well educated and clinically astute nurses and a professional association comprised of these same nurses that establishes a code of ethics, standards of care, educational and practice requirements, and policies that govern the profession.

Nursing has a professional organization, the American Nurses Association (ANA), through which nursing’s responsibility to society as a whole is exercised. The ANA performs an essential function in articulating and strengthening, as well as maintaining, the social contract that exists between nursing and society, upon which the authority to practice nursing is based. That social contract is evident in ANA’s work that is derived from the collective expertise of its constituent member associations, individual members, and affiliate member organizations. Such works include: (1) the Code of Ethics for Nurses With Interpretive Statements (2001), (2) development and maintenance of standards of practice, (3) support for development of nursing theory and research to explain observations and guide nursing practice, (4) established educational requirements of professional practice, (5) defined certification processes for professional role competence, and (6) developmental work directed towards nursing’s accountability to society, including practice policy work and governmental advocacy.

The following statements undergird professional nursing’s social contract with society:
• Humans manifest an essential unity of mind, body, and spirit.
• Human experience is contextually and culturally defined.
• Health and illness are human experiences. The presence of illness does not preclude health nor does optimal health preclude illness.
• The relationship between the nurse and patient occurs within the context of the values and beliefs of the patient and nurse.
• Public policy and the healthcare delivery system influence the health and well-being of society and professional nursing.
• Individual responsibility and interdisciplinary involvement are essential.
These values and assumptions apply whether the recipient of professional nursing care is an individual, family, group, community, or population.

Part II ANA Social Policy Statement

Professional Collaboration in Health Care

The nursing profession is particularly concerned with establishing effective working relationships essential to accomplishing its health-oriented mission. Multiple factors combine to intensify the importance of the direct human interactions, communication, and professional collaboration. Some of these factors include the complexity and size of the healthcare system and its transitional and dynamic state, increasing public involvement in health policy, and a national focus on health. Collaborative efforts correspond to the inherent focus of the nursing profession’s response to human needs and society’s expectations.

Collaboration means true partnership, in which the power on both sides is valued, with recognition and acceptance of separate and combined spheres of activity and responsibility. Collaboration includes mutual safeguarding of the legitimate interests of each party and a commonality of goals that is recognized by both parties. Such a relationship is based upon recognition that each is richer and more truly real because of the strength and the uniqueness of the other.

For successful collaboration, nursing and its members must be responsive to diversity by recognizing, assessing, and adapting the nature of working relationships with individuals, populations, and with other health professionals and health workers. These efforts extend as well to relationships within nursing, and between nursing and representatives of the public at large.

Definition of Nursing

Definitions of nursing have evolved to acknowledge seven essential features of professional nursing:
• Provision of a caring relationship that facilitates health and healing.
• Attention to the range of human experiences and responses to health and illness within the physical and social environments.
• Integration of objective data with knowledge gained from an appreciation of the patient or group’s subjective experience.
• Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking.
• Advancement of professional nursing knowledge through scholarly inquiry.
• Influence on social and public policy to promote social justice.
• Assurance of safe, quality, and evidenced-based practice.

In her Notes on Nursing: What It Is and What It Is Not, published in 1859, Florence Nightingale defined nursing as having “charge of the personal health of somebody…and what nursing has to do…is to put the patient in the best condition for nature to act upon him.”

A century later, Virginia Henderson (1961) defined the purpose of nursing as “to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.”

In the 1980 Nursing: A Social Policy Statement, nursing was defined as “the diagnosis and treatment of human responses to actual or potential health problems.”

In 2001, the ANA Code of Ethics With Interpretive Statements stated that “nursing encompassed the prevention of illness, the alleviation of suffering, and the protection, promotion and restoration of health in the care of individuals, families, groups, and communities.”

The definition for nursing remains unchanged from the 2003 Nursing’s Social Policy Statement, 2nd Edition:

“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”

This definition subsumes four essential characteristics of nursing: human responses or phenomena, theory application, nursing actions or interventions, and outcomes.

Human responses to actual or potential health problems are the phenomena of concern to nurses. Human responses include any observable need, concern, condition, event, or fact of interest to nurses, which may be the target of evidence-based nursing practice.

Theory is a set of interrelated concepts, definitions, or propositions used to systematically describe, explain, predict, or control human responses or phenomena of interest to nurses. Understanding theory from nursing and other disciplines precedes and serves as a basis for theory application through evidence-based nursing actions.

The aims of nursing actions are to protect, promote and optimize health, to prevent illness and injury, to alleviate suffering, and to advocate for individuals, families, communities, and populations. Nursing actions are theory and evidence based. Nursing actions require highly developed intellectual competencies including observational, technical, and interpersonal skills.

