Running head: CURRENT PRACTICE AS A NEONATAL NURSE 1

The Current Practice as a Neonatal Nurse, Importance of Nursing Theory to Practice, and

Preparing for a New Role

Mary E. Hefferan

Ferris State University

CURRENT PRACTICE AS A NEONATAL NURSE 2

Abstract

The knowledge, skills, and attitude (KSA) required to be a neonatal intensive care unit (NICU)

nurse are specialized, but still follow the scope and standards of practiced set by the American

Nurses Association (ANA). In addition to discussing the current practice of a NICU nurse,

specific examples of KSA required to practice as a registered NICU nurse are described. They

are then linked to the ANA’s standards of practice of a registered nurse. Incorporation of the

scope and standards of the ANA with continued self-reflection, prepare nurses to become

competent, quality leaders of the nursing community. In order to gain perspective on nursing

practice, nursing philosophy is also analyzed and the four metaparadigms of nursing, person,

health, environment, and nurse are defined according to the author. An example of a nursing

theory is discussed as well as the importance of nursing theory to practice. To further advance in

nursing practice, future KSA must be identified to prepare for a new role. This paper also

explores the KSA required to attain a specialty practice nursing role in informatics and how these

relate to the ANA’s scope and standards of practice for nursing informatics.

CURRENT PRACTICE AS A NEONATAL NURSE 3

The Current Practice as a Neonatal Nurse, Importance of Nursing Theory to Practice, and

Preparing for a New Role

The path toward becoming a registered nurse is different for every student. Although

each student fulfills similar educational and clinical requirements, where they specialize and

what skills are required for their practice, tailor to each specific position. With each position,

nurses are required to adapt the KSA they have acquired through nursing school, to each clinical

area they encounter throughout their professional career. This adaptation of abilities develops

through a variety of ways. Through learning from different teaching styles of preceptors,

observing and learning from coworkers, and eventually teaching others, a nurse becomes

specialized in their role. To further gain insight regarding a nurse’s current practice, nursing

theory is essential to incorporate during the continuation of learning throughout one’s career.

The purpose of this paper is to discuss the KSA needed specifically for the position of a staff

nurse in a NICU and how these abilities relate to the ANA’s scope and standards of nursing

practice. This paper will also analyze nursing theory based on the four metaparadigms of nursing

and discuss the importance of nursing theory to nursing practice. And to explore preparation

towards a new role, this paper will identify the KSA required for a future specialty practice

nursing role in the field of informatics; relating them to the ANA’s scope and standards of

practice for nursing informatics.

Current Practice

Neonatal intensive care nursing is defined by the National Association of Neonatal

Nurses (NANN) as “a subspecialty of nursing that works with newborn infants with a variety of

problems ranging from prematurity, birth defects, infections, cardiac malformations, and surgical

problems” (NANN, n.d., para. 1). Although the neonatal period is limited to the first month of

CURRENT PRACTICE AS A NEONATAL NURSE 4

life by definition, often times these infants will stay in the NICU for several months or even a

year. Because neonatal nurses take care of this highly fragile population, their training must be

specialized and vary from that of other areas of nursing. For example, in the author’s

experience, the training to become a NICU nurse included a three month intensive new graduate

orientation period. This orientation consisted of classroom time with other newly hired nurses

and on the unit shifts working with experienced preceptors. The classroom orientation, led by a

clinical nurse specialist, involved outlining current practice of taking care of critically ill

neonates and the scope and standards of neonatal nursing. These classes, combined with

working with experienced preceptors and coworkers, developed the current skills needed for the

author to become an experienced NICU nurse. The following sections will detail the specific

KSA required in the current practice of the author as a NICU nurse.

Knowledge

Taking care of critically ill, preterm, fragile neonates, demands a specialized knowledge

base catered to this population. According to the ANA (2010), one of the tenets characteristic of

nursing practice is that it be catered to each individual to meet their particular needs and be

unique to each situation the patient is in. Each patient may have very different disease process

that requires knowledge of each diagnosis and how to individualize care. For example, a two

patient assignment for a NICU nurse may consist of a very low birth weight (VLBW) preterm

infant weighing 750 grams on a ventilator, while the other patient is a full term infant who was

exposed to methadone in utero.

