Florence Prescription

Integrity is a deeply individualized phenomenon. It is the correlation between a person’s actions and their beliefs, principles, or convictions. Additionally, integrity correlates an individual’s actions and their self-understanding. When an individual identifies himself or herself as a nurse, there are often underlying personal characteristics that accompany. For example, most nurses identify themselves as caring individuals far before they become a practicing nurse. Ultimately, acting within an individual’s self-understanding is a demonstration of integrity (Nelson & Gordon, 2006). The integrity of the nursing profession has been challenged as the goals of healthcare delivery have shifted to improving the bottom line, leaving one to question if nursing has lost sight of its foundation, caring. In her reflection of the Caring Conference, Lou Reida’s expressed, “… I have been challenged to reflect on how I, as a future leader, will be able to find a balance between nurturing the caring spirit of nurses and the business component of healthcare,” (Reida, BSN, 2009). The purpose of this paper is to discuss how integrity of nursing may be compromised and the importance of leadership in the persistence of integrity throughout the profession.

According to Rosseter (2011), one of the largest segments of the US workforce are comprised of Registered Nurses, with over three million registered nurses worldwide. Due to the fast paced and rising complex demands placed on our healthcare environment, it is no surprise that over twenty-four thousand post graduate students were actively seeking and earning their master’s degree in nursing in 2011 (DHHS, 2013, p.ix). In order to gain an understanding of the interplay among my education, career path and opportunities afforded to me by taking an approach to higher degree learning. I approached a co-worker whose capabilities impressed me and asked her five questions in person, in order to gain her insightful information of what I will be facing during these next few months.

The Florence Prescription: From Accountability to Ownership is an excellent book by Tye and Schwab (2009) that encourages health care providers to be committed and empowered to make a change in their health care organization. There are hopes that this book will inspire and energize current and future healthcare workers. This book is powerful because it offers essential tools to be the best person that we can be for others and ourselves through a variety of ways. Essentially, the essence of becoming a stronger individual both in our personal lives and as a nurse can be found within the Florence Challenge which includes a “Seven Simple Promises” pledge that challenges every single one of us to become better people. These tools are presented to aid in our future nursing practice to strengthen us mentally, emotionally, and professionally. The “Seven Simple Promises” as listed within the “Self- Empowerment Pledge” are responsibility, accountability, determination, contribution, resilience, perspective, and faith. Each and every one of these promises can be integrated in my future nursing practice.

She believed that years of experience is what ultimately sets apart a novice and expert nurse. “Clinicians at different levels of practice live in different clinical worlds, recognizing and responding to different situated needs for action” (Alligood & Tomey, 2010, p. 141).

The new graduate nurses (NGN) are faced with various issues and challenges especially in their first year of nursing practice. The period of transition from a student to a graduate nurse is a demanding period that is filled with new experiences and there are several concerns and factors that can affect the transition process. The research into the issues has recommended some strategies that can be utilised to ease the transition process from being a student to a professional practicing nurse. Exhaustion, reality shock and time management are some of the factors and issues that the new graduate might encounter during their first year in their career.

The beginning of a new graduate nurses career rarely begins easily, there seems to be a distinct disconnect between the fantasy of what it means to be a nurse and the reality of bedside nursing. Nursing school seems to feed into this disconnection, in that it does not prepare the new graduate registered nurse (NGRN) for their professional practice. What nursing school does is give the NGRN the basics, a peak into what is to come. The NGRN has to find out for themselves what the true meaning of being a nurse is and if it fits their preconceived ideas.

This article researched the competency of new graduate nurses. “Nursing competence is not only a professional standard

Patricia Benner, a well-known nursing theorist who published From Novice to Expert, theorizes how a nurse should progress through their career. Benner’s theory explains what stage of nursing one is in based on your education and the amount of time one has worked in a specific nursing field. She describes the five stages of the theory: novice, advanced beginner, competent, proficient, and expert. While this theory has its limitations, it is beneficial to the well-being of both the nurse and patient and that is proven by real world clinical practice.

According to Chater and Litchfield's study done on new graduate nurses who work in a neonatal unit at an Australian hospital, five themes: "knowing, planning, support, fulfilment, adapting and being flexible" can be utilized to help student nurses and new graduate nurses to better manage their clinical time (Chater & Litchfield, 2007).

When most experienced registered nurses hear the word shock, they begin to use their critical thinking skills to determine the patient’s immediate need. However, new graduate nurses in the career field are faced with a different type of shock; they are faced with transitional shock. Transitional shock is a theory created by Judy Duchscher. Her theory is based on reality shock which is a term coined by Marlene Kramer. Reality shock is when new nurses recognize clinical practice and the classroom setting are two different worlds (Hentz and Gilmore, 2011, p.134). When new graduates transition to a registered nurse position, it does not happen with ease. Over the years, there has been a rise in concern with this transition. As new graduates move in the career field, they may feel anxious and uncertain about their new responsibilities. Unfortunately, when there is a high demand of nurses, new graduate nurses are expected to begin a new job at full speed, but they are not able to handle the fast pace position they are placed in. When new graduates are expected to accomplish task they are unprepared for, it sets them up for transitional shock. To minimize transition shock for new graduates, finding a mentor, preceptor, seeking an internship or residency program may help ease the transition.

Working well with people is an important factor in the nursing career; a nurse must always be respectful to every patient regardless of the situation. Persuasion sometimes has to be used because a patient may not want a certain medication so a nurse must help the person understand that it is what is best for him or her health and their track to recovery. A nurse must always pay close attention to their patients because if problems or concerns come up, a nurse must be the first to notice it.

The role of a nurse is viewed as stressful, so nurses need to be emotionally ready and be physically fit to participate in delivering care. Acts of kindness, trustworthiness, promoting privacy, ensuring dignity, being engrossed into the artistry of caring and engaging in anti-discriminatory practice (Baughan & Smith 2008) by respecting everyone, irrespective of age, culture, gender, socio-economic class, sexual orientation, religious beliefs and the condition from which they are afflicted, are caring indicators of a nurse.

I once heard someone say, “Find something you love to do and you’ll always be successful.” If you want to be in a field where you are continually learning, nursing would be the top pick. This paper will reflect the journey I have taken from Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) with the incorporation of my learning objectives from my clinical course.

In today’s world, it is essential to incorporate nursing theory into practice. Patricia Benner, through her work, “has provided essential understanding of how knowledge and skills are acquired and directly applied to nursing practice, education, research and administration” (Altmann, 2007, p. 114). According to Benner’s model of skill acquisition, “the nurse passes through five stages of career development, novice, advanced beginner, competent, proficient and expert” (English, 1993, p.387). Specific patterns of behavior, thinking, and performance is present in each stage. The most experience is associated with the expert nurse and the least experience is possessed by the novice nurse (Benjamin, 2007). This model is based on ascending level of proficiency and the key concepts of this model are: competence, skill attainment, experience, clinical knowledge and practical knowledge

"Brenner (1984) described the 5 stages of development for the professional nurse. The stages are (1) Novice (2) Advance Beginner (3) Competent practitioner (4) Proficient practitioner (5) Expert Practitioner. The stages progress from a nursing student to the professional practitioner through growth and knowledge." (Lopez-Boyd, 1997, p. 41) Nursing is a profession. Look around you, you see competent, caring individuals