Roles and Responsibilities of the Newly Qualified Nurse - Essay Example

?ROLES AND RESPONSIBILITIES OF THE NEWLY-QUALIFIED NURSE Roles and Responsibilities of the Newly-qualified Nurse Introduction The nurse is one of the crucial members of the health care team. Her role is often associated with fulfilling independent nursing functions and roles which require coordination with the other members of the health care team. The newly qualified nurse helps fulfill important functions in this health care system. Fresh from the academe, the newly qualified nurse is expected to fulfill functions which are bound to challenge the theories and the practices she has acquired during her nursing school days. By fulfilling such functions, her transition into actual clinical practice can be eased. The newly qualified nurse has to establish what roles and responsibilities she is expected to play in the actual practice. This paper shall now present a critical discussion on the roles and responsibilities of newly qualified nurses. It shall also critically discuss in detail two of these roles, with one of these roles focusing on patient group directions. Critical discussion on the roles of the newly qualified nurse The newly qualified nurse has the following professional roles: leading in care management and care delivery situations; maintaining standards of care; making ethical and legal decisions; being accountable; working in teams; and teaching others (Burton and Ormrod, n.d, pp. 1-2). The responsibility of taking the lead in care management and care delivery situations involves goal setting and self regulation (NHS, n.d). In effect, it also involves the process of group learning and problem solving, as well as taking a more active role in applying appropriate and vigilant nursing care skills (O’Connor, 2002, p. 69). The newly qualified nurses’ role is also to maintain standards of care. The standards of nursing practice have already been set and established long before the new nurse sought entry into the clinical practice. The new nurse’s role is to maintain said standards and to ensure that her actions in relation to patient care are in compliance with the legal and ethical standards of the nursing profession (Pozgar, 2007, p. 200). The newly qualified nurses’ role is also to make ethical and legal decisions. The legal standards of care are based on the standards as set by the Nurse Practice Act which governs each state; it is also governed by the Nursing Scope and Standards of Practice published by the American Nurses Association (Smith, 2009). The newly qualified nurses’ role is to follow these provisions and to ensure that other nurses also follow said standards. The newly qualified nurses must also base their ethical decisions on the principles of autonomy, beneficence, non-maleficence, and justice (Robertson, 1996, p. 292). The nurse must respect the patient’s right to autonomy and self determination in terms of making his decisions about his care (Silverman, et.al., 1995, p. 502). She must also implement such decisions based on what would best benefit the patient in terms of health care services (Melia, 1994, p. 7). The principle of non-maleficence also calls for the nursing decisions to not be harmful to the patient – to bring him ‘no harm’ (Black, 2002, p. 423). Finally, the principle of justice – that of giving the patient his due – must also be observed by the newly qualified nurse in order to help ensure that the patient would be receiving what he is entitled in terms of services and nursing care (Bishop and Scudder, 2001, p. 24). The newly qualified nurses’ role is also to be accountable for her actions or inaction. As soon as she takes oath and she practices her profession, the newly qualified nurse is as accountable for her actions as other nurses and health professionals (Smith, 2009). This accountability stems from the expected legal and ethical actions which she is supposed to carry out during her practice. Her accountability is also personal, in effect, she must be capable of making her decisions after due assessment of the chart orders. Blind obedience without duly assessing chart orders is part of the process of accountability (Hole, 2009, p. 41). Working in teams is also part of the newly qualified nurses’ role. It is important for the new nurse to coordinate her actions with other nurses and health professionals in order to ensure that all their actions contribute to the patient’s care and well-being (DiMeglio, et.al., 2005, p. 110). Finally, the newly qualified nurse must also be involved in teaching others – this involved the patient, the patient’s