The specialized knowledge that is required as NICU nurse for each disease process,

allows for the proficient progression through the standards of practice of nursing. The first

standard of nursing practice, as stated by the ANA, is assessment (ANA, 2010). In the previous

CURRENT PRACTICE AS A NEONATAL NURSE 5

example, the knowledge is recalled learned through orientation classes that the VLBW infant is

very sensitive to light and touch and therefore minimal handling is recommended to reduce

stress. Zahr and Balian (1995) found that the tactile interventions from nurses resulted in a

decrease in oxygen saturation and increased heart rate demonstrating indicators of stress. This

example represents incorporating the healthcare consumer’s individual needs and preferences to

guide the assessment (ANA, 2010). With the other patient, the NICU nurse knows that

methadone exposure could present an ethical dilemma when the mother visits her newborn and

“assesses family dynamics and [their] impact on healthcare consumer health and wellness”

(ANA, 2010, p. 32). The NICU nurse requires the knowledge that the mother may be ashamed

or feel guilty for her newborn’s diagnosis and directs care accordingly; supporting the mother

and facilitating a bond between mother and infant.

The knowledge required of a NICU nurse also applies to the second standard of practice

diagnosis, as outlined by the ANA (ANA, 2010). During the diagnosis of a VLBW infant, the

nurse uses knowledge to recognize possible risks and potential adverse effects that may affect the

healthcare consumer (ANA, 2010). The knowledge that high oxygen concentrations are harmful

to the underdeveloped retina of a VLBW infant leads the nurse to reduce the oxygen on the

ventilator. Regarding the infant exposed to methadone, the knowledge of the signs of

withdrawal aids the documentation of severity of the infant’s withdrawal. This documentation

communicates to the interdisciplinary team the progress of the infant, facilitating outcome

expectations and guiding the diagnosis and care of the newborn (ANA, 2010).

Skills

The skills required to be a NICU nurse span from the skills needed for communicating

with coworkers and families, teaching families how to take care of their newborn, and the actual

CURRENT PRACTICE AS A NEONATAL NURSE 6

bedside care of the neonate. In following the ANA’s standards of practice (2010), the nurse uses

practiced communication skills to incorporate the patient, the family and social support system of

the patient, and other healthcare providers to assist in developing outcome expectations when

fitting. For instance, the NICU nurse communicates to a visiting family that their VLBW infant

is stable, but also expresses carefully that their infant is still very fragile and expected outcomes

cannot be determined at the moment.

In addition to using practiced communication skills, a NICU nurse requires the skills to

follow a prescribed plan of care and adjust the plan of care according to the changing needs of

the patient. In accordance with the ANA standard of planning, the nurse provides direction to

the interdisciplinary team by using the plan and coordinating care appropriately (ANA, 2010). If

the VLBW infant in the aforementioned example had a blood gas outside the prescribed

parameters, the NICU nurse would then follow the plan of care by notifying the doctor and then

the respiratory therapist to make the appropriate ventilator changes. Also, if the newborn who

was exposed to methadone was not tolerating a recent wean in morphine, the nurse would

communicate this with the doctor to alter the plan of care to fit the patient’s current needs. In

both scenarios, the nurse implements the change in plan, coordinates care by advocating for the

patient, continuing through to the implementation and coordination of care standards of practice

(ANA, 2010). Following the changes, the nurse assesses the progress of the infant toward the

desired outcomes (ANA, 2010).