The purpose of nursing actions is to produce beneficial outcomes in relation to identified human responses. Evaluation of outcomes of nursing actions determines whether the actions have been effective. Findings from nursing research provide rigorous scientific evidence of beneficial outcomes of specific nursing actions. Figure 1. Defining Characteristics of Nursing Practice depicts the intertwined relationships of human responses, theory application, nursing actions, and outcomes.
Knowledge Base for Nursing Practice

Nursing is a profession and is both a science and an art. The knowledge base for professional nursing practice includes nursing science, philosophy, and ethics, as well as biology, psychology, and the social, physical, economic, organizational, and technology sciences. To refine and expand the knowledge base, nurses use theories on the basis of their fit with professional nursing’s values of health and health care, as well as their relevance to professional nursing practice. Nurses utilize research findings and implement the best evidence into their practice based on applicability to the individual, family, group, community, population, or system of care.
Consequently these efforts generate knowledge.

Nurses are concerned with human experiences and responses across the lifespan. Nurses partner with individuals, families, communities, and populations to address issues such as:
• promotion of health and wellness
• promotion of safety and quality of care
• care and self-care processes
• physical, emotional, and spiritual comfort, discomfort, and pain
• adaptation to physiologic and pathophysiologic processes
• emotions related to the experience of birth, growth and development, health, illness, disease, and death
• meanings ascribed to health and illness
• linguistic and cultural sensitivity
• health literacy
• decision-making and the ability to make choices
• relationships, role performance, and change processes within relationships
• social policies and their effects on health
• healthcare systems and their relationships to access, cost, and quality of health care
• the environment and the prevention of disease and injury
Nurses use their theoretical and evidence-based knowledge of these human experiences and responses to collaborate with patients to assess, diagnose, identify outcomes, plan, implement, and evaluate care. Nursing interventions are intended to produce beneficial effects, contribute to quality outcomes, and above all, do no harm. Nurses evaluate the effectiveness of their care in relation to identified outcomes and use evidence-based practice to improve care

Scope of Nursing Practice

Professional nursing has one scope of practice, which encompasses the range of activities from those of the beginning registered nurse through the most advanced level of nursing practice. The scope of practice statement describes the who, what, where, when, why, and how of nursing practice. While a single scope of professional nursing practice exists, the depth and breadth to which individual nurses engage in the total scope of professional nursing practice is dependent on their educational preparation, their experience, their role, the setting, and the nature of the population they serve.

Further, all nurses are responsible for practicing in accordance with recognized standards of professional nursing practice, professional performance, and the recognized professional Code of Ethics. Note the lower level and foundation of the pyramid in Figure 2. Model of Professional Nursing Practice Regulation includes the scope of professional practice, standards of practice and the Code of Ethics.
© 2008 ANA
Figure 2. Model of Professional Nursing Practice Regulation

Each nurse remains accountable for the quality of care within his/her scope of nursing practice. The level of application of standards varies with the education, experience, and skills of the individual nurse. The nurse must engage in self-determination and self-regulation as the final level of professional accountability.

Professional nursing’s scope of practice is dynamic and continually evolving. The scope of practice is characterized by a flexible boundary that is responsive to the changing needs of society and the expanding knowledge base of applicable theoretical scientific domains. This scope of practice thus overlaps those of other professions involved in health care. The boundaries of each profession are constantly changing, and members of various professions cooperate and collaborate by sharing knowledge, techniques, and ideas about how to deliver quality health care. Collaboration involves some shared functions and a common focus on the same overall mission. Collaboration among health professionals also involves recognition of the expertise of others within and outside the profession, and referral to those other providers when appropriate.

Nursing practice necessitates using critical thinking processes, such as the nursing process, to apply the best available evidence to care giving and promoting human functions and responses. Such care giving includes, but is not limited to, initiating and maintaining comfort measures, establishing an environment conducive to well-being, providing health counseling, and teaching. Nurses independently establish plans of care and also carry out interventions prescribed by other authorized healthcare providers. Advocacy, communication, collaboration, and coordination of the health regimen are notable characteristics of nursing practice. Nurses must base their practice on understanding the human condition across the life span and the relationship of the individual, family, group, community, or population within their own setting and environment.

Nursing care is provided and directed by registered nurses and nurses with advanced graduate education and preparation. All registered nurses are educated in the art and science of nursing with the goal of helping individuals, families, groups, communities, and populations to promote, attain, maintain, and restore health, or to experience dignified death. Nurses may also develop expertise in a particular specialty. The increasing complexity of care reinforces the ANA’s consistent affirmation since 1965 for the baccalaureate degree in nursing as the preferred educational requirement for entry into professional nursing practice.

