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PROFESSIONAL DEVELOPMENT PLAN

Professional Developmental Plan 2012

Sherry A. Brabon

NURS 324

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Running head: PROFESSIONAL DEVELOPMENT PLAN

Abstract

This document includes a summary of American Nurses Association’s (ANA) Standards of

Professional Performance. Ethics, education, evidence-based practice and research, quality of

practice, communication, leadership, collaboration, professional practice evaluation, resource

utilization and environmental health will be examined. A review on how I currently use each of

these 10 standards in my current professional practice and a discussion regarding weaknesses

associated with these standards will be evaluated. In addition, my plan for professional practice

and goal attainments at five and ten years will be presented. Tools used to evaluate progress or

revision of the proposed plan will accompany these goals.

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Profession Development Plan 2012

To maintain sight of my goals as a good nurse, this paper outlines my current

professional practice and areas in which improvement is desired. My plan to complete additional

education will be presented as well as a time frame in which to meet these goals. The nursing

profession requires ongoing education and promotes quality assurance in the form of practice

evaluation. This paper is an attempt to meet these requirements and present an ongoing plan for

additional education.

Standards of Professional Performance

Ethics

Ethics are the actions a nurse takes while caring for a patient. According the ANA, this

includes preserving patient autonomy, dignity, values and beliefs (ANA, 2010). Also, how

professionals handle confidential information, legal aspects, advocacy, information sharing and

consideration of other members of the health care team are all part of providing ethical care.

This area is one of my greatest strengths. My background in Hospice care taught me the need for

collaboration, legalities and use of family and friends in the care of a patient. Also,

confidentiality is high on my priority, not only for patient safety but also for my safety as a

professional. As a public health nurse, I have access to more information regarding patients than

a floor nurse in an acute care setting. This information may be accessed, by direction of Public

Health Code, without direct consent of the patient. Access to this information must remain

confidential; I keep paper charts locked up and use passwords to protect my electronic

documentation. Furthermore, I try to be sensitive to other cultures and value systems. For

example, I work with a large Amish community. As a public health nurse, I must recommend

vaccines. Amish place much value on Gods will; by vaccinating they feel this is a direct

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violation of Gods will. I provide education with compassion to their belief system and respect

their final decisions.

Even though I place high value on ethical care, there are some areas in which I can

improve in my professional practice. I do not encourage ethical behavior in my co-workers who

may have an impact on the care of my patients. Setting the standard by role modeling is not

always effective. Oftentimes, I find co-workers making stereotypical comments regarding

patients; this may or may not occur in front of patients. Simply walking away from the

conversation does not promote ethical standards a more active part should be taken. My plan for

improvement will include making a non-offending comment to the persons when I hear this

happening. A comment such as “It could happen to anyone” or “We will never know unless we

are in their shoes” may be enough to silence further hurtful conversation. Another weakness

involves the lack of participation on an ethical committee. My agency does not have such a

committee and I can be instrumental in encouraging such a committee to improve our services to

patients. I will continue to develop interventions to improve these weak areas in my professional

practice.

Education

It is expected that professional nurses have a life-long learning path. They must critically

assess their own weaknesses and develop an education plan that strengthens their knowledge

base. This learning path may be formal or informal (ANA, 2010). In a broad sense, this is why I

have returned to a formalized educational setting after working as a Registered Nurse for 13

years. I felt that I have more that I can offer my community, patients and employer. By

completing the BSN program I am meeting this standard for improvement of professional

knowledge.

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However, in my current practice, I lack ongoing education in the programs in which I

work. I have struggled with this shortfall in learning for some time. There are many programs

that I work in and it is very difficult to manage my time that will allow for patient care,

mandatory meetings and quality assessment including chart review. There is little time left for

continuing education in all of the programs in which I am responsible. As I reflect on this

weakness, I believe I can take one webinar or other type of training in one program monthly. I

will plan to review each program, establish my greatest weakness and plan to enhance my

knowledge base in that program first. I will schedule some type of training for each program

every month. This will certainly strengthen my abilities in each program in which I work.

Evidence-Based Practice and Research

Research is the foundation of nursing. All activities a nurse performs should be

evidence-based. I use research in my practice especially when it involves immunizations. This

is an ever-changing program and it requires a nurse stay on top of current findings. Also,

communicable diseases require routine research so that current information is being taught to

clients. For example, I recently had a report from local hospital Infection Control of a

Leptospirosis case. This is not common in this area of the US and I researched the

epidemiology, contacted local Veterinarians and performed online searches to determine the

likelihood of a confirmed case. As it turned out, there was a recent outbreak in Detroit from

infected rats. Fortunately, this case was negative and there was no contact with the Detroit

outbreak. Public health duties can sometimes be compared to that of a detective.