Attitude

While taking care of patients who have no voice to communicate, a special attitude is

required. The NICU nurse must adopt the attitude of a calm teacher with the newborn’s parents

and families. Parents are often scared and intimidated by the multitude of wires and equipment

CURRENT PRACTICE AS A NEONATAL NURSE 7

surrounding their baby, therefore the nurse slowly includes the parents in each activity. The

nurse may first include the parents in a diaper change, taking a temperature and then

coordinating time to hold their infant on a ventilator. There also must be collaboration between

the nurse and the family to reach the desired outcomes (ANA, 2010). The nurse teaches the

parents how to take care of their infant at home, working together to achieve the same goal.

Ethical dilemmas also occur in the NICU, compelling the NICU nurse to put personal

feelings aside and assume a neutral attitude. There are times when infants are kept alive via

numerous machines and medications at the request of the parents. The nurse may feel these

infants are suffering, or will never achieve an acceptable quality of life, but their attitude cannot

affect the care they provide. They must maintain a compassionate, therapeutic, patient-nurse

relationship, but create appropriate boundaries that facilitate an appropriate professional

relationship as well (ANA, 2010). Although difficult, the nurse must put their personal feelings

aside and continue to provide excellent care to the patient and family.

Philosophy

Personal philosophies of nursing begin with the initial inspiration of becoming a nurse.

A student identifies qualities they believe nurses possess and aspires to adopt these qualities by

studying to become a nurse. The identification of these qualities is the basis of a personal

philosophy of nursing. The personal philosophy of the author originated from a desire to

integrate scientific knowledge into practice, with the ability to work within a team that

collaborates to improve the health of individuals and the community, while catering to the

unique perspectives of each individual.

Philosophy is the basis of nursing theory and research and contributes to the development

of new theories (Peterson & Bredow, 2009). Identifying a personal philosophy and then

CURRENT PRACTICE AS A NEONATAL NURSE 8

adapting it through further knowledge gained through nursing theory is important to guide one’s

personal practice. This will ensure that the personal philosophy evolves and maintains its

accuracy based on current nursing practice. The framework of nursing theory is based on the

four metaparadigms: person, health, environment, and nursing. These metaparadigms create

boundaries for guiding nursing theory based on the common concepts integrated in nursing

practice (Tourville & Ingalls, 2003). In the following sections, the four metaparadigms will be

discussed based on the author’s perceptions that were formed from experience and through

research.

Person

The metaparadigm of person, according to the author, encompasses the person who is

receiving care and with whom the nurse is interacting. This may also include the patient’s

support system, loved ones, and family members when directly involved in the patient’s care.

This definition was inspired by Neuman’s System Model which refers to the patient as a system

that interacts and reacts to stressors within their internal and external environment (Masters,

n.d.). The systems model is based on the belief that “the world is made up of interconnected

systems” and the person is defined by the balance of their physical, psychological,

developmental, sociocultural, and spiritual factors (Tourville & Ingalls, 2003, p. 26). Since a

patient’s support system or family members influence these factors, the person metaparadigm

must be expanded and included in this definition. This relates to the author’s current practice as

a NICU nurse as well; where including the family environment is vital to nursing care because

newborn patient will be taken care of by the family at home.

To further explore the metaparadigms of nursing, it is beneficial to understand how they

relate to practice by defining them through actual nursing theories. For example, the theory of

CURRENT PRACTICE AS A NEONATAL NURSE 9

unpleasant symptoms (TOUS) is a middle range theory that explores symptom experience and

how the clustering of symptoms can produce multidimensional effect on a person’s

physiological, psychological, and situational well-being (Lenz, Pugh, Milligan, Gift, & Suppe,

1997). In this theory that focuses on the symptom experience, the person would be defined as

the person experiencing and exhibiting the symptoms. This may also include those who are

contributing to the symptom experience such as the family or friends of the patient.

Health

The second metaparadigm health, as defined by the author, is the optimal functioning of a

patient based on their potential in relation to their surroundings. This definition was gleaned

from Neuman’s System Model and Dorothy Johnson’s Behavioral Systems Model. Each model

focuses on the stability and balance of a person in relation to their health (Tourville & Ingalls,

2003). When a patient’s system and subsystems are in balance, they are considered in good

health. However, if a patient’s system is unstable, or negatively influenced by their subsystems

or environment, it is considered a deviation from the continuum of health, in other words, a state

of illness (Tourville & Ingalls, 2003). This definition encompasses more than a disease process

or state of illness; it focuses on the influence of the holistic environment and its effect on the

patient in relation to their health.

