Academic Master


Professional Accountability

Nursing Theory

Nursing theories define what nursing is, and provide the guidelines for nursing practice based on fundamental concepts. Among the different types of nursing theories, I would like to describe one approach that has influenced my nursing practice (Alligood, 2017). Florence Nightingale, the first nursing theorist, highlighted how environmental factors affect an individual’s health and wellness. Understanding her environmental theory helps me provide the quality of care to my patients.

Excellent Nursing Practice

Florence Nightingale described how various environmental factors such as light, noise, cleanliness, air, nutrition, warming, and ventilation relate to the patient’s health. Based on her theory, nurses make sure that they provide a healthy environment for each patient. She advocates that practices such as hand washing are an example of practicing good hygiene to prevent infections (Alligood, 2017). Nurses also understand that it is essential to provide a quiet and peaceful environment for those who are sick so that they can get the quality of sleep while they are recovering.

Professional Nursing Practice Theory

Since I am a nightshift nurse, I ensure that each of my patients receives the quality of sleep throughout the night to restore the energy that they have lost during the day. All the patients need a favorable environment in the hospital with minimum noises (Alligood, 2017). These are some of the practices I employ based on Nightingale’s environmental theory. Our department is mainly dealing with cardiac and renal patients. Most of them are chronically ill or elderly. They are very sensitive to heat or cold. Some of them are confused and agitative. So I believe that providing a quiet, warm environment and proper nutrition to these patients is part of the essential treatments to faster recovery to our patients.

Two Historical Nursing Figures in the 19th or 20th Century

Florence Nightingale was also known as the lady with the lamp in 1860. She was the first nursing theorist for developing the Environmental Theory that revolutionized nursing practices to create sanitary conditions for patients. Also, Hildegard Peplau was a theorist who created the Theory of Interpersonal Relations in the 19th Century. Her theory helped nurses develop more therapeutic interventions for patients (Alligood, 2017). Peplau believed that reducing unnecessary stressors by using therapeutic interactions lead to positive outcomes for patients.

Differences in Contributions

While Peplau focused on the interpersonal relationship as the foundation of nursing practice, Nightingale emphasized the environmental factors which contribute to an individual’s health and wellness. Peplau described seven roles of nursing which are the surrogate role, the leadership role, the stranger role, the teaching role, the technical expert role, the counseling role, and the resource role (, 2016). Again, Florence Nightingale believed that some environmental factors affect the patient’s recovery.

Description of Historical Figures

Because of Florence Nightingale’s theory, we as nurses follow infection control practices using hand washing, providing a clean environment, implement the nursing care plans based on each patient’s needs. Additionally, Peplau’s theory reminded me to use therapeutic communication to establish appropriate care plans for my patients and find ways to help them recover faster.

State Board of Nursing and American Nurses Association

State Board of Nursing is a legal organization to regulate the rules and enforce the regulations for nursing practice in each state. It also defines the scope of practice for nurses within the state. Nurse practice acts, nursing education and licensure requirements vary in each state. State Board of Nursing can issue the nursing licenses, take disciplinary actions, and approve the nursing education programs. The American Nurses Association (ANA) is an organization that empowers and advocates nurses. It represents the interests of the nation’s 4 million registered nurses (“About ANA,” n.d) (American Nurses Association, 2017b).

Roles of Organizations

According to the Iowa Board of Nursing, the roles of the board are “to protect the public health, safety and welfare by regulating the licensure of nurses, the practice of nurses, nursing education and continuing education” (Enforcement, & ENFORCEMENT, 2018). The American Nurses Association is the voice of its members and their needs. It promotes a safe and ethical work environment and supports the nurses to lead change in healthcare.

Influence of the State Board of Nursing and ANA

The State Board of Nursing regulates the rules for nursing practice and issues the nursing licenses. By following the state rules and regulations of the nursing scope of practice, I can maintain my license (Schaeffer, & Haebler, 2019). Board of Nursing always issues the newsletters quarterly. I can update my information related to nursing practice and education from that as well. Due to American Nurses Association fights for what nurses believe and supports a safe work environment, I think we can raise our voices if there is an issue.

Requirements for Professional License Renewal

The Licensees need to renew their licenses every three years. It costs $99 for renewal, and a licensee may renew a license beginning 60 days before the license expiration date. All renewals require 36 contact hours of continuing education.

Failure to maintain license requirements

Board of nursing rules does not prohibit the practice of nursing during the 30 day grace period (Valdmanis, Rosko, Leleu, & Mukamel, 2017). However, the employer has the right to prohibit practice during this time frame. Anyone who fails to maintain the license requirements may be imposed, such as citation and warning, civil penalty, probation with conditions, suspension, or revocation.