Though, I do research for my own practice, I rarely share it with my co-workers. Also, I

do not advocate as much as I should for policy changes. My employer does not take kindly to

suggestions for improvement; they must be given in a way in which she believes it was her idea

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first. This is cumbersome and exhausting at times. Often, I take the easy way out and do not

advocate, as I should. This is a problem in which I currently do not have a solution. I am not

planning on staying with my current employer once I graduate and I will certainly inquire about

offering suggestions with any prospective employers.

Quality of Practice

This standard refers to maintaining quality of care and assessing current practice for

quality improvement (ANA, 2010). I participate on committees in my work place that develop

tools to assess quality of care. This is typically in the form of chart audit checklists and forms

for documenting staff proficiency. I also review charts and discuss findings with staff, good or

bad results. I have also participated in community meetings such as the 0-6 and local hospital

infection control meetings both of which assess and identify community needs, determine who

can meet those needs and where our weaknesses are. These meetings also assist in preventing

duplication of services.

One area that I would like to improve upon is our client satisfaction surveys. They are

the same surveys that we have been using for more than ten years. They are in need of updating

for both language and presentation. I have seen clients fill these out and they just circle the

number without even reading the area they are evaluating. Right now, the survey consists of 15

questions and I would like to condense it down to about five questions and change the range

from a numerical system to a ‘satisfied’, ‘not satisfied’ or ‘needs improvement’ type of format. I

believe client feedback is an important component when assessing quality of care.

Communication

Communication is not merely talking. It is speaking in a manner in which allows one to

conveys their thoughts in an effective way so that the listener will acknowledge the interaction. I

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believe I am able to communicate my needs to the appropriate level within the professional team.

Medical staff do not easily intimidate me and I am not afraid to say, “I do not know.” Patients

appreciate the honesty. I would rather check my information and ensure I am giving accurate

instructions, rather than give wrong information. Furthermore, I will always call the doctor if an

order seems out of the ordinary or wrong. Most doctors appreciate the concern. My

communication skills are pretty good when it involves talking with clients, families and

colleagues.

When in conflicts, especially with supervisors, I tend to be less meticulous. It is at these

times that I need to maintain professionalism. Counting to ten or asking to be excused for a

moment are two things I can do to collect my thoughts and think about how to reply in a conflict

situation. Most often clarifying the situation will solve some of the problem. At some point in

my career I will be a supervisor and I hope that I remember to clarify situations with a staff

member before jumping to conclusions and confronting them.

Leadership

Even though I have not been in the formal leadership type positions such as supervisor or

program coordinator, I have demonstrated competence in advising colleagues in correct nursing

techniques and continuous learning activities. After performing quality assurance activities, I

often recommend trainings to enhance staff skills. I have worked in a setting in which there were

LPN’s and CENA’s that I was responsible for. I find that if people are acknowledged and

respected, you get the same in return. Also, I am usually the nurse that is assigned with student

nurses, as I enjoy mentoring new nurses. Leadership is not necessarily a position of power; it is

a way of performing duties.

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There are areas in which I could improve my leadership abilities. I plan to join the

Michigan Nurses Association and be an active participant. This is something I want to do when I

have the time to be an active participant and not just a silent member. I plan on joining by the

end of my BSN education.

Collaboration

Communication is key in collaboration or teamwork efforts. To be an effective nurse,

one must engage in working well with others, both clients and colleagues. My care is always

centered on what the client is most concerned with. I effectively communicate with clients to

determine the cause or source of the issues at hand and respect the client’s decisions. Also, I

have successfully completed group work for school and my job. I sit on several committees and

have assisted with health fairs, community connection activities and breastfeeding education

programs. On a daily basis I collaborate with various members of the health care team: medical

directors, supervisors, dieticians, social workers, state staff and doctor office staff.

I enjoy working with others. Luckily, my interactions with group work or collaboration

activities have usually been positive. As stated earlier, if there were a conflict, I would need to

check myself so I maintain professionalism. There was a community group in which I used to

participate, I resigned my position, as my director would tell me our agency could contribute

certain resources to our activities, only to go in after me and claim she never authorized such

resources. This made me appear to the group as unreliable. I explained my view of the situation

and the group members seemed to be ok with it, but I still resigned and continue to avoid

activities in which this director is involved. This is another situation in which I do not seem to

have a solution. I have talked to my supervisor about it, and she agrees it is an issue, but since

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this person is a director, we just have to “deal with it”. My response is to avoid her as to also

avoid conflict.

