Management Skills in Adult Nursing - Personal Statement Example

This essay will discuss the management and leadership skills in relation to the management of the administration of medications. Using Driscoll (1994) Reflective Cycle (appendix one), I will identify my learning needs and competences in this area. The key points under discussion with regard to this topic will be legislation, risk management, Trust policy and procedures, as well as effective delegation. I have chosen this skill to the lack of experience within the hospital setting. However, the Nursing and Midwifery Council (2004) also helped to influence my decision by stating that: "The administration of medicines is an important aspect of the professional practice of persons whose names are on the Council's register. It is not solely a mechanistic take to be performed in strict compliance with the written prescription of a medical practitioner. It requires thought and the exercise of professional judgement " Therefore, the administration of medications is considered an essential component of nursing care and one that I aim to develop and take forward into my future practice. In order to achieve and maintain a satisfactory level of competence, I feel it is necessary to be aware of some previous research that has been provided by the Audit Commission (2002a), who states that approximately 7,000 doses of medication are administered within a typical NHS hospital with thousands more self-administered in their own homes. Alarming statistics highlighted by the Department of Health (2000), suggest approximately 10,000 serious adverse drug reactions are reported each year in the U.K. By the data of recently conducted researches (Pirmohamed at al., 2004) approximately 6.5 per cent of people admitted to hospital had experienced adverse drug reactions By the assessment of Hitchen (2006) adverse drug reactions result in 250,000 UK admissions a year. These cases cost the NHS around 466 mln. per year. In other countries the incidence of adverse drug reactions is comparably high. Thus in USA (Bond & Raehl, 2006) they are registering nearly 1.7% of ADR cases resulted in the significant increase of death rate (by 19.2%), length of hospital stay (by 8.3%) and charges for medical services (by 19.9%) To decrease number of death and serious complications, better management of medications administration is required. Currently, MHRA (2007) defines ADR as "an unwanted or harmful reaction experienced following the administration of a drug or combination of drugs, and is suspected to be related to the drug". This reaction could be a new or known side effect of the drug or it may be a mismanagement of administration of the medication. The role of nurse in the modern Britain is significantly extended. Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases (DoH, 2004, 2005; Thomas et al., 2002). These processes require conduct of ethico-legal principles and theories applied to teaching and learning, leadership, prioritising care; principles of management within the trust, clinical governance and maintaining/monitoring standards. Continued professional development in the field of the administration of medications requires management skills. However, only advanced learner can manage the administration of medications effectively. The period of transition from the novice to the expert can take several years thus effective mentoring became the powerful tool to accelerate this process. Reflective Cycle of the professional development One of the first things to do in the new professional environment is obtaining new perspectives and own management style. Some people in fact do not know how they appear to others and they are genuinely surprised when confronted. My personal experience demonstrated that misunderstanding and ineffective collaboration between mentor and learner and significantly complicate training. The administration of medication wass only one aspect of my work in Adult Nursing Unit. When I started this module I saw mostly formal aspects of management and was not able to demonstrate my leader skills. With time I understood the context of my new duties better and felt I'm ready, confident to do the prescriptions. My progress was determined by the strong leadership skills of my tutors and my motivation to obtain such skills in future professional career (While & Biggs, 2004). Future outcomes of this skill are presented by the development of sustainable model of the management in drug administration. The proficiency and higher level of competence are the pledge of safe and successful practice. This circumstance is emphasised by the fact that the administration of medication is considered an essential component of nursing care. The combination of the primary legislation and the statutory instruments on medications produced since 1968 provides the legal framework for the manufacture, licensing, prescription, supply and administration of medications. The Misuse of Drugs Act (1971) prohibits the possession, supply and manufacture of the medicinal and other products, except where such possession has been made legal by the Misuse of Drugs Regulations, (2001). The legislation is concerned with the control and categories these schedules are placed in. Therefore as a Registered Nurse I should be familiar with the regulations concerning the five separate schedules, in particular the regulations concerning Schedule 2 (controlled medications) such as morphine, diamorphine, pethidine and Schedule 3 drugs such as barbiturates. In this assignment my learning needs and competence are critically analysed using Driscoll's Model of Reflective Practice (cited by Fitzpatrick & Wallace, 2005). Increasing complexity of drug therapy especially in hospital wards requires new modes of drug administration. Nurse can try to substitute the physician and simply prescribe drugs from the list. However this is deadlock way, due to my experience and knowledge I arrived at an idea that medicine management is a key element of the nurse-patient relationship. Later I found that this idea was not my own only. Many researchers (While & Biggs, 2004) determined the patient-centred care as the highest priority. Furthermore this concept became one of the principles used for reforming national health care system (DoH, 2004). Another important issue is delegation, especially as the element of management of drug administration is such an area