family, the community, and possibly, other members of the health care team (Curtin, 1979, p. 8). Health education is part of the nursing process and this can help improve the patient’s recovery and health maintenance. Critical discussion: making ethical and legal decisions Making ethical and legal decisions are important aspects of the newly qualified nurses’ practice. This role basically means that the nurse must follow the legal and ethical standards and requisites of nursing care. In other words, she must follow the provisions of the Nurse Practice Act (NPA) as set forth in her state (Smith, 2009). This act has installed the Board of Nursing as the regulatory authority in evaluating nursing actions and determining accountability. Moreover, the Board of Nursing: enforces the provisions of the Nursing Practice Act; sets forth the licensure of qualified nurses; approves of education programs; and implements disciplinary actions against licenses (Smith, 2009). In other words, the new nurse has to comply with these provisions or else be liable for disciplinary and legal actions based on negligence or violation of policies. In terms of ethical standards, the new nurse also has to comply with the ethical principles of autonomy, beneficence, non-maleficence, and justice. The principle of autonomy as discussed by Nourredine (2001, p. 3) is about allowing the patient to determine the direction of his care. In this regard, each decision in relation to his care must be consulted with him. In other words, his informed consent must be gained before medical care and procedures would be administered to him. The principle of beneficence is discussed by Macklin (2003, p. 275) and he emphasizes that this principle is basically about implementing care which would benefit and not bring the patient any harm. This is very much related to the principle of non-maleficence wherein the nurse must perform actions which would not bring the patient any harm. Finally, the principle of justice is about giving the patient his due. As the patient is in the care of medical professionals, he is entitled or due professional care based on the legal and ethical standards of the practice (Silva and Ludwick, 1999). This calls for the new nurses to be vigilant and to perform professional and quality services at all times. This is an essential part of the patient’s entitlement. The nurses’ role of making ethical and legal decisions requires awareness and a sense of leadership in the newly qualified nurse. More often than not while practicing her profession as a newly qualified nurse, she is bound to encounter various dilemmas which she has to resolve based on the ethical and legal standards (Memarian, et.al., 2007, p. 203). In these instances, it is therefore important for the nurse to be familiar with said standards. She also needs to be self-aware at all times – to be vigilant in her actions – in order to avoid violating the legal and ethical standards and to, more importantly, avoid harm from befalling the patient (Memarian, et.al., 2007, p. 203). This role may pose some issues on the delivery of nursing care like when the patient refuses medical care and his decision is being rejected by his family (Holloway, 1995, p. 223). It also involves the dilemma of informed consent – when informing the patient of the implications and risks of the medical care may cause the patient emotional stress and further endanger his health (Appelbaum and Grisso, 1988, p. 1636). These are some of the issues which the new nurse may have to resolve in her practice. However, with the proper application of the legal and ethical standards of care as well as due consultation with the other members of the medical team, it is possible to make decisions which would be legal, ethical, and which would be beneficial for the patient. It is important for the newly qualified nurse to be skilled in resolving ethical and legal dilemmas in her practice. An issue like a DNR order which is signed by the patient, but not supported by the family is considered an ethical dilemma (Murphy, 1988, p. 2098). The family may argue that the patient is not emotionally stable enough to make the decision about his care, and the patient may argue that he is of sound mind and is capable of making his own decisions about his care. The new nurse must evaluate the situation and must respect the patient’s right to autonomy; however this should not stop her from consulting with the patient and his family regarding the patient’s decisions (Murphy, 1988, p. 2098). The nurse is accountable for violations of these legal and ethical standards. The Board of Nursing