When relating this metaparadigm to the TOUS that concentrates mainly on symptom

experience, health should be defined according to this experience. Symptoms defined by the

TOUS are the “perceived indicators of change in normal functioning as experienced by patients”

(Lenz et. al., 1997, p. 14). Therefore, the absence of symptoms would be a patient in good

health, functioning ‘normally’. The TOUS focuses on subjective symptoms expressed by the

patient and the influencing factors upon the patient’s symptom experience. By incorporating the

CURRENT PRACTICE AS A NEONATAL NURSE 10

influencing factors (physiological, psychological, situational), the TOUS integrates the holistic

view of health as a metaparadigm; looking beyond the disease process alone (Thorne et al.,

1998).

Environment

The next metaparadigm, environment, includes the location where care is provided and

any external influences produced by the environment that the patient experiences. This may

include the temperature of the environment, lighting, smell, or the home environment where the

patient is expected to recover. The influence of the environment can negatively or positively

impact a person’s health. The author’s definition was inspired by Callista Roy’s Adaptation

Model, where the person is viewed as constantly interacting and adapting to the environment

(Tourville & Ingalls, 2003). Roy’s Adaptation Model focuses on the response of the individual

to their environment and how or if adaptation to external influences occurs. When properly

adapted to their environment, a person is considered healthy.

The TOUS relates the environment to influences situational factors have on an individual

and their symptoms. This translates to a person’s social environmental factors as well as

physical environmental factors (Lenz et al., 1997). Lenz et al. (1997) refer to social situational

factors as being a patient’s employment status, marital status, presence or absence of social

support, and their level of access to health care. The physical situational factors are more related

to temperature of a room, sounds, and light exposure (Lenz et al., 1997). The TOUS also

broadens the conceptualization of environment to include social environment as well as physical.

This in turn, expands nursing practice to view environment as more than simply what is

surrounding the patient at the time care is being given, to a more complete, holistic system.

CURRENT PRACTICE AS A NEONATAL NURSE 11

Nursing

The final metaparadigm, nursing, encompasses the nursing profession and the desired

traits that a nurse possesses. According to the author, the profession of nursing combines the

ability to integrate scientific knowledge with philosophy and the esthetic art of caring to assess,

diagnose, plan, and intervene when caring for a patient (Tourville & Ingalls, 2003). The desired

traits of a nurse are drawn from Jean Watson’s carative factors and her human care values related

to nursing. Included in Watson’s carative factors and care values, are aspects of nursing that

incorporate a scientific responsibility of nurses along with establishing a caring, trusting

relationship with a person as the essence of nursing (Tourville & Ingalls, 2003). Watson focuses

on the caring aspect of nursing, but also embraces the full scope of nursing by requiring the

integration of scientific and philosophical knowledge.

Nursing as defined by the TOUS, is the process of evaluating symptoms and identifying

the contributing factors and how they affect the symptom experience (Lenz et al., 1997). The

TOUS provides a framework for nursing by establishing a theory for assessing multiple

influences on a patient’s health. It then aids in the design of an intervention for alleviating the

resulting unpleasant symptoms (Lenz et al., 1997). Although this definition is limited and does

not include much of the esthetic art of nursing, establishing a caring, therapeutic relationship

could aid nurses in evaluation of symptoms, whether they are subjectively expressed, or

influenced by the physical or social environment.

