Responsibilities of a Newly Qualified Nurse - Essay Example

College: Introduction Nurses have borne the responsibility of medicine administration as a critical part of the nursing role since the beginning of nursing, but the latest role of prescribing is what has become very challenging (Sines, Saunders & Forbes-Burford 2009, p.293). The different formularies and programmes encompassed in prescribing are intricate and bear the potential to confuse a patient. The added responsibility and accountability nurses perform as prescribers may initially be very daunting. The roles played by nurses in supplying and administering medicines to patients help in improving the ease of patients accessing medicines, effectively utilizing skills, developing the capability of the workforce and ensuring more effective and accessible provision of patient care. This period is a thrilling one for nurses as they start developing new roles, focused on prescribing and these new roles have undoubtedly benefited patients and significantly contributed to expanding nurses’ roles, hence promoting the nursing image as a prime profession (Sines, Saunders & Forbes-Burford 2009, P.294). This paper aims to discuss the nursing roles of Patient Group Directions and Supplementary Prescribing by newly qualified nurses. The structure of the paper covers a detailed analysis of what the roles entail, the definitions of these roles, reasons for selecting these particular roles for the study and an in- depth discussion of these roles supported by relevant literature. The paper covers the legal, ethical and professional issues related to these roles. The paper ends with a summary and conclusion of the discussed roles. Taking up these roles for newly qualified nurses may be challenging. The claim has been that less than 50% of nurses in practice would recommend their career option and 25% on the other hand, would keenly discourage from the nursing profession. It is no surprise that 33% to 61% of newly recruited nurses plan to depart from nursing in their initial year as professional nurses or completely change employment (Basford, 2003). It is important to explore the adaptation process of newly qualified nurses to the professional job environment, so as to respond and understand issues causing motivated and energetic nurses to leave the profession altogether. It is evident that the transition journey for newly qualified nurses is often frustrating, disillusioning, stressful and discouraging (Basford, 2003).Existing knowledge indicates that new nurses experience moral distress, disillusionment and discouragement in the early stages of practicing professional nursing. Other than undergoing developmental and personal changes, it is expected they make clinical judgments and decisions that are advanced. However, confidence develops into competence, and as the nurse prescribers multiply in number so will the attitude towards the new role become more encouraging (Sines, Saunders & Forbes-Burford 2009, p.293) Rationale for Role Choices The increasing roles of nurses from the traditional medicine administration to current prescribing roles have played a significant role in the provision of quality healthcare to patients. There has been growing acknowledgment that pressures experienced by the health care sector could be partly solved by nurses providing a wider variety of services including prescribing, to patients. The programs have resulted into considerable savings from efficiently using nurses’ and doctors’ time. The important extended roles for nurses have played a critical in improving health care provision and hence are important topics of study in the medical field. Supplementary Prescribing Supplementary prescribing refers to a partnership of voluntary prescription between an independent and supplementary prescriber, for implementation of a plan on clinical management that is patient specific. The patient has to be in agreement and the role of independent prescriber played by a doctor. It is therefore about the relationship between a patient, nurse and doctor, each contributing to the Clinical Management Plan (CMP) that will be used in articulating the process of prescription (Keady, Clarke & Page 2007, pp. 128). Supplementary prescribing could still be a highly appropriate prescribing mechanism in instances where for example, nurses are newly qualified as prescribers( Bradley & Nolan, 2008).The prescription method aims at providing patients with more efficient and quicker medicine access, making use of the nurses’ skills. Nurses have been enabled to train for this role to simplify the doctor’s burden as well as ease medicine access. This also allows doctors to direct more time towards patients with complex and complicated treatment regimen and conditions. Supplementary prescribing also plays a role in improving patient choice and supplementary prescriber’s job satisfaction as well as formalising various vicarious prescribing currently going on ( Milliard, 1990). The roles of supplementary prescription in the life of a patient include assessment and monitoring of progress outlined in a Clinical Management Plan and as relating to the prescribed medicine, including reports of noted adverse reactions. It also contributes to the plan of clinical management by prescribing according to the laid out management plan and changing prescribed medicine indicated as clinically appropriate according to the management plan. The supplementary prescriber also accepts professional accountability