Part III ANA Social Policy Statement DRAFT


Standards of Practice and Professional Performance

Nursing has established standards of nursing practice to guide professional practice. The standards of nursing practice have been further differentiated as standards of practice and standards of professional performance.

Definition and Function of Standards

Standards are authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable. Standards reflect the values and priorities of the profession. Standards provide direction for professional nursing practice and a framework for the evaluation of this practice. Standards also define the nursing profession’s accountability to the public and the outcomes for which registered nurses are responsible. (Adapted from ANA, 2004)

Development of Standards

A professional nursing organization has a responsibility to its members and to the public it serves to develop standards of practice. Standards of professional nursing practice may pertain to general or specialty practice. The American Nurses Association, as the professional organization for all registered nurses, has assumed the responsibility for developing generic standards that apply to the practice of all professional nurses. Standards do, however, belong to the profession and, thus, require broad input into their development and revision. The scope and standards of practice developed by ANA describe a competent level of nursing practice and professional performance common to all registered nurses. (Adapted from ANA, 2004)

Standards of Practice

The Standards of Practice describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process. The nursing process includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. These standards encompass all significant actions taken by registered nurses, and form the foundation of the nurse’s decision-making. (Adapted from ANA, 2004)

Standards of Professional Performance

The Standards of Professional Performance describe a competent level of behavior in the professional role—including activities related to quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. Registered nurses are accountable for their professional actions to themselves, their patients, their peers, and, ultimately, to society. (Adapted from ANA, 2004)

The nursing process is usually conceptualized and presented as the integration of singular actions of assessment, diagnosis, identification of outcomes, planning, implementation, and finally, evaluation. Figure 3. Nursing Process and Standards of Nursing Practice reflects how the nursing process in practice is not linear but relies heavily on the bi-directional feed back loops from each component. The standards of practice are co-located by the steps of the nursing process to represent the directive nature of the standards as the professional nurse completes each component of the nursing process. Similarly, the standards of professional performance relate to how the professional nurse adheres to the standards of practice, completes the nursing process, and addresses other nursing practice issues and concerns.

Figure 3. Nursing Process and Standards of Nursing Practice

Application of Scope and Standards

Content within the current edition of Nursing: Scope and Standards of Practice should serve as the basis for:
• Quality Improvement systems
• Data bases
• Regulatory systems
• Healthcare reimbursement and financing methodologies
• Development and evaluation of nursing service delivery systems and organizational structures
• Certification activities
• Position descriptions and performance appraisals
• Agency policies, procedures, and protocols
• Educational offerings
• Specialty nursing scope and standards of practice

Code of Ethics for Nurses

The Code of Ethics for Nurses With Interpretive Statements (2001) “…functions as a general guide for the profession’s members and as a social contract with the public that it serves” (Fowler, 2008. p. xi). It is the profession’s expression of the values, duties, and commitments to that public. The nine provisions in the Code of Ethics give voice to professional nurses. The Code of Ethics not only provides what the nurse owes to others but also to him- or herself. This includes, but is not limited to, professional growth, preserving integrity and safety, and continued personal and professional growth (Fowler, 2008).

The Code of Ethics is intended to be a living document for nurses. In spite of health care becoming more complex, the certain basic tenets found within the Code of Ethics remain unchanged. The Guide to the Code of Ethics for Nurses (Fowler, 2008) provides interpretation and examples of the application of the nine provisions.

Autonomy and Competent Practice

Autonomy is the capacity of a nurse to determine his/her own actions through independent choice within the full scope of nursing practice (Ballou, 1998). Competence is foundational to autonomy. The public has a right to expect nurses to demonstrate professional competence. The nursing profession and professional associations must shape and guide any practice assuring nursing competence.

The key indicators of competent practice are identified with each standard of practice and professional performance. For a standard to be met, all the listed competencies must be met. An individual who demonstrates competence is performing successfully at an expected level. A competency is an expected level of performance that integrates knowledge, skills, abilities, and judgment. Standards should remain stable over time, as they reflect the philosophical values of the profession. Competency statements, however, may be revised more frequently to incorporate advancements in scientific knowledge and expectations for nursing practice.

