Nursing 108

N108: Transition to the Registered Professional Nurse Role Study Guide of 172 The nurse must always remember that his or her role is to develop and maintain a therapeutic relationship with patients and families, and avoid under-involvement or over-involvement. Over- involvement includes boundary crossings, boundary violations, and professional sexual misconduct. For example, favoritism, physical contact, friendship, socializing, gifts, dating, intimacy, disclosure, chastising, and coercion are examples of boundary violations. Boundary violations can occur on the other end of the continuum as well, with under-involvement by the nurse. Examples of under- involvement include distancing, disinterest, and neglect of patients. These behaviors are harmful to both the patient and the nurse. Often, it is not always clear if a boundary violation has occurred. For example, picking up groceries for a home-bound patient, having social contact with former patients, or accepting a small gift (candy or a home-made item) from a patient are situations that are not always straightforward. In every patient encounter, nurses should review and examine the situation, their behavior, and the standards and guidelines of the profession. The National Council of State Boards of Nursing has been in a leading role in bringing this issue to the forefront. More states are including specific language in their Nurse Practice Acts about professional boundaries, professional misconduct, and boundary violations, especially in the areas of sexual boundary violations. Role Differences Between the RN and LPN/LVN The nurse practice acts for LPNs/LVNs and RNs differ in one very important way--the independence of each practitioner. They state that LPNs/LVNs practice under the supervision of an RN or a physician/dentist. The language used is often restrictive, meaning that practical/vocational nurses are restricted to the functions and procedures outlined in the regulations. RN practice acts use permissive and autonomous language, meaning that RNs practice without external supervision and they can make decisions and use judgment about their nursing care. LPN/LVN education is usually medical model based with students learning about disease and the medications and procedures used to treat disease. Educational programs for registered nurses are based on nursing conceptual models, using the research of nursing theorists to focus on not just disease, symptoms, treatments, and procedures, but on the human responses to disease. In other words, nursing diagnoses and care planning. As a provider of care, there are also significant differences in practice between LPNs/LVNs and professional nurse practice. In terms of the nursing process, LPNs/LVNs can assist with the collection of data with focused assessments and the identification of patient strengths and weaknesses. Only RNs, however, can perform comprehensive assessments (i.e. admission, post-operative), analyze the data, and develop nursing diagnoses. RNs establish goals and outcomes with the contribution of the LPN/LVNs, and practical/vocational nurses implement basic interventions within their scope of practice. In most states, only RNs can delegate nursing care. LPN/LVNs can evaluate the effects of care they give, but only RNs can revise the goals and outcomes to reflect that evaluation. For example, the New Jersey nurse practice act defines the practice of professional nursing as: “The practice of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential physical and emotional health problems, through such services as case finding, health teaching, health counseling, and provision of care supportive to or restorative of ©2018 Achieve Page 40