and clinical responsibility for the prescribed practice and decisions by working within professional Code of Conduct and clinical competence, consulting whenever necessary with the independent prescriber especially for a matter falling outside their clinical competence. The prescriber records facts that are clinically relevant including monitoring and prescribing activity in medical records referring the responsibility of prescribing to independent prescribers when approved clinical evaluations are not done within specified intervals of the management plan or when the progress of the patient deems it appropriate ( Darley, 1996). Nurses and other health workers are obligated by the 'Code of Professional Conduct' (UKCC, 1992). The objectives of the code may be termed as: i) The expected conduct of practitioners by the UKCC; ii) The definition of professional accountability; iii) An account of values termed professional; iv) A way to measure conduct (Pyne, 1992). The document 'Scope of Professional Practice' (UKCC, 1992) guides nurses in developing roles receptive to needs of patients. The code of conduct constantly makes reference to ways nurses are required to respect autonomy of patients. They are required to act in the interests of the patients (clauses 1 & 2), work in a cooperative and open manner fostering involvement and independence in patients’ care (clause 5), respecting dignity and uniqueness without prejudice (clause 7) as well as respecting confidentiality (clause 10). Justice is identified in clause 7 of the Code of Conduct, in that nurses must act in response to care needs, “irrespective of the ethnic origin, religious beliefs, personal attributes, the nature of their health problems or any other factor” (UKCC, 1992). The responsibility and accountability the Code and Scope of practice bestows upon nurses ensures patients have the professional bodies and the law for reparation and compensation for negligent practice (Dimond, 1995). Training nurses professionally allows for medicines to be prescribed within a patient’s Clinical Management Plan. Some of these medicines include drugs under concentrated monitoring by the Committee on Safety of Medicines, antimicrobials and products named as being “less suitable” for prescription (Brew, 1994). Prescribing effectively and safely are explained as the training pack components according to Brew (1994), including the knowledge of the products appropriate use. This training aspect together with the existing knowledge nurses have, should guarantee ethical practice. Supplementary prescribing allows for prescriptions within a CMP that is patient-specific and whose parameters have been agreed upon previously. The patient agrees to the drawn up plan following the independent prescriber’s diagnosis, in consultation with supplementary prescribers. At this point, the nurse whose role is of a supplementary prescriber can make medicine related decisions such as drug choice, dose, formulation and frequency among other variables. The independent prescriber reviews the patient’s condition and prescribed drugs at intervals that are predetermined and may even fully resume patient’s care responsibility. Other than an initial training done by a supplementary prescribes, he/she should ensure annotation of all learning and assessments, as well as agree on a partnership with the independent prescriber. Patient Group Directions (PGDs) Patient Group Directions have existed since 2000, and constitute legal frameworks allowing certain professionals in health care to administer and supply medicines to patient groups fitting the criteria outlined in the Patient Group Direction. It is a document allowing prescription only medicine supply to patient groups without specific prescriptions. The written instruction allows for the administration, supply and sale of named medication in a clinical situation that has been identified (Brooker, 2006). It is applied to patient groups that do not need to be identified individually before treatment. A nurse could for example, administer medicine to patients directly without requiring prescriptions or prescribed instructions. PGDs allow administration and supply of particular medication to patients falling into a PGD defined group, even though it may not be termed a mode of prescription. The administration and supply of medication under PGDs, is reserved for limited situations offering patient care advantage without compromise to patient safety, and where there is consistency with suitable professional accountability and relationships (Coles & Porter, 2008). A PGD however, becomes valid upon meeting certain criteria with regard to patient groups that the PGD may apply and how it has been designed. Under a variety of circumstances, they allow the public access to prescription only medicines (POMs). Some of them include: Orlistat for obesity cases and weight loss, Levonorgestrel as emergency hormonal contraception, Sildenafil dealing with erectile dysfunction and Finasteride for hair restoration in Male-pattern baldness among others. Patient Group Directions are beneficial in a number of ways. They allow for provision of medication at times or in situations where doctors become unavailable. Other than improving care of patients through faster medicine access, the program increases patient contact to medicine. Patients are also given a choice about when, where and who to access services from. PGDs also reduce time spent waiting for treatment and additional time waiting to see