Assurance of competence is the shared responsibility of the profession, individual nurses, professional organizations, credentialing and certification entities, regulatory agencies, employers, and other key stakeholders. (ANA, 2008b)

Regulation

The Model of Professional Nursing Practice Regulation (Figure 4) clarifies the roles and relationships associated with the regulation of nursing practice. The model recognizes the contributions of professional and specialty nursing organizations, educational institutions, credentialing and accrediting organizations, and regulatory agencies; explains the role of workplace policies and procedures; and confirms the individual nurse’s ultimate responsibility and accountability for defining nursing practice (Styles, Schumann, Bickford, & White, 2008).
©2006 American Nurses Association

Figure 4. Model of Professional Nursing Practice Regulation

The scope and standards of nursing practice and the code of ethics serve as the foundation for legislation and regulatory policies to assure protection of the public’s safety (Styles, Schumann, Bickford, & White, 2008).

Under the terms of a social contract between society and the profession, society grants authority over functions vital to the profession and permits considerable autonomy in the conduct of its own affairs. Professional nursing, like other professions, is accountable for ensuring that its members act in the public interest in the course of providing the unique service society has entrusted to them. The processes by which the profession does this include professional regulation, legal regulation, and self-regulation. The scope and standards of nursing practice, the code of ethics, and the social policy statement are components of professional regulation and serve as the foundation for legislation, regulatory policy-making, and nursing practice that may be set in place to help assure the protection of the public’s safety.

Professional Regulation

Professional regulation is a profession’s oversight, monitoring, and control of its members based on principles, guidelines, and rules deemed important. Professional regulation of nursing practice begins with the professional definition of nursing and the scope of professional nursing practice statement. Professional standards are derived from the scope of nursing practice.

The social contract for nursing has been made specific through the professional society’s work, derived from the collective expertise of ANA, in collaboration with members of its constituent member associations and members of other nursing organizations. These responsibilities include:
• Establishing and maintaining a professional code of ethics
• Determining standards of practice
• Fostering development of nursing theory, derived from nursing research
• Establishing nursing practice built on a base of best evidence
• Specification of educational requirements for entry into professional practice at basic and advanced levels
• Developing certification processes as measures of competence

Certification is a judgment of competence made by nurses who are themselves practicing within the area of specialization. It is the formal recognition of the knowledge, skills, abilities, judgment, and experience demonstrated by the achievement of formal criteria identified by the profession. Several credentialing boards are associated with the ANA and with specialty nursing organizations. These boards develop and implement certification examinations and procedures for nurses who wish to have their specialty practice knowledge recognized by the profession and the public. One component of the required evidence is successful completion of an examination that tests the knowledge base for the selected area of practice. Other requirements relate to the requisite content of course work and the amount of supervised and unsupervised practice hours. Credentialing bodies are exploring the use of professional portfolios as psychometrically and legally defensible alternatives for certification examinations. Professional portfolios provide a comprehensive and reflective representation of professional abilities, achievements and efforts.

In response to the increasing complexity of care and exponential explosion of data, information, and knowledge, contemporary nursing practice related to specialization is in transition. Specialization is a mark of the advancement of the nursing profession. Specialization in nursing practice assists in clarifying, revising, and strengthening existing practice. Specialization expedites production of new knowledge and its application in practice. It also provides preparation for teaching and research related to a defined area of nursing. The specialist in nursing practice is evolving to be increasingly more often a nurse who, through study and supervised practice at the graduate level (masters or doctorate), has become expert in a defined area of knowledge and nursing practice.

Legal Regulation

Legal regulation is the oversight, monitoring, and control of designated professionals based on applicable statutes and regulations, accompanied by the interpretation of these laws. All nurses are legally accountable for actions taken in the course of professional nursing practice, as well as for actions delegated by the nurse to others assisting in provision of nursing care. Such accountability is accomplished through legal regulatory mechanisms of licensure, granting of authority to practice, such as nurse practice acts, and criminal and civil laws.

The legal contract between society and the professions is defined by statute and by associated rules and regulations. State nurse practice acts and related legislation and regulation serve as the explicit codification of the profession’s obligation to act in the best interests of society. Nurse practice acts grant nurses the authority to practice and grant society the authority to sanction nurses who violate the norms of the profession or act in a manner that threatens the safety of the public.

Statutory definitions of nursing should be compatible with and build upon the profession’s definition of its practice base. The definitions must be general enough to provide for the dynamic nature of an evolving scope of nursing practice. Society is best served when consistent definitions of the scope of nursing and advanced practice nursing are used by states. This allows residents of all states to access the full range of nursing services. Currently such definitions are not consistent across the various regulatory bodies. However, multiple stakeholders have established a collaborative effort to garner consensus in this arena.