holds nurses liable in the professional practice in relation to decisions made by the nurse in violation of the nursing standards (Smith, 2009). This does not preclude criminal and civil actions which may be brought against the nurse by the patient for actions which may have injured or which may have caused the patient physical or psychological harm (Smith, 2009). The new nurse must therefore thoroughly evaluate and incorporate the ethical and legal standards of care into her practice. By doing so, she would be able to seamlessly transition from a student nurse (who has limited legal and ethical liability) to a qualified nurse (who has full legal and ethical liability). Critical discussion on Role 2 – working in teams This role is very much related to coordinated medical care and interprofessional practice. Working in teams is about coordinating with each other as health care professionals for the delivery of health services to the patient (Vazirani, et.al., 2005, p. 71). For the newly qualified nurse, her role is to coordinate and work with the other nurses and the other health care professionals and to ensure that they services they would perform would form a cohesive and unified health service for the patient. The actions of the new nurse must be in line with her functions as a nurse and as a member of the health team; it must not contradict the overall goals for the patient (Vazirani, et.al., 2005, p. 71). Interprofessional practice is about working with the other members of the medical team which may include the doctor, other nurses, the pharmacist, the dietician, the social worker, the psychiatrist, and similar members of the medical team. For the new nurse, it means learning to communicate with the members of the team. It is about consulting with each other and ensuring that the medical decisions being made for the patient would not contradict or cancel each other out or possibly bring the patient more harm (Vazirani, et.al., 2005, p. 71). Interprofessional practice is an important part of the health care delivery. In a systematic review by Zwarenstein, Goldman, and Reeves, (2009, p. 1) the authors established that the “extent to which different healthcare professionals work well together can affect the quality of the health care that they can provide”. In effect, when problems on the communication of these health professionals occur, problems with the patient would also be seen. Interprofessional coordination practices are applied in the health care setting in order to improve the interactions between the different health professionals (Zwarenstein, Goldman, and Reeves, 2009, p. 1). The authors cited various studies in their review and they especially highlight one of these studies which revealed that interventions under interprofessional collaboration led to improvements in patient care, including drug use, length of hospital stay, and total hospital charges (Zwarenstein, Goldman, and Reeves, 2009, p. 1). As much as possible, the newly qualified nurse must make herself an indispensable part of the team in order to ensure that the patient would experience improved outcomes in the shortest time possible. In a study by D’Amour, et.al. (2005, p. 116), the authors set out to identify conceptual frameworks which could improve the understanding of interprofessional practice. In the course of their research, they were able to establish that collaboration can be defined through five main concepts: sharing, partnership, power, interdependence, and process (D’Amour, et.al., 2005, p. 116). They also established that the interprofessional practice requires the members to work with each other after duly considering the diverse qualities of the members and even the patients. All in all, the study implies that the new nurse must learn to share her duties with the members of the team; and she must also consider her role as a partner in the delivery of patient care, not as an independent one-woman/man team. Clark, et.al., (2007, p. 591) discuss that ethics in the interprofessional collaboration is already a part of the ethical code for each health profession and is being implemented “in the interest of improved patient care. The authors also pointed out the importance of understanding how other disciplines work as well as their strengths and limitations (Kelly, 2009, p. 133). Teamwork is therefore about establishing different practices which would highlight the strengths of each team member in order to deliver efficient patient care. Ethical issues in the team working process must therefore be defined in order to specify the roles of the team members and to eventually