Professional Practice Evaluation

Self-reflection activities when performed honestly are brutally tough. One must be

honest with themselves and critically evaluate their actions as if it were someone else being

evaluated. When one looks at their own nursing activities, making excuses and justifying

behavior is easy. This reflection paper has encouraged me to be brutally honest with my nursing

activities in regard to these ten professional standards. My current employer performs a yearly

evaluation in which my interpretation of weakness, strengths and progress towards goals are

scrutinized. This process is done in between patient care activities and is usually rushed.

Unfortunately, this process is important for self-growth and requires time and reflection.

No one likes to be informed of self-improvement needs. I have suggested our agency

change our evaluation method to include confidential peer evaluations to get a better idea of

areas in which need improvement. Unfortunately, feedback it usually negative, as most often the

positive aspects are overlooked. My agency also has client surveys to evaluate how our care

impacts clients; I am in the process of encouraging that these surveys be redesigned in an effort

to improve feedback from clients. Not only self-reflection, but also peer evaluations are helpful

when determining where improvements are needed in professional practice.

Resource Utilization

ANA (2010) supports that resources must be “…safe, effective and financially

responsible” (p. 60). This includes appropriate use of staff when delegating, use of supplies and

request for resources to improve patient care. Furthermore, the nurse should ensure that each

patient is receiving the appropriate care and educate patients and families to advocate for

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necessary care. My job requires that I refer clients to resources everyday. I may help clients

apply for Medicaid or send them to a food pantry. A big share of my time is spent ensuring

children with chronic illness’s are maintaining their specialist appointments. Usually this entails

organizing a driver or providing mileage reimbursement. I also evaluate for necessary care and

identify care that is not related to the diagnosis and may not be medically necessary.

Furthermore, I am the first in the office to try new computer software or tools that are intended to

improve nursing care. Overseeing proper usage of resources can be a big task and sometimes

clients are upset that they do not get what they want.

As a case manager, I need to ensure that there is no unnecessary medical interventions or

resources utilized, including duplication of services. Oftentimes, services are cut because more

than one provider is offering the same care. I will get calls from both the agency and the client

upset that the services are no longer covered. This is a tough job telling clients that they do not

need a certain item just because the doctor said they could have it. Most recently, I had to deny a

Jacuzzi tub. The doctor wrote an order for it but it is not covered under insurance. I referred the

client to area resources that she could utilize and pay out of pocket. I also discussed with her the

benefits and other ways in which she may achieve the same results. While I can understand how

a resource may benefit a client, not all are truly medically necessary. Resources need to be

utilized correctly so that utility can be achieved.

Environmental Health

Safe water, adequate sewage disposal, comfortable surroundings to promote healing, safe

products and healthy communities all fall under the nurses’ responsibility to provide safe care

(ANA, 2010). This is the cornerstone of Public Health. Daily I receive recall notices of food

items, medications, car seats, cribs and other items. Recall information is posted on our website

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and I share this information with clients so they can play an active role in avoiding harmful

products. Communicable disease reporting is a program I manage, here clients are reported that

have a contagious illness. I interview them and attempt to identify the source of illness and

instruct practices the client can institute to prevent illness transmission. I also communicate with

the local hospitals and emergency room’s to determine if there is an increase in reported

symptoms that may indicate an increase in influenza or food borne complaints. Some may claim

this is a breech of confidentiality, but the Public Health Code requires certain diseases to be

reported to the Local Health Department.

Unfortunately, I receive calls everyday regarding possible mold growth in homes. There

are no programs currently that will pay for clean up and this is a costly process. Black mold can

cause severe illness especially in children. I feel I should do more, but all I am able to provide

for these clients are phone numbers to agencies that will do environmental clean up. I also

suggest the client move if they are not able to afford the costs associated with clean up. Of

course, I also refer to their primary care providers for any symptoms associated with mold

exposure. I have referred a certain agency to the building inspector as I was notified that the

landlord was aware of the black mold and choose to ignore clean up before renting the apartment

to another family. The biggest challenge in ensuring that the community is aware of the health

threat or recalls before more injury is sustained.

Goals

Five-year goals

Completion of the BSN program is my first goal in the next five years. I have changed

my original plan for taking classes to include a summer class. By doing this, I will complete the

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program a semester sooner. My goal for completion of my BSN is by May 2014 (See

Appendix). I also plan to join the Michigan Nurses Association within this timeframe as well.