Self Regulation

Self-regulation requires personal accountability for the knowledge base for professional practice. This self-regulation is an individual’s demonstrated personal control based on principles, guidelines, and rules deemed important. Nurses develop and maintain current knowledge, skills, and abilities through formal academic and continuing education professional development programs. Where appropriate, nurses hold certification in their area of practice to demonstrate this competence.

Nurses exercise autonomy and freedom within their scope of practice. Autonomy is defined as the capacity of a nurse to determine his/her own actions through independent choice within the full scope of nursing practice (Ballou, 1998). This autonomy and freedom is based upon the nurses’ commitment to self-regulation and accountability for practice. In Figure 5 the apex of the pyramid labeled Self Determination represents autonomy, self-regulation, and accountability for practice.

Figure 5. Self Determination in Model of Professional Nursing Practice Regulation

Competence is foundational to autonomy. Competency is an expected level of performance that integrates knowledge, skills, abilities, and judgment (ANA, 2008). Specialists in nursing practice have autonomy and freedom in practice greater than do nurses in general practice. Autonomy and freedom are based on broader authority rooted in expert knowledge in selected areas of nursing. This expert knowledge is associated with greater self-discipline and responsibility for direct care practice and for advancement of the nursing profession. A greater degree of autonomy imposes a greater duty to act and to do so competently. This, in turn, also increases accountability.

Nurses also regulate themselves as individuals through peer review of their practice. Continuous performance improvement fosters the refinement of knowledge, skills, and clinical decision-making processes at all levels and in all areas of professional nursing practice. As expressed in the profession’s code of ethics, peer review is one mechanism by which nurses are held accountable for practice. As noted in Provision 3.4 (Standards and Review Mechanism) of the Code of Ethics for Nurses with Interpretive Statements, nurses should also be active participants in the development of policies and review mechanisms designed to promote patient safety, reduce the likelihood of errors, and address both environmental system factors and human factors that present increased risk to patients. In addition, when errors do occur, nurses are expected to follow established guidelines in reporting committed or observed errors. The focus should be directed to improving systems rather than projecting blame.

All nurses are ethically and legally accountable for actions taken in the course of nursing practice, as well as for actions delegated by the nurse to others assisting in the delivery of nursing care. Such accountability may be accomplished through the regulatory mechanisms of licensure, through the scope and standards of nursing practice, through criminal and civil laws, through the code of ethics of the profession, and through peer evaluation.

Last Part ANA Social Policy Statement DRAFT

Application of Social Policy Statement

Nursing faculty should find content within Nursing’s Social Policy Statement: The Essence of Nursing critical for curriculum planning and inclusion in undergraduate, graduate, and doctoral level course materials. Similarly, nurses in professional development roles will want to reinforce the concepts presented in this resource in the practice setting, especially those related to autonomy, competence, scope and standards of nursing practice, and the nursing process.

Students will benefit from reading the social policy statement as they learn about the evolution to the contemporary definition of nursing, the profession’s delineation of the characteristics of a nursing specialty, and the importance of the scope of practice statement and accompanying standards and competency statements. The models depicting the nursing process with its feedback loops and the relationship of the standards of practice and professional performance to the nursing process will be invaluable in generating improved understanding of the complexity of nursing practice. Similarly, clear delineation of six social concerns in health care and statements that undergird nursing’s social contract with society reaffirm the importance of collaboration within nursing and interprofessional healthcare teams. Registered nurses will find even greater relevance of this content in every practice setting.

Nurse administrators may wish to use the nursing social policy statement as a resource for strategic planning activities, public explanations about nursing and its registered nurses, and the development of vision and mission statements. Members of legal and regulatory bodies and organizations should review this document to better understand how professional, self, and legal regulation can compliment rather than conflict with each other. Healthcare consumers may wish to use the social policy statement to better understand the foundation upon which the nursing profession and its registered nurses base their practice.

Conclusion

This social policy statement describes the pivotal nature and role of professional nursing in health care where health care is part of the larger society. The definition of nursing, introduction of the scope and accompanying standards of nursing practice, and discussion of specialization and regulation within the social context in which nurses practice, presents an overview of the essence of nursing. Registered nurses focus their specialized knowledge, skills, and caring on improving the health status of the public and ensuring safe, effective, quality care. This statement serves as a resource to assist nurses in conceptualizing their practice and provides direction to educators, administrators, and researchers within nursing. This statement also informs other health professionals, legislators and other regulators, funding bodies, and the public about nursing’s social responsibility, accountability, and contribution to health care.

References (emphasis added)

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursesbooks.org.

American Nurses Association. (2002). Nursing’s agenda for the future: A call to the nation. Accessed on August 18, 2008 at http://nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/Reports.aspx.