maintain the efficacy of the team (Clark, et.al., 2007, p. 591). The principles of autonomy, beneficence, non-maleficence, and justice must also be followed by the members of the team in order to ensure that the patient’s welfare would be secured within ethical boundaries. Moreover, interpersonal factors and professional obligations must be taken into consideration to secure improved patient outcomes (Clark, et.al., 2007, p. 591). As more structure is developed in the interprofessional practice, changing patterns in the practice would likely create moral issues and ethical concerns. It is important therefore for the new nurse to accept these issues and assist the rest of the team in addressing such problems. Patient group directions In relation to patient group directions, new nurses basically have to follow the mandates for the NHS. Basically, patient group directions (PGDs) “are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment” (Royal College of Nursing, 2006). Through the Royal College of Nurses, the newly qualified nurse is mandated to support the use of PGDs as an effective and practical means of identifying the ability of practitioners to adequately use medicines for the benefit of their clients. In order to effectively implement this, the new nurses have to be adequately knowledgeable about prescription medicines, including their indications, their dosage, their adverse effects, their drug interactions, and all pertinent patient teachings. In other words, new nurses using medicines under PGD guidelines must be confident in their abilities and competence to do so; moreover, they must act based on the NMCs Code of Professional Conduct and Guidelines for the Administration of Medicines (Royal College of Nursing, 2006). In the entirety of PGD functioning, the senior nurse, the senior doctors, and the senior pharmacist are responsible for ensuring that the necessary and appropriate PGDs are conceptualized within a given practice area, and that only the competent professionals work with them (Royal College of Nursing, 2006). In order for the newly qualified nurse to be considered within this context, she must gain the necessary competency in relation to the dispensation of prescription medications and the appropriate precautions which must be followed. The newly qualified nurse must therefore be familiar with the following: the Prescription only medicines (human use) Amendment Order 2000; the Medicine (Pharmacy and General Sale – Exemption) Amendment Order 2000; and the Medicines (Sale and Supply) (Miscellaneous Provisions) Amendment (No. 2) Regulations 2000 (MHRA, 2010). Summary/Conclusion The newly qualified nurse has the following functions: leading in care management and care delivery situations; maintaining standards of care; making ethical and legal decisions; being accountable; working in teams; and teaching others. For the most part, the new nurse has a daunting task ahead especially during the first few months of transitioning from the academic setting to the actual clinical practice. Failing to successfully transition into the clinical setting can sometimes lead to a change of profession for these nurses – leaving the health care practice and opting for other less stressful and less demanding professions. Nevertheless, for the new nurse successfully making the transition, her roles and responsibilities cover a wide range of tasks which are essential for the delivery of effective patient care. Her task is to work within the existing health care system and to ensure that her activities are within the ethical and legal standards of care. The two roles chosen for this study are: making ethical and legal decisions and working in teams. These are important tasks which the new nurse must hurdle through in order to ensure efficient patient outcomes. There are various ethical and legal standards which the new nurse must take to heart in order to ensure that the patient would receive appropriate and effective health care services. These legal standards are based on the Nursing Practice Act as regulated by the Board of Nursing. Ethical standards include the application of the four ethical principles: autonomy, beneficence, non-maleficence, and justice. Working in teams is also another important task which the new nurse must master. Her role is part of a bigger picture. The patient has various health needs which are delivered by other health professionals. By working with each other as a team and by understanding the functions of the team, it is possible to help ensure improved patient outcomes. For the new nurse, working as a team would also help ease the