After that, I plan to obtain a job at Michigan Department of Community Health or

Centers for Disease Control. I believe it would take me the rest of the five years to learn my job

before continuing my education for completion of a MSN program. If I cannot find a position at

these government agencies, I will most likely continue my education and pursue my MSN

immediately. My MSN would focus on education and research. Another goal I have considered

is applying for medical school. I am not really sure where I want to go with my educational

career at this point.

Weaknesses associated with this plan include ambivalence to my future. There are so

many interests I have that I cannot say right now what I will do next. My next steps truly depend

on the economy and availability of jobs.

Ten-year goals

My 10-year goal depends on what occurs in the next five years. I plan to be well into

either a MSN program or a Doctor of Osteopathic Medicine (DO) program. I cannot claim what

I want to do, typically life guides me where I need to be and I embrace it fully. This makes it

difficult to evaluate my progress, as there is really no set goal here, I know I will be working and

continually making a difference in lives.

Again, ambivalence is a weakness here. I will continue my education, what is uncertain

is which program I will pursue. Another weakness is life events. I may get married or even have

a child and that would certainly alter my goals.

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Conclusion

There are many areas within ANA’s Standards of Practice in which I have identified

weaknesses and suggested improvement strategies. I have also identified strengths in these

areas. My five and 10-year goals remain weak due to my lack of vision of where I want my

higher education to continue, either MSN or medical school. What is certain though, is that I

will continue lifelong learning, a necessary component of professional nursing.

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Reference

American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver

Spring, MD.

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Goal year 2018 1. Join Michigan Nurses Association2. Complete BSN by Spring 2014.3. Obtain job at Michigan Department of

Community Health or Centers for Disease Control by spring 2015.

4. Apply for MSN or DO program by 2018.

Goal year 2023 1. Enroll in MSN or DO classes by 2019.2. Complete MSN or DO program by

2023.

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CHECKLIST FOR SUBMITTING PAPERS

CHECKDATE, TIME, & INITIAL

PROOFREAD FOR: APA ISSUES

11-17-12 1600 SB

1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)]

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2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2” from the top of your title page? (Should be a few words from the title of your paper). [p. 229 and example on p. 40]

11-17-12 1600 SB

3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract and know what to find in your paper. [p. 25 and example on p. 41]

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4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use ‘Introduction’ as a heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and example on p. 42]

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5. Margins: Did you leave 1” on all sides? [p. 229]

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6. Double-spacing: Did you double-space throughout? No triple or extra spaces between sections or paragraphs except in special circumstances. This includes the reference page. [p. 229 and example on p. 40-59]

11-17-12 1600 SB

7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229]

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8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions.

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9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a person’s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 87-88]

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10. Typeface: Did you use Times Roman 12-point font? [p. 228]

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11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111]

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12. Plagiarism: Cite all sources! If you say something that is not your original idea, it must be cited. You may be citing many times…this is what you are supposed to be doing! [p. 170]

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13. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this:“The variables that impact the etiology and the human response to various disease states will be explored” (Bell-Scriber, 2007, p. 1).Please note where the quotation marks are placed, where the final period is placed,

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no first name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p. 170-172]

N/A 14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172]

N/A 15. Paraphrase: A paraphrase citation would look like this:Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007).It may also look like this: Bell-Scriber (2007) found that…… [p. 171 and multiple examples in text on p. 40-59]For multiple references within the same paragraph see page 174.

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16. Headings: Did you check your headings for proper levels? [p. 62-63].

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17. General Guidelines for References:A. Did you start the References on a new page? [p. 37]B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often they are not and must be adapted. Make sure all fonts are the same.C. Is your reference list double spaced with hanging indents? [p. 37]

PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE

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18. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out where you addressed each section.)

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19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you become breathless or it doesn’t make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did you do this?

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20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit?

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21. Conversational tone: Don’t write as if you are talking to someone in a casual way. For example, “Well so I couldn’t believe nurses did such things!” or “I was in total shock over that.” Did you stay in a formal/professional tone?

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22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?

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23. Did you check to make sure there are no hyphens and broken words in the right margin?

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24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.?

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25. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as “they” or “them”. Also, in referring to a human, don’t refer to the person as “that”, but rather “who”. For example: The nurse that gave the injection….” Should be “The nurse who gave the injection…” Did you check for subject agreement?

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26. Don’t refer to “us”, “we”, “our”, within the paper…this is not about you and me. Be clear in identifying. For example don’t say “Our profession uses empirical data to support ….” . Instead say “The nursing profession uses empirical data…..

11-17-12 27. Did you check your sentences to make sure you did not end them with a

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1600 SB preposition? For example, “I witnessed activities that I was not happy with.” Instead, “I witnessed activities with which I was not happy.”

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28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?

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