that could potentially cause harm if the incorrect medication was given. Therefore, effective management and leadership of the team in which one works is vital especially to avoid interruption when supplying and management the drugs. Through the use of the reflective model I must try to demonstrate that I am an effective, well-organised manager that is aware of how to organise staff according to their abilities and competencies so that I may fulfil my duties and develop not only my own skills but also that of the team. Professional accountability dictates that registrants ensure the following administration of medicine (NMC 2004): Ensure the patient's identity, condition, allergies to medications. Check clarity of prescription, the medicine expiry date, therapeutic use, normal dosage, side effects, precautions and contra-indications. Administration method, route and timing, clear and accurate recording of all medicine administered, refusals by the patient, countersign students who are being trained". Medication errors must be reported immediately. Error incidents should be carefully and thoroughly investigated at a local level. Comprehensive assessment and sensitive management should be exercised before a managerial decision is reached concerning the error committed. Inconsiderate disciplinary action may discourage reporting of errors or incidents in the future. Errors caused from reckless or incompetent practice should be handled different from errors caused by pressure of work. NMC urges managers to take local disciplinary action where it is considered to be necessary, but urges that they also consider each incident in its particular context (NMC 2004). Disguising medication is only used if it is in the best interests of the patient. It can only be used to save lives, prevent deterioration, or ensure an improvement in the person's physical or mental health. Nurses involved in the practice of administering medicines covertly should be fully aware of the aims, intent and implications of such treatment. Disguise or forced medication is administered while recognizing the he person's right to give consent. Patient can participate in decision-making also through his help in drug history collecting (Radford et al., 2007; Gore & Mouzon, 2006; Porter, Kohne, Goldman, 2005). A good drug history is helpful for choosing next step in therapy, for preventing polypharmacy and drug repetitions, preventing complication of poorly tolerated drugs and reducing delay in appropriate treatment. Nurse must ask patient whenever appropriate about over the counter medications, herbal and alternative remedies as well as about the oral contraceptives (Proctor & Farquhar, 2006). A competent adult has the legal rights to consent or refuse treatment, even if a refusal will adversely affect his or her health or shorten his or her life. The patient must be given adequate information about the nature, purpose, associated risks and alternatives to the proposed medication. Medication is only given upon the patients' agreement. Failure to do so may amount not only to criminal battery or civil trespass, but also to a breach of their human rights. When a patient/client is considered to be mentally incapable, people that are close to the patient should be consulted. Nobody can consent for someone else, but relatives help clarify a patient's wishes. Respect must be made to consent made by the patient before his/her state of mental incapability. Parents of children under the age of 16 legally have the right to consent or refuse mediation. Children under 16 are considered to lack the capacity to consent to or refuse treatment, including medication. For effective drug administration the clinical governance as a framework that aims to maintain and improve high standards of nursing professional practice is required. This is achieved through quality assurance initiatives such as: clinical audit, evidence-based practice and clinical supervision. Quality assurance initiatives highlight good practice and identify where improvements are required. Clinical governance is underpinned by the following qualities: professional self-regulation, strong leadership, effective communication, being patient focused, a commitment to quality, valuing each other, continuing professional development (NMC 2004). My new role in management of drug administration includes such issues as the increased patient contact and the supervision on the outcomes of treatment. In this way I had a key role in drug usage and can see both therapeutic and any toxic effects of an administered drug. My knowledge of the algorithm of drug administration and management skills is helpful in preventing drug interactions and drug toxicities and in providing better patient care. Latter & Courtenay (2004) urged that "some concerns about the adequacy of their [nurses'] pharmacological knowledge have been raised" (p. 15). Many patients hesitate to talk about their psychological problems with medical staff. They can feel that their feelings are unreasonable and this will increase the intensity of stress. Because nurse use holistic approach to health and her duties include not only clinical but also ethical and social aspects her participation in decision-making can be crucial. In analysed case nurse considered that patient need pain relief and inform doctor about this. Of course, physician could make same decision but it could be delayed decision when patient get more discomfort. The NMC code of professional conduct: standards for conduct, performance and ethics includes paragraphs which require immediate response of nurse to clinical situation: they "must act quickly to protect patients and clients from risk if you have good reason to believe that you or a colleague, from your own or another profession, may not be fit to practise for reasons of conduct, health or competence. You should be aware of the terms of legislation that offer protection for people who raise concerns about health and safety issues". (NMC Code, 8.2 p. 11) Of course nurse's individual experience and knowledge can be accepted as crucial factors of decision-making. But decision-making process is not only clinical thinking or professional algorithm. Appropriate decision can be made only in the frame of existing organizational culture, including political influences and health and social care policy. Thus Department of Health uses the term "clinical governance" which is