New Australia National Nurses Registration - Research Paper Example

New Australia National Nurses Registration Outline I. II. Introduction III. Body a. Defining Scope of Practice b. Professional competence relating to Professional Portfolio. c. Analyzing the relationship between Professional Organizations and Lifelong Learning d. Responsibilities of the new nurse observing misconduct IV. Conclusion V. Works Cite I. Abstract There have always been issues with the scope of nursing practice, not only in Australia but in the rest of the world. As nursing becomes more important in the leadership of quality care for patients, it has become very important to look closely at regulations, portfolio, and scope of practice. Decision making tools have become extremely important as practice becomes more advanced. Nursing in the past has been a pretty generic term and when the definition of a practice is generic, it is difficult to understand the process of determining scope. The New Australia National Nurses Registration process has led to the understanding by RN's, Nurse practitioners, and other healthcare workers through an Act of Parliament which enacted the law called the Health Practitioner Regulation National Law. Australian National Nurses Registration II. Introduction This new registration system has been enacted through relevant education in each State. This new law oversees the administrative aspects of several health professional groups into one national entity. There are many good reasons to make the change and yet there are also many issues that need to be resolved. Nursing in Australia has been mostly a two tiered structure in which there are level one nurses who have a bachelor degree and level two nurses who have extended their education to receive certificate or diploma. Nurses have been the driving force of the healthcare system in Australia. The system is changing with the needs that have been created with the shortage of nurses and the ageing of the present nursing population. This paper will discuss that change. In 1984, the Commonwealth government made a decision to transfer nursing education to tertiary education with level one nurses prepared at the diploma level. In 1992, it became necessary to have a bachelor's degree (Kenny & Duckett, 2004). The Project 2000 report resulted in the change of second level RN training everywhere but Australia. Australia chose not to do this based on the fact that Australia has stronger unions and different strategies for their professional nurses, such as viewing the second level RN as an associate to the RN. This nurse is called the Enrolled Nurse. These EN's are meant to practice under the direction of the level one nurse or RN (professional nurse). They report to the level one nurse but are still responsible for their own practice (Kenny et.al. 2004). Core competencies for the EN have been difficult to monitor as they have been different according to where one works. In some states they have been able to administer medicines and in some states not. The new law which took place July 1, 2010 creates the National Registration and Accreditation Scheme for health care practitioners, including nurses and midwives. This new law will create many changes in the way that healthcare is delivered in Australia, in particular, in the rural areas (Forsythe, 2009). It also creates standardization in licensing and in competency levels. It assures the understanding of the RN level of nursing which is University level, the EN which is diploma level and the NP or nurse practitioner level. III. Body iii.i Scope of Practice There are three essential criteria that are noted for defining scope of practice. Those are education, competency, and authorization to practice. These guidelines are published under the ANMB-codes and guidelines in Australia. These guidelines give the nurse and organized process in determining whether something that needs to be done is within her scope of practice. Failure to understand these guidelines can lead the new RN to make errors in judgment that may leave her vulnerable to allegations. Understanding that the scope of practice is basically defined by education, competency and authorization for practice, Australia as well as many other countries are looking at delegation as a major process of importance in that scope. Delegation is a critical nursing competency in today's healthcare. The need for delegation has been around for some time, even since the days of Florence Nightingale who told us that knowing everything that needed to be done did not mean the nurse had to do it all. Today, there are far too few RN's for the population of patients that need care and the situation is only getting worse. The fact that the present generation is getting older and along with that comes the retirement of many new nurses as well as the need for more care, dictates the critical need for nursing to understand and be able to delegate to other staff. Legal parameters related to nursing practice are defined in the National Framework for Development and decision. In almost every definition there is some language that allows an RN to delegate. There is an understanding that delegation is appropriate. There is concern as to the ability of the nurse to delegate appropriately. There are actually nine principles of appropriate delegation. Those include, being responsible and accountable for nursing practice, directing care and determining the utilization of any assistants in that case, delegating components of that care while maintaining the nursing process, using judgment in that delegation process, delegating only the tasks that other healthcare workers have the knowledge to take care of well, individualize communication in a collaborative way, allowing for questions and follow up, using critical thinking skills and the five rights to delegation and becoming accountable for the systems to assess, monitor and verify application of the delegation model. The fact that there have been two levels of practice has created some of the ambiguity because of overlapping roles of the two levels. These roles might also be determined by the geographical location, organizational policy, and management practices, as well as a lack of differentiation in policy (Gibson & Heartfield, 2005). However, it is clear that one of the professional RN's responsibilities is delegation to and the management of the EN. There is still not evidence as to how the new registration will impact the variation in policy and clinical practice but it is suspected