Nursing Theory

Establishing a basis of nursing theory knowledge will contribute to the development and

enhancement of one’s personal practice as well as further contribute to defining the uniqueness

of the nursing profession (Peterson & Bredow, 2009). Nursing practice must be distinguished

CURRENT PRACTICE AS A NEONATAL NURSE 12

from other areas of the health care field because nurses approach patient care in a distinct holistic

and artistic way (ANA, 2010). Nurses establish a personal, caring, relationship that is central to

the nursing process. Nursing theory also intends to provide the foundations for nursing practice

and further produce knowledge that guides nursing practice for the future (Colley, 2003). By

identifying new areas for research and evidence based practice, nursing theory further supports

the scope and standards of practice and ensures the delivery of excellent patient care (ANA,

2010).

The TOUS contributes to nursing practice by creating new avenues to research symptom

expression and the contexts within symptoms are experienced. An example of the theory’s

application is Lenz and colleagues’ (1997) study of breastfeeding outcomes in new mothers.

They applied the theory by identifying the unpleasant symptoms that affect the mothers in

concurrence during the first stages of breastfeeding their infant. Lenz et al. (1997) found that

fatigue and pain were the most common unpleasant symptoms that were experienced and that the

influencing factors that potentially contributed to these symptoms were: insufficient exercise,

rest, depression and anxiety, and absence of support. They then used the influencing factors as a

guide for symptom treatment. Lenz et al. (1997) addressed these factors by promoting asking for

help for mothers who had little, and providing strategies to promote rest and conserving energy.

Specific interventions were also included that addressed the physiologic symptoms as well; such

as sleeping when the infant is sleeping, or applying warm compresses to relieve pain (Lenz et al.,

1997).

Conclusion

To be a competent, practicing nurse in any specialty, nurses must keep the ANA’s scope

and standards of practice at the forefront of their career. They must seek out ways to improve

CURRENT PRACTICE AS A NEONATAL NURSE 13

themselves as nurses, the nursing community, and the unit in which they work. Nurses cannot

isolate themselves, but must continue to embrace knowledge acquisition and continue to educate

themselves regarding the specific population they are serving or the role in which they are

fulfilling (ANA, 2010). This development of oneself is rooted in a personal nursing philosophy

to build upon for a future in excellent nursing care. Included in this development is identifying

nursing theories that could prove valuable to nursing practice and expand thinking beyond what

lies directly ahead.

In addition to enhancing one’s personal nursing practice, the integration of nursing

theories into the nursing profession leads to methods for improving patient care, defining the

uniqueness of nursing, and revealing areas in need of further research (Colley, 2003). The

TOUS is an example of a nursing theory that expands thinking beyond simply symptom

management. It integrates holistic thinking by viewing symptom management in terms of

psychological, physiological, and situational factors occurring together and their unique

influence on the resulting unpleasant symptoms (Lenz et al., 1997). The TOUS creates a new

method for approaching care and aids the design of interventions to address the three different

factors. Theories like this show that they can drive nursing practice towards continued

improvement and excellence in all facets of nursing.

Transition

Preparing to step into a new role requires reflecting on previous KSA and then

identifying what is needed for transitioning to a new, more advanced role. This transition may

prove to be challenging, but proper identification of the KSA required will provide a pathway for

building confidence in a new role. Previously discussed in this paper were the KSA required for

practicing as a NICU nurse. These abilities were then related to the ANA’s scope and standards

CURRENT PRACTICE AS A NEONATAL NURSE 14

of practice. In the following sections, the KSA required to attain a specialty practice nursing role

in informatics is described and then related to the ANA’s scope and standards of practice for

nursing informatics.

Knowledge

Nursing informatics is a specialty that integrates computer, nursing, and information

science to connect and disseminate knowledge and data within the nursing practice (ANA,

2008). In order to practice as an informatics nurse specialist (INS), specific knowledge of the

human-computer interaction (HCI) is required. HCI refers to how humans interact with

technology and relates to the usability and ease of learning for a range of end users (Patel &

Kaufman, 1998). This knowledge is attained by learning the thought processes the end users will

go through when utilizing a particular program. To obtain this knowledge, it would be beneficial

to follow standard one of the ANA’s (2008) scope and standards of nursing informatics:

Assessment. Within this standard, the INS analyzes “current practice, workflow, and the

potential impact of an informatics solution on that workflow (ANA, 2008, p. 67). Proper

analysis of the environment and stakeholders utilizing the informatics solution provides insight

as to how the end users will interact with the program and how the INS can cater to their

practice.