corresponded to the systematic approach to the improvement of decisions quality. It was stated that "clinical governance is a framework through which NHS organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish" (DoH, 1998, p. 33) Hoffman, Donoghue & Duffield (2004) identify decision making in nursing practice as "participation decisions made by nurses in their usual clinical practice covering areas such as activities of daily living, wound dressings, administration of medications, emotional support and referrals" (p. 53). The control on the quality of clinical decisions is entrusted to the Boards of National Health Service and such bodies as the Commission for Health Improvement and the National Institute for Clinical Excellence (Thompson & Dowding, 2000). In nursing the principal statutory body is the Nursing and Midwifery Council (NMC). Alison While (2002) from Florence Nightingale School of Nursing and Midwifery considered that nurses-prescribers should develop a range of new or enhanced skills to practice effectively. There is a common problem of the transition skills from experiences nurses to the novices. The problem of nurses staff training, their involvement in research activity, transfer of skills from experienced nurses to junior nurses can not be solved without changes of social and professional role of the nurse. The professional duty of every nurse working is keeping up-to-date with changes and developments in their work by delivering care based on current best evidence based practice (NMC, 2002, 2004). Implementation of evidence based practice requires introducing protocols which standardise the procedure of prescription. These protocols are patient-focused and usually concerned to be used by the nurses well-educated in the action, contraindications and adverse affects of the medications. The protocols using in the Royal Marsden Hospital ("nurse led clinic") is a good example of this sort of regulatory documents (Soanes et al., 2003). They comprise two parts, the first one details the symptoms which require administration of the medicines, the goals of the treatment and the algorithms of assessing its effectiveness whereas the second part focuses specifically on the medication to be used as part of the overall management of the symptom (RMH, 2006). There is a difference in the strategies of the management of medications by the doctors and nurses. I think that the division of labour in medicine and nursing remains intrinsically unchanged. Traditionally doctors assess and diagnose patient's conditions and choose the treatment strategy whilst nurses implement the medical plan. However the development of the variety of nursing roles has led to considerable blurring of boundaries between nursing and doctors' practice (Seale, Anderson & Kinnersley, 2006). During recent years nurses have become involved in an increasing number of nurse led initiatives. An example of these initiatives is "nurse led clinic" establishes in the Royal Marsden Hospital where prescribing protocols were implemented (RMH, 2006). I think that major advantage of nurse led services is the high accessibility of the services provided by the nurse - the nurses are perceived to be more approachable for the patient than doctors. I found some references, which support my idea (Sahlesten, 2007). However I feel that the arranging of the management in nurse prescribing in general is too slow. Actually introducing the protocols of nursing prescribing is a compromise of the practice needs and patients interests. Key policies and procedures determined by the trust could be different. These documents determine specific local arrangements and responsibilities at the local trust but they must be in conjunction with the Guidelines for the administration of Medicines (NMC, 2004). The cautions are required whilst waiting for wider legislation to become a reality. Probably the answer is retarded accepting the ideas of evidence-based practice applied to nursing. Evidence based practice was determined by Sackett et al. (2007) as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (p. 3). In other words, the evidence-based practice is "the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients" (p. 3). Thus, evidence-based nursing practice can be described as the use of empirical research findings to achieve greater reliability in successful accomplishment of the desired results of the clinical intervention, e.g. administration of medications. Personal experience is often based on the anecdotal cases and situations in which the nurse has been previously involved. There is obviously do not substitute for experience but it must be remembered that practice should be based on sound evidence but not on anecdotal experience. Training and dealing with certain situations often gives more confidence. This may be the confidence to use a particular drug or it may be a senior colleague's recommendations. I think that it's impossibly to remember enough details about all medications to be able to manage their administration them without reference to such powerful information sources such as the British National Formulary (Courtenay, Carey & Burke, 2006). Most nurses will limit the list of used medications to a limited number they are familiar with and they know in details. The delegation of specific duties of drug administrations to other members of the team requires complex calculations of need volume or quantity of the medication. In such cases the assistance of a second more experienced practitioner could be necessary. There is necessary to substances for injection ex tempore but not in advance of their immediate use and avoid to administer medication drawn into a syringe or container by another practitioner when not in nurse's presence. NMC guidance (2004) provide only one exception for "already established infusion which has been instigated by another practitioner , or medication prepared under the direction of a pharmacist from a central intravenous additive service and clearly labelled for that patient" (p.5). Due to working within a different trust, I needed to read the local trust policy and procedure surrounding the implementation of the administration of drugs. This as stated by the Nursing and Midwifery Council is considered a Professional Duty of Care to your patients and clients, who are entitled to receive safe and competent care. Professional negligence or breach of the professional