American Nurses Association. (2003). Nursing’s social policy statement, 2nd edition. Silver Spring, MD: Nursesbooks.org.

American Nurses Association. (2004). Nursing: Scope and standards of practice. Silver Spring, MD: Nursesbooks.org.

American Nurses Association. (2008a). Adapting standards of care under extreme conditions: Guidance for professionals during disasters, pandemics, and other professionals during disasters, pandemics, and other extreme emergencies. Silver Spring, MD: Author.

American Nurses Association. (2008b). Professional role competence position statement. Accessed November 2, 2008 at http://nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/ANAPositionStatements/practice/PositionStatementProfessionalRoleCompetence.aspx.

American Nurses Association. (2008c). Health system reform agenda. Accessed November 2, 2008, at http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/HSR/ANAsHealthSystemReformAgenda.aspx.

American Nurses Association. (2008d). Recognition of a nursing specialty, approval of a specialty nursing scope of practice statement, and acknowledgment of specialty nursing standards of practice. Silver Spring, MD: Author.

Ballou, K. A. (1998). Concept analysis of autonomy. Journal of Professional Nursing, 14(2), 102-110.

APRN Consensus Workgroup & APRN Joint Dialogue Group. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Accessed August 18, 2008, at http://www.aacn.nche.edu/Education/pdf/APRNReport.pdf.

Donabedian, A. (1976). Forward, in M. Phaneuf, The nursing audit: Self-regulation in nursing practice. 2nd edition. New York: Appleton-Century-Crofts. P. 8.

Fowler, D. M., Ed. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: Nursesbooks.org.

Henderson, V. (1961). Basic principles of nursing care. London: International Council of Nurses. P. 42

Nightingale, F. (1859). Notes on nursing: What it is and what it is not. London: Harrison and Sons. (Facsimile edition, J.B. Lippincott Company, 1946). Preface, p. 75.

Page, B. B. (1975). “Who owns the profession?” Hastings Center Report, 5(5) October 1975, 7-8.

Styles, M. M., Schumann, M. J., Bickford, C. J., & White, K. M. (2008). Specialization and credentialing in nursing revisited. Silver Spring, MD: Nursesbooks.org.

Good morning,

I greatly appreciate the information you shared with me; however, I am not in the States. I live in Canada.

The College of Nurses in Canada has a similar code of ethics. When I approached them to register a complaint and request intervention, they informed that they do not have any jurisdiction over Nursing schools.

After all that, I finally realized that you are in Canada, but Canadian nursing also has a written code ofethics, which may be of help.

You might want to contact PZ Myers at his blog, Pharyngula. He is a college prof, an atheist, a staunch advocate for critical thinking and reason, and he would certainly have something to say (with a huge blog audience), about the email you included in your photo set from the instructor who states that no religion accepts "certain lifestyles".

http://scienceblogs.com/pharyngula/

Nursing is a failing profession, and it has a long history of persecuting and running off excellent nurses and nursing students who exhibit appropriate skepticism of nursing ideology and who call BS on nurses fighting against each other and undermining their own profession, their own members and the rights of patients.

Perhaps your former instructor, bigoted and ignorant as she admits through her communication to you, is right that nursing isn't for you.

For any sane person who isn't totally dependent on the income from nursing, she's probably on target.

This is one of the most confusing and difficult posts I've tried to read for awhile.

I think I'm sympathetic to the original poster, codeblue insomnia. Maybe if you copied/pasted the relevant parts of the email and formatted it as a quote, so I could read it more easily. Having to copy/paste links to read words from an email is painfully unnecessary. At least learn how to embed the links to them.

As for Mr./Ms. periwinkle: Why copy/paste an entire book in "comments"? It is truly annoying. Please use links instead.

Sorry, but not rated. I have too much to read elsewhere to wade through this.

I posted the exceedingly long excerpt because the ANA only makes the final version available for hard copy purchase, the draft version link no longer works, and the writer and many readers would not have access to it otherwise. Sorry for making it difficult, but didn't know of another way to make the info available.

Obviously, lesbianism and homosexuality are sins, but sexual orientation is not particularly relevant as it relates to medical care. I'd rather have my life saved by a skilled male physician who packs fudge than to lose my life to a heterosexual, but incompetent physician. We'll all have to answer for our sins at some point, but if a lez wants to be a nurse, then she should be able to be a nurse.

rwnutjob, you are an eloquent spokesman for your positions. I am sure that you will win many converts here on OS.

shmadoff quote: "rwnutjob, you are an eloquent spokesman for your positions. I am sure that you will win many converts here on OS."