Additionally, with efforts focused on achieving access to electronic health records by

2014 for most Americans, health information technology and those who interact with it must

have knowledge of ethical use of electronic health information and health care communication

(American College of Emergency Physicians [ACEP], 2013; ANA, 2008). To acquire ethical

knowledge, looking to the ANA’s (2008) standard 12: Ethics, guides learning in this area. The

measurement criteria state that the INS will follow the Code of Ethics for Nurses and practice

CURRENT PRACTICE AS A NEONATAL NURSE 15

according to its principles (ANA, 2008). The INS should use this to obtain advanced knowledge

of the Health Insurance Portability and Accountability Act (HIPAA), how health information

should be protected, and how to approach ethical dilemmas when they arise. For example, with

complete access to a personal electronic health record, information may reach a patient before a

provider is given the opportunity to explain the data appropriately (ANA, 2008). The ethical

dilemma for the INS is deciding whether to limit the access for the patient until proper

explanation by the provider is given.

Furthermore, knowledge of cost, safety, and effectiveness should be achieved. Following

the standard 14: Resource utilization, the INS will evaluate cost, safety, and effectiveness when

instituting an informatics solution (ANA, 2008). With health care expenditures skyrocketing

($2.2 trillion in 2007), the INS should be focused on maintaining efficient, safe, and cost

effective patient care solutions (Centers for Disease Control and Prevention [CDC], 2013). The

INS achieves this by developing methods to evaluate the efficiency and safety of the informatics

solution and advising stakeholders regarding the costs, benefits, and potential risks of a plan

(ANA, 2008).

Skills

Technology grows and changes at an exponential rate (Kurzweil, 2001). With these rapid

changes, the INS must have the skills to adapt and manage change accordingly. The healthcare

arena has already changed dramatically incorporating telemedicine and electronic or telephone

appointments with providers. To manage these changes, the INS should maintain the skills of

practicing evidence based research referring to standard 13: Research, of the ANA’s (2008)

scope and standards of practice for nursing informatics. Within this standard, the INS

contributes to research activities by utilizing findings to guide practice, participating in data

CURRENT PRACTICE AS A NEONATAL NURSE 16

collection, conducting their own research, and identifying areas for further research (ANA,

2008). By following this standard and meeting its measurement criteria, the INS will become

skilled at researching and incorporating new innovative solutions in their practice; keeping up

with the pace of technology.

The INS must also be skilled in evaluation methods to measure progress and results of a

particular plan. The ANA’s (2008) standard six: Evaluation, guides skill development and

addresses the criteria that must be met. In order to produce effective, ethical, and usable

informatics solutions, the INS should include continually assess and evaluate data and solve

problems as they arise (ANA, 2008). This requires skills of analysis and critical thinking when

evaluating a new process or procedure. Being present with key stakeholders, organizations’

information technology departments, and public consumers builds evaluation techniques and

skill development.

Similar to a NICU nurse skill required, the INS must also be skilled in effective

communication and collaboration within an interdisciplinary team. Teamwork is implied in all

aspects of healthcare and the complexity of healthcare communication requires extensive skill

development. The INS may be required to consult and communicate with many individuals in

the healthcare field. Following the standard 10: Collegiality, the INS can learn what effective

communication entails (ANA, 2008). The INS “shares knowledge and skills with peers”,

provides feedback, and mentors others when needed (ANA, 2008, p. 81). It will be imperative

when implementing and evaluating informatics solutions to foster caring and open relationships

with colleagues and peers (ANA, 2008). Valuable input can be obtained when consulting with

various disciplines within an organization that could prove useful for the INS. Also, an INS

CURRENT PRACTICE AS A NEONATAL NURSE 17

must be open, approachable, and available during implementing informatics solutions so the end

users feel comfortable reporting problems or errors.