role transition through collaborative efforts and effective communication techniques. Works Cited Appelbaum, P. & Grisso, T. (1988) Assessing Patients Capacities to Consent to Treatment, University of Massachusetts Medical School, viewed 16 March 2011 from http://libraryinfo.bhs.org/DOCUMENT4.PDF Are newly qualified nurses ready to lead? (n.d) Hampshire Partnership, National Healthcare System, viewed 16 March 2011 from www.hampshirepartnership.nhs.uk/EasysiteWeb/getresource.axd Black, D. (2002) Autonomy and Trust in Bioethics, J R Soc Med. 95(8): pp. 423–424. Bishop, A. & Scudder, J. (2001) Nursing ethics: holistic caring practice, London: Jones & Bartlett Learning Burton, R. & Ormrod, G. (n.d) Becoming a qualified nurse, FDS.OUP, viewed 16 March 2011 from http://fds.oup.com/www.oup.com/pdf/13/9780199568437.pdf Clark, P., Cott, C., Drinka, T. (2007) Theory and practice in interprofessional ethics: A framework for understanding ethical issues in health care teams, Journal of Interprofessional Care, 21(6): pp. 591 – 603 Curtin, L. (1979), The Nurse as Advocate: A Philosophical Foundation for Nursing, Advances in Nursing Science, 1(3); pp. 1-10 D’Amour, D., Ferrada-Videla, M., Rodriguez, L. & Beaulieu, M. (2005) The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks, Journal of Interprofessional Care, 19(1), pp. 116-131 DiMeglio, K., Padula, C., Piatek, C., Korber, S., Barrett, A., Ducharme, M., Lucas, S., Piermont, N., Joyal, E., et.al., (2005), Group Cohesion and Nurse Satisfaction: Examination of a Team-Building Approach, Journal of Nursing Administration, 35(3), pp. 110-120 Ethical and legal responsibilities in nursing (2002), Michigan State University, viewed 16 March 2011 from https://www.msu.edu/~nurse/classes/spring2002/841/Ethics2002.ppt Hole, J. (2009) The Newly Qualified Nurse's Survival Guide, London: Radcliffe Publishing O’Connor, M. (2002) Nurse Leader: Heal Thyself, Nursing Administration Quarterly, 26(2), pp. 69-79 Holloway, I. (1995) Ethical Issues in Qualitative Nursing Research, Nurs Ethics, 2(3), pp. 223-232 Kelly, P. (2009) Essentials of Nursing Leadership & Management, London: Cengage Learning Macklin, R. (2003), Applying the four principles, J Med Ethics, 29: pp. 275-280 Medicines and Healthcare Products Regulatory Agency, (2010), Patient group direction in the NHS, viewed 27 March 2011 from http://www.mhra.gov.uk/Howweregulate/Medicines/Availabilityprescribingsellingandsupplyingofmedicines/ExemptionsfromMedicinesActrestrictions/PatientGroupDirectionsintheNHS/index.htm Melia, K. (1994), The Task of Nursing Ethics, J Med Ethics; 20(7); pp. 7-11 Memarian, R., Salsali, M., Vanaki, Z., Ahmadi, F., & Hajizadeh, E. (2007) Professional Ethics as an Important Factor in Clinical Competency in Nursing, Nurs Ethics 14(2); pp. 203-214 Murphy, D., (1988) Do-Not-Resuscitate Orders: Time for Reappraisal in Long-term-Care Institutions, JAMA. 260 (14): pp. 2098-2101 Nourredine, S. (2000), Development of the ethical dimension in nursing theory, International Journal of Nursing Practice, 7; pp. 2-7 Pozgar, G. (2007) Legal aspects of health care administration, London: Jones & Bartlett Robertson, D. (1996) Ethical theory, ethnography, and differences between doctors and nurses in approaches to patient care, J Med Ethics, 22: pp. 292-299 Royal College of Nursing (2006), Patient Group Directions: Guidance and information for nurses, viewed 27 March 2011 from http://www.rcn.org.uk/__data/assets/pdf_file/0008/78506/001370.pdf Silva, M. Rudwick, R. (1999) Ethics: Interstate Nursing Practice and Regulation: Ethical Issues for the 21st Century, ANA Periodical, Nursing World, viewed 16 March 2011 from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999/InterstateNursingPracticeandRegulation.aspx Silverman, H., Tuma, P., Schaeffer, M., Singh, B., (1995) Implementation of the Patient Self-Determination Act in a Hospital Setting: An Initial Evaluation, Arch Intern Med. 155(5): pp. 502-510. Smith, M. (2009) Legal Basics for Professional Nursing: Nurse Practice Acts, Nursing World, viewed 16 March 2011 from http://www.nursingworld.org/mods/archive/mod995/canlegalnrsfull.htm Vazirani, S., Hays, R. (2005) Effect of a Multidisciplinary Intervention on Communication and Collaboration Among Physicians and Nurses, American Journal of Critical Care, 14: pp. 71-77 Zwarenstein, M., Goldman, J., & Reeves, S. (2009) Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes, Cochrane Database of Systematic Reviews, viewed 16 March 2011 from http://www.glostruphospital.dk/NR/rdonlyres/836594E4-0629-4F38-A7A3-21F3DD1FCE9C/0/interprofessionalcollaborationcochranereview.pdf Read More