doctors for a prescription. The authorization and production of PGDs should include a multidisplinary group of a senior pharmacist and doctor, and the health professional group representative using the PGD. Authorization must be done by the relevant organization using the PGD (Tschudin, 1992). Qualified professionals in health care are the ones allowed by law to administer or supply medicine under PGD are, other than nurses, health visitors, ambulance paramedics, optometrists, midwives, pharmacists, and state registered orthoptists, radiographers, chiropodists and physiotherapists. Supplies can only be made by these professionals as particular individuals having signed the document. Senior people should be assigned to ensure only fully trained, qualified and competent professionals are allowed to operate within the mentioned directions. Professionals applying PGDs need to be registered members of the health profession acting within the proper professional conduct code (Basford, 2003). Assessments and robust training need to be in place to make certain that staff using PGDs can properly assess a patient belonging to a particular group the directions are intended for. They should also ensure sufficient understanding of contraindications and interactions of various drugs, and the side-effects to construct realistic assessment on risks. Proper training also ensures safe administration of medicine, especially for injections, correct dosage calculation and when arrangements of follow-up are needed and placed appropriately. On the issue of ethical and moral considerations, a nurse should be in a position to provide sufficient knowledge of a particular product to enable patients make informed decisions when a need arises. Nurses must personally deal with patient requests and decide if he or she is to supply the patient with the product or not. Privacy is also a critical ethical issue as the nurse needs to allow certain levels of privacy and confidentiality when dealing with patients. A teenager requiring contraceptive services will be more at ease if she is assured that her information will not be publicized. This will in the long run improve the confidence of clients and encourage frequent visits to the facility for advice or any other services (Brew, 1994). A client should always be treated fairly regardless of the moral stand the attending nurse has on the issue at hand and in a case where he or she may not be able to deliver the needed services, the client has a right to be directed elsewhere. Certain code of ethics should also be outlined to govern how nurses issue medication to patients as some may be tempted to provide these clients with drugs and medications they may abuse. The nurses themselves are also at a risk of abusing medications if proper guidelines are not set to ensure proper checks are done. Conclusion The roles of prescribing medications are now moving into the nurses’ docket, a situation that was not so years back. The need to provide easy access points to medication on non-complicated matters saw the creation of these roles to be facilitated by other professionals in the healthcare industry other than just depending on the doctors. Adoption of prescription by nurses has increased the choice of patients as regarding medicines access according to research in the United Kingdom (Winstanley, 1996). Patients now find it more convenient to talk to nurses on issues that do not need the doctor’s attention making it easier to access the services more efficiently. Although this has been extremely overwhelming on the part of newly qualified nurses facing difficulties in adopting their new roles, training is slowly easing the transition into these roles and making the nurses more competent in handling patients. Training is important in carrying out these roles as one learns what is required of them professionally when dealing with clients. Professional handling of clients is important to ensure proper and factual information is provided to the clients and to know how to handle every unique situation presented by a client. Client confidentiality and privacy also plays a crucial role in handling client problems and making them more at ease while visiting health care facilities. Legislation is clear-cut and implementation needs clinical governance organizations that are robust to ensure the process of providing medicine to patients who are not identified individually is not harmful (Winstanley, 1996). Lack of proper guidelines in providing drugs to unidentified individuals as is the case in Patient Group Directions may lead to disastrous results and hence needs proper procedures of implementation. All in all, nurses themselves could do with the self discipline and determination in ensuring their competence in fulfilling their roles in the patients’ interests, and not only as a means to develop practices that are more independent. Even though, to a large number of community nurses this appears as a legalisation and formalisation of existing practice, the accountability and responsibility to act ethically and legally is recent and must not be viewed lightly. References Basford, L, 2003, Maintaining nurse prescribing competence: experiences and challenges. Nurse Prescribing, vol. 1, pp.40-45 Bradley, E & Nolan, P, 2008, Non-Medical Prescribing: Multidisciplinary Perspectives, Cambridge University Press Brew, M.1994, ‘Teaching Nurses to Prescribe’, Nursing Times, vol. 90, no.21, pp.32­34. 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