NSG/397 Week 1: Personal Practice History and Professional Role Identity, sample paper

Nurse First, Behind a Locked Door: A Personal Practice History and the Professional Identity of a Correctional Nurse

[Student Name]

University of Phoenix

NSG/397: Professional Nursing Role

Week 1 Assignment

[Instructor Name]

[Date]

The nurse and settings described are a composite written for a model paper. No real patient or facility is described.

I became a nurse twelve years ago with an associate degree and spent my first three years on a medical-surgical unit. For the past nine years my workplace has been a county jail that holds about 1,100 people, most of them awaiting trial. When people learn where I work, they often ask whether I am a guard. The question is understandable, and answering it has become the clearest way I know to explain what a nurse is. This paper describes my practice history, examines professional nursing identity through a published concept analysis and the profession's code and considers what I expect the baccalaureate program to add.

A Practice History in Three Stages

My first years on a medical-surgical unit taught me the tasks of nursing: assessment, medications, wound care and the rhythm of a twelve-hour shift. I defined myself mainly by competence, by whether I could manage six patients without missing anything. My identity was borrowed from the unit: I was a nurse because I did what the nurses around me did.

The move to the jail changed that. I took the position for its schedule, and within weeks I found that the tasks were similar but the context was not. Patients arrived in handcuffs, many withdrawing from alcohol or opioids, many with untreated mental illness, diabetes or hypertension. Officers controlled when I could see a patient, and some colleagues from custody staff openly doubted that inmates deserved the same care as other people. The environment pushed me to decide what my role was when no one around me defined it the way a hospital does.

The third stage came after a man I had assessed twice in one night for chest pain was sent back to his housing unit by an officer who believed he was seeking attention. I insisted, over the officer's objection, that he be transferred to the emergency department. He had an acute myocardial infarction. That night clarified for me that my obligation ran to the patient and to the standards of my profession, not to the institution's view of him.

What Professional Identity Is

Fitzgerald (2020), in a concept analysis of professional identity in nursing, described it as a sense of oneself as a nurse that develops over time, influenced by knowledge, values, ethics and the relationships and experiences of practice, and that includes both the individual's self-concept and the way the profession's values are internalized. Among the attributes identified were a sense of belonging to the profession, a commitment to its values and ethical standards and a shared understanding of the nurse's role. Antecedents included education, role models and experience; consequences included job satisfaction, retention and quality of care.

Read through this analysis, my practice history shows an identity that began as borrowed competence and became internalized commitment. The medical-surgical years supplied knowledge and role models. The jail supplied the test: without a surrounding nursing culture, I had to decide whether the profession's values were mine. The chest pain night was the moment when a value I had been taught, advocacy for the patient, became one I acted on at a cost.

The Code and the Correctional Setting

The profession's code gives this identity its content. Its opening provision asks nurses to respect the dignity and worth of every person they care for, without conditions, and its next provisions place the nurse's first loyalty with the patient and make advocacy for the patient's health, safety and rights part of the job itself (American Nurses Association [ANA], 2015). In a jail, these provisions are not abstract. They define the difference between the nurse and the officer: both work for the same county, but only one is bound to the patient first.

Correctional nurses often describe this tension. Weiskopf (2005), interviewing nurses who cared for inmate patients, found that they struggled with custody rules, with their own reactions to patients' crimes and with colleagues' attitudes, and that many resolved the tension by focusing on the patient in front of them and on their professional obligation to provide care regardless of circumstances. That description matches my experience closely.

Standards and Accountability

Professional identity also includes accountability for meeting standards. The ANA's standards of practice describe the nurse's competent use of the nursing process, from assessment through evaluation, and standards of professional performance that include ethics, advocacy, communication and collaboration (ANA, 2021). In the jail, where supervision by other nurses is thin and nights are staffed by one nurse, these standards are the external check that a hospital unit's culture would otherwise provide. I have come to rely on them to answer questions such as how often a patient in alcohol withdrawal must be reassessed, regardless of what the housing schedule allows.

What I Expect From the BSN

My identity is firmer than it was, but it has gaps the program should fill. I have practiced the nursing process with individual patients but have little background in population health, although the jail population has high rates of chronic disease, infectious disease and mental illness. I advocate at the bedside but not yet at the level of policy, such as the jail's withdrawal protocol, which I believe undertreats patients. I read research only occasionally. I expect the baccalaureate program to add knowledge in these areas and to connect me with nurses in other settings, which may strengthen the sense of belonging that a correctional setting often lacks.

Conclusion

My practice history moved from borrowed competence on a hospital unit to an internalized professional identity tested and clarified in a jail. A concept analysis of professional identity explains that movement as the product of education, role models, experience and the internalization of the profession's values. The Code of Ethics and the standards of practice give that identity its content, particularly the commitment to every patient's dignity and to advocacy. The BSN program is the next stage: extending that identity from the individual patient to the population and the policies that shape care.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Publishing.

American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.

Fitzgerald, A. (2020). Professional identity: A concept analysis. Nursing Forum, 55(3), 447-472. https://doi.org/10.1111/nuf.12450

Weiskopf, C. S. (2005). Nurses' experience of caring for inmate patients. Journal of Advanced Nursing, 49(4), 336-343. https://doi.org/10.1111/j.1365-2648.2004.03297.x