Compact versus Non-compact State

The RN under Nurse Licensure Compact can practice in both home states and other small states. A resident of the non-compact state may apply for a license by endorsement in a compact state.

Agencies Functional Differences

Regulatory bodies within nursing practice address issues from a public protection perspective in favor of the patient and nurse safety (Valdmanis, Rosko, Leleu, & Mukamel, 2017). On the other hand, professional associations handle issues related to the nursing field from a more comprehensive professional dimension. At the same time, unions focus on problems basing on the needs and requirements of individual nursing practitioners.

D. Discuss the functional differences between the Food and Drug Administration and the Center for Medicare and Medicaid Services (see the web links below).

In general, there are numerous ways in which people pursue to treat illness in the U.S, yet still, several people opt for therapies alternates to infections. Despite Western medicine availability is not a significant problem, traditional healers and believers use treatments usually herbs, homeopathy, biofeedback, supplements, and acupuncture, among many others as alternative forms of therapies. A dangerous loophole is linked to this type of treatment because it is neither covered nor regulated by the federal agency CMS and other insurance healthcare providers as supposed to be like those that are regulated (CMS.GOV, 2020). FDA’s (Food and Drug Administration) role is exceptional in regulating herbs and supplementing dietary compared to drug substances passed in Congress to ensure safety, effectiveness, and selling due to its designation in law that is passed in 1994 (Bell, 2015).

Influence of FDA and CMS on nursing practice

CMS has influenced my career as a nursing professional in various ways. First and foremost, it has helped me in becoming an advocate for my patients while serving them throughout the treatment period. I like it since the advocacy refers to the act of supporting a cause by standing in to protect the interests of other individuals. In case some patients do not have private insurance, they can opt for Medicaid and Medicare services to gather for their bills. It is my pleasure that CMS has enabled in helping patients to get affordable insurance, hence giving me room to offer quality care services to them, therefore, relieving them from the stress they use to go through.

FDA, on the other hand, has helped me in my nursing career in understanding how to regulate medication that I dispense to my patience (Centers for Medicare and Medicaid, 2016). This is guided by the existing standards, which make sure that I offer the medications with regards to the prevailing facts on intervention ability. It has helped me in sticking to recommended dosages, understanding the side effects of the drug, and the contraindications, among others. It is through FDA that I am able as a nurse to prevent any kind of harm on my patients hence promoting patient recoveries (Centers for Medicare and Medicaid, 2016).

Discuss how the two regulatory agencies influence your professional nursing practice.

Regulatory agencies in the United States play significant roles of outlining the rules and regulations to be adhered by nurses’ practitioner by expounding standards, its definitions, and benefits for patient’s advocacy and safety. Such is because Centers for Medicare (CMS), along with my professional nursing practices, assists me in describing the nursing practices in terms of roles played in patient’s advocacy, and safety achieved by establishing the standard restrictions and offering other definitions of healthcare aspects (Bell, 2015). Food and Drug Administration (FDA) regulatory agency is commonly responsible for regulating the specific laws passed by Congress into law before resuming to its fully operational, in particular the medicine field (Ibrahim, 2018). The Iowa board of nursing is not excluded in the process of regulating the laws about patient’s advocacy and safety. This nurse’s body agency offers proposals on specific proposed rules and regulations before its version is adapted to be final for approval. In the nursing field, these two federal regulations help me with insights on how to value patient advocacy and safety provides the scope of respecting patients’ rights, autonomy, confidentiality, awareness, and education.

Describe your role as a patient advocate in promoting safety when a patient has requested to use an alternative therapy.

Many patients are vulnerable to seeking medic care outside the healthcare setting for alternative therapies, mainly traditional medicines indicated above to better health complications. As a Registered Nurse under the Iowa board of nursing, my responsibility is to facilitated safety among all patients’. I will take necessary steps to thoroughly research treatment costs, healers, and education onto the methodological aspect related to this contra-indication integrated into already existing therapies. While having no choice in healthcare as a caregiver, I am obliged to ensure that holistic care to better patient’s life quality is provided,

E. Discuss the purposes of the Nurse Practice Act in your state and its impact on your professional practice.

Every state in the U.S has its exclusive Nurse Practice Act, which is prescribed and enforced by BON. A care provider must adhere to the rules and regulations stipulated by BON to maintain a license for nursing practice. Iowa’s board of nursing describes the framework of nursing practice legal duties and necessities for licensed and exams for nurses related to within the stated. The precise roles and rules in NPA, help me know my working rules on what I should do and not as a Registered nurse.