duty of care including drug administration cannot only influence on patient's satisfaction but also decrease the responsiveness of care as well. An understanding of the differences between Management and Leadership would also help to develop my skills especially if I relate this to risk management and effective delegation within the team. Management and Leadership are often two terms, which are frequently used interchangeably. According to Fayol, Management skills involve planning, organization, commanding, coordinating and control (Kitson, 2007:79). However, Leadership may be viewed as the process of guiding, teaching, motivating and directing others towards attaining goals. According Cronin (1995: 27) "Leadership can be exercised in the service of noble, liberating, enriching ends, but it can also serve to manipulate, mislead and repress." Therefore, it is a role that I should develop to regularly exercise my professional judgement by appropriately delegating specific duties to team members with the aim to avoiding interruptions and potential risk of making errors. Mier (1999), suggest using a rationalist approach to decision analyses. One of the tools of a rationalist approach is the use of a decision tree. This tool provides a successful means to help focus on a situation. Dependently on key policies and procedures accepted in the local thrusts the relevance between each trust or position held is different. I would like to clarify the changes of my competence during my training. Through a previous placement where I was asked to shadow the Senior Sister, I was able to identify my learning style as for advanced beginner (Benner's theory) due to my past experience in community nursing. This help me to develop and take this into my future practice on the Medical Admissions Unit knowing that I would learn more effectively by concentrating on the tasks at hand and remembering the rules. However at the stage of my learning I was not able to recognize differential differences and had global but not specific experience (Benner, 2007). However during my practice, my skill level in the management and leadership of medication administration has improved significantly. My theoretical awareness of the guidelines of NMC on professional accountability, management of medicines and patient consent helped to keep my evaluation of situations encountered. After 16 weeks of practical training, I have learned new principles from the practical interaction with the administration of medication. My skill level has moved to the third stage, the Competent Learner. I have developed a sense of better understand at situations encountered. Long term goals and plans are perceived during assessment and understand of different problems, yet the overall picture is still not clear. I am able to prioritise and manage my workload, and that of the team. I feel that if I am given enough time to handle the situation, I would be able to manage the administration of medicine proficiently. I intend to maintain and improve my competent proficiency level in my future practice. I undertook SNOB (Skills-Needs-Outcomes-Barriers) analysis to determine the pattern of my personal development in drug administration and professional competence in its management. During training in Adult Nursing Unit I gained skills to communicate effectively as a member of the multi-professional health care team. I am able to plan and make appropriate referrals to the members of multi-disciplinary team to enhance effective patient care in the cases of adverse reactions or other complicate situations. With progress at the stage of advanced learner (Bernet, 1984) I can prioritise the accommodation of needs of the service and patients/client care. When I started work at new role I developed the management and leadership skills to the expected level required to enter the NMC Register as a qualified practitioner with a degree in adult nursing. However I must progress to a satisfactory level in assertiveness (the level of advanced learner or expert) as well as develop to the required standards the management and leaderships skills expected in the administration of Medication. My active participation in the learning programme arranged to meet my needs was supported by practical placements organised through the university and clinical team lead. I achieved new level of my professional development (as an advanced learner) however there are some serious barriers which retard my professional development in the field of the management of drug administration, including lack in assertiveness skills and some personal and family commitments. 3731 words References 1. Astles (2006) Extended nurse prescribing: improving care for older people. Br J Nurs. Vol. 15(3) pp. 150-151. 2. Benner & Sutphen (2007) Learning across the professions: the clergy, a case in point. J Nurs Educ. Vol. 46(3) pp. 103-108. 3. Bond & Raehl (2006) Adverse drug reactions in United States hospitals. Pharmacotherapy. 2006 May;26(5):601-8. 4. Brooks et al. (2001) The patient's view: the benefits and limitations of nurse prescribing. Br J Community Nurs. Vol. 6(7) pp. 342-348. 5. Brooks et al. 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Vol. 45(6) pp. 559-567 Appendix DRISCOLL (1994) MODEL OF REFLECTION WHAT (returning to the situation) is the purpose of returning to this situation exactly occurred in your words did you see Did you do was your reaction Did other people do e.g. colleague, patient, visitor Do you see as key aspects of this situation SO WHAT (understanding the context) Were your feelings at the time Are you feeling now Are there any differences Why Were the effects of what you did (or did not do) "good" emerged from the situation, e.g. for self/others Troubles you, if anything Were your experiences in comparison to your colleagues, etc Are the main reasons for feeling differently from your colleagues, etc NOW WHAT (modifying future outcomes) Are the implications for you, your colleagues, the patient etc Needs to happen to alter the situation Are you going to do about the situation Happens if you decide not to alter anything Might you do differently if faced with a similar situation again Information do you need to face a similar situation again Are the best ways of getting further information about the situation should it arise again Driscoll, J. (1994) Reflective Practice for Practise. Senior Nurse. Vol. 13 pp. 47-50 Read More