Attitude

In addition to the knowledge and skills required to become an INS, the attitude of a

leader must be demonstrated. In most advanced practice nursing roles, leading a team and

engaging in teamwork will be required. Following standard 16: Leadership, the INS assume the

attitude of a leader that includes “serv[ing] in key leadership roles defining the vision, strategy,

and tactical plans related to the management of data, information, and knowledge” and gives

clear direction to an “interdisciplinary team and key stakeholders” to increase efficiency (ANA,

2008, p. 90). The INS leads their organization in education regarding advancements in

informatics and communicates understandable information through writing or presentations

(Tupper & Alexander, 2012; ANA, 2008). Leading in this field and communicating the vision of

nursing informatics will require confidence and presence; which will be learned through ongoing

education and experience.

The INS will also be required to adopt the attitude of a teacher and educator; similar to

the requirements of a NICU nurse. The audience will be dramatically different for the INS

compared to a NICU nurse, but the calm, empathetic demeanor remains the same. The INS will

follow the standard 5b: Health teaching and health promotion and education (ANA, 2008). The

INS must be in touch with the needs of the patient and professionals to create educational

material appropriate for particular patient demographic and training programs for the end users

of an informatics solution (ANA, 2008). And since the health information technology

requirements are continually changing to meet new standards, the INS will be learning and

teaching for the extent of their career (ANA, 2008).

CURRENT PRACTICE AS A NEONATAL NURSE 18

Reflect

Progressing towards an advanced practice role in nursing requires building upon the KSA

of past experiences and building a new area of expertise. Also, to gain better perspective on role

advancement, gaining insight from others who have experienced a similar transition is important

to guide understanding. Prior to the conception of this paper, the author interviewed a recently

graduated advanced practice nurse (APN) and their experience of the recent transition to a new

role. Utilizing the research method of ethnography that explores human experiences within a

specific cultural group, valuable information regarding the transition experience was gathered

(Robinson, 2013). Interviews provide valuable ethnographic data to provide understanding of an

experience and “develop theoretical explanations for the experience” (Robinson, 2013, p. 16).

The semi-formal interview provided insight regarding the difficulty releasing past

structures of behavior from a prior nursing role and transitioning to a new pattern of behavior.

For example, the APN stated that she felt herself reverting back to prior skills she learned as a

bachelor prepared registered nurse. Through experience and development of the KSA she was

able to gain the confidence to step out of her past role and fully into the role of an APN. The

APN interviewed also referenced many influential individuals that encouraged and helped define

the role she was advancing towards. By providing her with support and information regarding

her new role, these individuals were following standard 12: Leadership as outlined by the ANA’s

(2010) scope and standards of practice. They mentored her and provided direction in the

advancement of her new role (ANA, 2010).

An advanced practice nursing role implies a new responsibility to those who achieve it.

With this responsibility requires defining what is required specifically for that new role. As a

future INS, the KSA have similarities to that of a NICU nurse, but differ in their application.

CURRENT PRACTICE AS A NEONATAL NURSE 19

Becoming an INS will require knowledge in new areas that relate to HCI, ethical use of

electronic health information, and cost effectiveness of an informatics solution. Communication

skills will be required beyond that of a NICU nurse of communicating with families and

interdisciplinary neonatal teams. The INS will be required to communicate with entire

organizations and communicate as a leader in their field. And although each role requires the

attitude of a teacher, the audience and students will differ when assuming this new role. The INS

will be required to teach to the individual needs of the patient and professional they interact with.

And because the health information technology field is constantly advancing, the INS must adapt

and be comfortable with change; continuing to learn with each new change. These attributes

combined in practice, define an advanced role as an INS that follows the ANA’s (2008) scope

and standards of practice and will hopefully continue the advancement of the nursing profession.

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CURRENT PRACTICE AS A NEONATAL NURSE 20

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