I'm not a professional writer shmadoff and I'm just writing an opinion. My objective is not to win converts........true liberals will never be converted by conservatives and vice versa. I actually find this forum educational as there is a great variety of folks who post here, most are liberals, but still it is an interesting forum.

Just a sidenote... did you know that eating shrimp is also a sin? It's an "abomination"... Leviticus 11:9-12 & Deuteronomy 14:9-10.

Why is it that all the best, and tastiest things in life are an abomination?

fair enough nutty, go on with your bad self.

In fact, I think what makes ALL of this more interesting is the fact that I have never confirmed my sexual orientation, because I feel that it's something between MYSELF and GOD, and whoever I choose to share my bed with.

My performance and preference in the bedroom, have never, and will never have any bearing, or impact on my ability and performance in a clinical/medical setting.

You are correct codeblue, but having been reared on the East coast, I'm still having trouble giving up shellfish. ( I never claimed to be a perfect Christian.....just a Christian)

I need to expand on the food restriction answer a bit codeblue. The New Testament covenant eliminated the need to stick with many of the Old Testament restrictions. Some Christians still abide by the Old Testament laws. From an environmental standpoint, the shellfish restriction makes good sense since it is the shellfish that keep the oceans clean..........I do miss pickin' blue crabs though.

I am not a lawyer, but I work with a lot of them. I would have suggestions for you if you were in my jurisdiction. I am not sure what the due process rights are in Canada. However, if you have not gotten a lawyer, please get one.

This is a little off the subject, but it begs a similar question.

In the interest of fairness, does anyone care that some straight people have an honest question? If men/women in the military can't bath and bunk with the opposite sex, why is should they be required to live in intimate situations with gays?

Is it simply because of outdated modesty reasons? Is it because of sexual attraction reasons? Is it because of discipline reasons?

Although I think the author of this letter is very obviously misguided, misinformed and operating with what seems to be a horrible stereotypical perspective, the root question here still has validity.

When it comes to gender and sexual attraction and all of the modesty issuses that are involved with situations like this, it begs the question....where do we as rational, civil, moral (meaning caring for our fellow person) adult people draw the line.

Is it solely at the place where the gay or lesbian person gets offended?

Why do most high schools have gender specific coachs? Why do most schools require that men teach boys phys ed and women teach girls?

I am a straight male. I would be suspect of a gay man who was living with me in a barracks arrangement. The questions would be valid. Just like I could not expect to be allowed to shower with the women.

The gay and lesbian community is going to have to give a little. There are generations of bias, but not all of the issues straights have are based on "homophobia". Some are reasonable and should be recognized by the gay community.

Since as things stand today male nurses often care for women and even more often female nurses care for men, I can't see any basis whatsoever to object to a gay nurse.

Philos777

Your comments are homophobic.

You need to go back into a school and check things out. Guys coach girls sports and in many schools, 1 PE teachers teaches both guys and girls. In the overwhelming number of cases, it works just great.

Male nurses help female patients and vice versa.

People doing their jobs does not mean they're checking you out or copping a feel. Gay sex panic was removed as a defense years ago, as most people now recognize that gay does not equal predator.

Would someone help me out please? Its possible that I might like to be biased but I'm having trouble remembering how to tell the difference?

Out of curiosity, you said this is under appeal. Does this mean you went to http://www.cdpdj.qc.ca/en/home.asp to file a complaint? If not, you should. I suspect you have a hugely strong case against them and from my count they've violated about 5-6 of the rights outline. (particularly important since it is CEGEP and, IIRC, gov't run or gov't subsidized at the least).

One thing I will say is this is not reflective of Quebec Nursing in general. My aunt is a Head Nurse in Quebec and she's very proud of her nurses and what they can do. She does not, however, ever judge them based on their orientation, skin or whatever. It is there abilities that matter.

I think, unfortunately, you found the bad apple of a whole bunch of nice ones. :( Good luck.

@Philos--Male nurses attend to female patients, and female nurses attend to male patients all the time.

Most men are heterosexual, but their sexual attraction to women doesn't disqualify them from becoming OB/GYNs.

Unless the original poster is going around saying things like: "Hello, I'm Jane and I'll be your lesbian nurse while you're here in our facility..." then the email she provided us at the beginning of the post was way, way, WAAAAAY out of line.

Not that there's anything wrong with being homosexual; I would feel just as uncomfortable with a nurse who referenced her heterosexuality upon greeting me.

Since there's no way to gauge the original poster's actual ability, I can't really say one way or another if she was failed because of her perceived sexuality or because she just wasn't up to snuff as a nurse.