Discuss the scope of practice for an RN in your state.

A Registered Nurse in Iowa plays roles such as appraisals, evaluate, plan, and implement responses related to the nursing care of patients and families assigned to provide care. Such process always involves nurse practitioner, patient, and families to ensure quality care are provided as well as bearing all the obligations of actions in the nursing setting to offer safe and proficient care (Bell, 2015).

Discuss how your state defines delegation for the RN.

In Iowa, nurses are allowed to delegate tasks to unprofessional person stipulated under provision found in Board rule 224 and 225 on delegations of RN to personnel for patients. However, delegation is allowed only under the circumstances provided under those provisions, while accountability is solely upon the RN for any outcome. RN nurses must be conversant with the delegate’s skills and competences ability and assured no harm would transpire.

F. Apply each of the following roles to your professional practice:

• A scientist

As a registered nurse and scientist professional, I champion promoting patients’ advocacy by finding ways on how to improve the overall health of the patient by providing adequate care. Also, with the acquainted skills of nursing theory and practice, I assist in enhancing patient care by providing the best evidence-based practices.

A detective

Typically detectives collect information from several sources within the healthcare setting and outside, then jolt down inquired details, ask questions diligently and document it well. As a Registered Nurse, I would exemplify the traits of detectives described above so that I give patients the best conceivable care they need. In doing so, I will be meeting the nursing practices related to the patient’s competent and safe care to mitigate adverse impacts on patients’ overall health.

• A manager of the healing environment

The healing environment is crucial in reducing the patient’s anxieties and stresses-related to illness or negative feelings about the environmental unit. Therefore, as a Registered Nurse, I will ensure that the healing environment facilitates the patient’s well-being, self-worth, and supporting them with their families in time illness in the healthcare setting. While acting as an RN manager within a healing environment, I will always stay calm, manage stress, including the support staff in the process, as well as being conversant and interactive to promote patient advocacy, safety, and educational needs.

G. Identify two provisions from the American Nurses Association (ANA) Code of Ethics (see weblink below).

According to the Iowa board of nursing, Provision 1 and Chapter 152 of Iowa code indicates that it is a unique attribute for everyone practicing nursing to be empathetic and show respect for the inherent dignity and worth (American Nurses Association, 2015).

Also, Provision 5 states that the nurse is indebted with the same responsibilities to self in a similar way and equal measures to others, especially in promoting health and safety, preserving wholeness of character and integrity, upholding and maintaining competence, and embracing growth at personal and professional levels.

  1. Analyze how the two provisions identified in part G influence your professional nursing practice.

ANA code of ethics is an aspect that is understood by every nurse because it is a crucial aspect taught during professional training and practice. In my nursing profession, I usually focus on provisions 1 and 5, as stated in section G of the paper. This is true because provision 1 entails the vital equal principles of human dignity. Besides, it discusses the nature of health and the plausible mutuality between patients and colleagues. Therefore, I create utility out provision 1 in my day to day nursing responsibilities by attending all the patients with equality and following their conditions (American Nurses Association, 2015). Having considered nursing a natural call to me as a career, I found provision getting instilled in me naturally.

With regards to provision 5, nurses ethical duties and responsibilities to themselves alongside the profession. This follows the fact that most nurses submit too much of themselves to the business than their aspects. Provision 5, therefore, addresses these aspects as it is known to attribute a good number of physical and mental burnout. Before getting deemed to the provision of nursing services, such as treating and caring for patients, I decided to assess my values and beliefs critically. Even though patient rights need to be valued and respected, it does not mean that the mind as a nurse should be sacrificed for the sake of the patients.

  1. Describe a nursing error that may occur in clinical practice (e.g., clinical setting, skills lab, or simulation).

Nursing practice is a field that is prone to errors that arise in various dimensions. These include errors encountered in documentations, medications, and safety aspects, among others. During my first venture in practice as a nurse, I made several mistakes, but I am grateful none of the errors impacted any of the patients I was attending (American Nurses Association, 2015). One of the mistakes that I made was a patient underestimation. There was a lot of confusion in my patient, and following he had a history of being violent and hot-blooded, I decided to stay back a little to allow him to attain some calmness before commencing my assessment.

  1. Explain how the ANA provisions identified in part G can be applied to the error discussed in part G2.

Following the plausibility of safety errors encountered in the nursing practice, provision 5 is always essential in providing care services. This follows the fact that nurses are still thought of the idea that a patient’s safety should be the priority. Thus, it is crucial that as nurses, we need to consider and uphold our safety in equal measures the way we do for patients (American Nurses Association, 2015). This infers that any threat towards a patient or nurse from any force should be rejected and condemned.