I do, however, believe she's more than justified in pursuing an appeal. If for no other reason than the complete lack of propriety on display in the email from her instructor.

Some people are very uncomfortable with gays and lesbians for reasons that have always been hard to discern to this straight male. I never really got that, why it makes some people very uncomfortable, but then it is a part of life I guess. I hope that you find a place that is more tolerant of what is obviously not a changeable feature of who you are, and if it helps any, colleges and universities are bureaucracies that are surpisingly hostile to differences in general; they actually make governments and even the military from what I have seen look open-minded, which is another perhaps lamentable feature of human nature, our desire to dominate others by forcing them in boxes, and I am sorry for your difficulties, as someone who has been attacked repeatedly for questioning the conventional wisdom only to have it later demonstrated that the conventional wisdom was wrong.

I can't believe I am saying this but I actually agree with rwnut. It was worded in a provocative way but basically he was saying he'd rather have a good homo doc than a bad straight one. I am sure there are doctors of other religions that he would say the same thing about, ie they are hindu and therefore not going to heaven but they are the best cancer doc in town...
Philos777 it is off topic but fortunately I just concluded a post on homophobic ignorance that you might benefit from. Also the ban on men/women sharing showers and sleeping quarters is not to limit their attraction to each other it is to limit that attraction from becoming rape, something which has not historically been a problem for male/male soldiers despite the dirty little vids you must be watching on X-tube.

This is a nightmare. I know. The same thing happened to me, only for racial reasons. I was living in a town in Arizona in the 70 and I signed up for nursing studies. They hated me. I was an affront, an educated "Mexican" (I'm Salvadorean, but no one then knew what that was) who got straight As in classroom work. The first semester, anybody black, Latino or Indian got pushed out with bad clinical reviews. I protested and got to stay another semester. That semester, the clinical instructor was conveniently somewhere else when I had to get checked off on procedures. I got checked off by the hospital nurses, which was permitted. Nevertheless, the instructor failed me in clinical--to the shock of the nurses whom I worked with. My appeal went nowhere, in spite of the fact that the hospital nurses wrote letters in my favor. I cut my losses and returned to California.

Nursing instructors are nurses first, and I have a love/hate relationship with nurses. There is a deep conservative strain in nursing, more so than in medicine. It's sad that the public and more nurses themselves don't see the profession as more than just assistant to a doctor, but the lack of professionalism and the conservatism seem to feed off each other.

I had a strange and painful experience during my stay at Stanford Hospital, a major teaching hospital, with the nurses, a couple of whom were frankly incompetent. My friend, a former managing editor of a major publication who chose to go into nursing, was turned down for a job with Stanford. Too smart. They seem to want submissive, passive types.

More power to you if you become a nurse. I never did. The taste was too bad. I became a teacher, a really good one, then a technical writer in databases, then I went to law school. I'm much, much smarter than the nursing instructor who failed me in clinical.

Hi:

The Flickr links don't seem to work. That makes it hard to assess what's being presented here.

Chris.

I purposefully slept on this overnight rather than commenting immediately. I have been an advanced practice nurse for 39 years, male and straight. Not that that makes any difference, sexuality of any variety is not a disqualifier to being a nurse. That being said, I think you have problems over and above your sexuality which have interfered with your progress. As a former grad school instructor I would not have been accepting of your turning in work late, but I agree your clinical instructor was way out of line.

Perhaps it would be in your best interest to really examine where you are in life and determine what is really important to your future. Good luck with finding an answer to your dilemma. I hope it works out for you.

I am so, so sorry for you. I can't believe this kind of stuff can still happen. Please don't give up.

Hey tijo & Jeffrey Marks, Forgive my ignorance regarding coaching protocol in HS. I haven't been around a locker room in a few years and I haven't ever spent the night in a hospital. That doesn't change my silly "homophobic" perspective. It may have to do with a healthy dose of modesty, but I wouldn't expect everyone to buy into that. The minute someone disagrees, even if they have a valid well thought, reasonable perspective......attack!

I just had to respond to your name calling. Your slanderous use of the term "Homophobic" is so stereotypical. Get over yourself and face reality. I have a main stream perspective that you disagree with & I never ever used the term "predatory". The whole human race deals with attractions to whatever sex they have CHOSEN to pursue. And further more, if you can’t control whom you are attracted to, then you make my point.

There is nothing overtly predatory about it. Millions of healthy non-homophobic people prefer to not dwell in a situation with those whom "might" be attracted to them sexually and with whom they find behaving unnaturally. You may call that homophobic, but the vast majority of the world (90%+) agrees.

You are "straightophobic".

Your slanderous remarks expose you as ignorant.