H. Identify four leadership qualities or traits that represent excellence in nursing.

Various leadership qualities are evident for the excellent provision of services in a nursing setting. These include;

  • Excellent communication– Effective communication in nursing practice is vital in the provision of service since it brings mutuality among the various departments, thus, creating a good association that helps provide the best care services to patients (Weberg, Mangold, Porter-O’Grady, & Malloch, 2018). Communication, when in place, builds a strong relationship among all the participants in the nursing setting.
  • Time management –This is a critical leadership quality in nursing that is linked to quality. Since medication is offered on a timely basis, being considerate of time management suggests that service delivery to patients will be of high quality (Weberg, Mangold, Porter-O’Grady, & Malloch, 2018).
  • Self and social awareness– Every leader must be aware and mindful of their one beliefs, strengths and weakness, and the way these aspects affect other people. Since nursing requires bold leadership, this feature is not exceptional (Weberg, Mangold, Porter-O’Grady, & Malloch, 2018).
  • Reliability- Nursing is one of the fields that is trusted in the U.S and the entire globe. This infers that when nurses fail to have trust in their leaders, it is inevitable that they will encounter several shortcomings as a result of mistakes made.

1. Discuss the significance of the four leadership qualities identified in part H in the nurse’s role as each of the following:

  • A leader at the bedside: Being a leader at the bedside implies that nurses should show the ability to communicate with patients, peers, and colleagues in the most effective manner. This quality is essential because it enables nurses to manage their own emotions and those for patients without offending or getting offended. Proper time management is also a crucial part of nursing; hence, to be an effective leader in the nursing setting, a nurse should show effective leadership by being competent in the field. It enables management to allow nurse leaders to effectively give priorities to care to enhance better patient outcomes. This is rightful in situations when patients are going through acute ailments and significant changes as far as treatment plans are concerned.
  • Within a nursing team or interdisciplinary team- Effective communication in the nursing setting suggests that plausible errors will be addressed and avoided amicably (Hall, 2017). Failure to uphold this quality, it is inevitable that preventable mistakes will be committed. In addition, effective communication in nursing practice addresses the dangers likely to be suffered as a patient outcome following uncontrolled emotions among nurses and patients.

2. Identify how your work environment impacts the following:

Nursing Leadership- Situations in the nursing working environment plays a crucial role in determining the quality of services offered. Most of the time, Nurses feel pressured to increase productivity by improving patient outcomes (Hall, 2017). However, the working environment determines the quality of services offered by the nurses. When the situation is conducive, it suggests that patients and nurses will be favored hence better outcomes, and the reverse is true.

• Decision making- Decision making in nursing practice is crucial since it attributes to the best thoughts in improving and salving wanting situations. If there is a lot of rigidity in the nursing surrounding, it means making decisions on critical grounds will be difficult hence affecting the patient outcomes.

Professional development– The nursing environment determines the scope of practice in the provision of care services. When the situation is unfavorable, it implies that limited opportunities for nurses will be available.


Alligood, M. R. (2017). Nursing theorists and their work-e-book. Elsevier Health Sciences.

American Nurses Association. (2015) “Code of Ethics for Nurses with Interpretive Statements.” OVID. 2015. Web. 12 June 2017.

American Nurses Association. (2017b). “Agencies and Regulations.” Retrieved March 10, 2020, from

Bell, L. (2015). Code of ethics for nurses with interpretive statements.

CMS.GOV. (2020). CMS Homepage | CMS. Retrieved 10 March 2020, from

Hall, H. (2017). Advancing Future Nursing Executive Practice: The Evidence Base for Servant Leadership in Nursing.

Ibrahim, I. (2018). Complementary and Alternative Medicine (CAM) as Treatments for Psychiatric Disorders: A Guide for Mental Health Professionals. JURNAL PSIKOLOGI MALAYSIA32(2).

Schaeffer, R., & Haebler, J. (2019). Nurse Leaders: Extending Your Policy Influence. Nurse Leader, 17(4), 340-343.

Valdmanis, V. G., Rosko, M. D., Leleu, H., & Mukamel, D. B. (2017). Assessing overall, technical, and scale efficiency among home health care agencies. Health care management science, 20(2), 265-275. Enforcement, I. I., & ENFORCEMENT, I. (2018). Iowa Board of Nursing.

Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2018). Leadership in Nursing Practice: Changing the Landscape of Health Care. Jones & Bartlett Learning.

White, M. J., Gutierrez, A., Davis, K., Olson, R., & McLaughlin, C. (2011). Delegation knowledge and practice among rehabilitation nurses. Rehabilitation Nursing36(1), 16-24.



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