that there will be improvement as there will be less blurring of lines between service types (McEwen, 2008). Professional RN's have more power in the groups that are now being formed because of the registration, allowing them to change the scope by numbers. The new Nurses Registration also allows for a necessary competency level that the Board has wanted to see for some time. In allowing nurses to be involved in the process related to practice, the definition of the scope of practice is better defined based on the opinions of those who are actually practicing (Bagg, 2004). Practice parameters are being defined through this process with the building of standardized policies and frameworks. iii.ii Competence and Portfolios Competency standards are becoming much more rigorous and specialized and should. An example is the professional RN. She must now demonstrate that she has had much ability to use critical thinking skills as well as delegation and clinical skills. . This is in the study process for many of the other fields of nursing (Pincombe, McKellar, Grech, et.al. 2007, 4). Portfolios have become more and more popular in many countries to help a nurse demonstrate her abilities in nursing. Portfolios are meant to demonstrate competence in nursing and are an important part of that education and training. The portfolio is a method of nurses meeting the new standardized competence levels of the RN. Assessing these nurses should occur on competence and capability. That testing as well as experience tracking can be a part of the portfolio (Anderson, Gardner, Ramsbotham et.al. 2004, 71). Documentation of lifelong learning should also take place in the portfolio. Many countries are presently in the process of putting the requirement for a professional portfolio in place for nursing. The thought is that this assures that the nurses are consistently meeting competency levels. These portfolios would be required to maintain licensure and employment or to obtain promotion (Meister, Health, Andrews, 2002). In Australia each State and Territory determines their competency requirements. It is believed with the new registration process and the requirement of a portfolio that there would be a better standard of practice (Mills, 2009). The main role of the registering authorities is to assure that nurses are practicing safely and to protect the public from errors. RN's and Midwives are audited randomly in Australia and the portfolio helps the nurse to show that she is competent to practice. It covers the mandatory competencies and those that the nurse has completed on her own (Mills, 2009). iii.iii Professional Organizations and Lifelong Learning Australia has always had a strong opinion about lifelong learning and expects its nurses will follow this belief. Most of the Universities are now teaching information literacy in hope of improving lifelong learning practice. Nayda and Rankin (2008) performed a study of BN students to determine an assessment of information literacy skills. They were given a questionnaire to answer to help evaluate their understanding of lifelong learning and literacy skills. The study showed a need for staff development toward information literacy and a progressive curriculum approach to assure that these students received lifelong learning. The Australian Commonwealth Government has made lifelong learning a strategic priority. In many of the States of Australia there are reforms beginning put into place to pursue lifelong learning. The Australian Government has many goals that they hope to achieve by achieving lifelong learning. Some of these are a knowledgeable and more highly skilled workforce leading to economic advance, a stronger democracy and more inclusive society, and personal development, autonomy and choice (Chapman, Gaff, & Toomey et.al. 2005). The learning experiences in which they feel they can accomplish that are pre-schooling, compulsory schooling, adult, community and further education, post compulsory education, the workplace, and universities. This is certainly a picture of the lifelong learning that the nursing process will have. iii.iv Ethics and The Newly Registered Nurse The ethical dimension of nursing and its effect on the quality of patient care has come under scrutiny recently. Nurses are constantly confronted with decision making that is ethical in nature related to patients and sometimes to colleagues (de Casterle, Izumi, & Godfrey et.al. 2008). Misconduct is in the realm of ethics. Misconduct in nursing has to do with reasons and values (Monteverde, 2009). Often when a nurse, especially a newly registered nurse feels she has to report misconduct of a peer or of a nurse that has more experience, she feels as though she is trapped in a situation that compromises her practice. She must decided to go to someone about this peer or be quiet about what she has seen or heard, both of which are extremely uncomfortable decisions. What makes one nurse advocate for patients instead of peers in a given situation Jones (2005) says the answer is not yet known but the study and education of ethics must be a committed program. This possibility should be handled in classes that prepare the young nurse for the fact that it will happen and how to solve the issue. Nursing students according to most studies do often report misconduct that they have noted. However, it is also noted that this attitude toward others misconduct does not guarantee that they will not perform the misconduct themselves. Misconduct in the nursing field can be many things, very much like any other profession. It is much more notable in nursing because of the conduct that is expected in a caring profession (McCrink, 2008). This was evident in the case of a nurse I once worked with who was addicted to drugs that affected her quality of care, critical thinking skills & duty of care to patients. As a RN it would be my responsibility to confront her or report the issue. This is a very uncomfortable place to be. As a new RN, it would be even more difficult. Thinking of the ethical issues for patients may be the thing that makes one make the right decision. Other things seen are nurses not washing hands appropriately or swearing & being disrespectful to client. This is seen more often than any of us would like to admit. There are those nurses that do not follow policies of importance such as recently when 2 nurses walked & pushed food into a palliative aged care client that was in last stage of life. The poor lady almost died in the process. These are the kinds of things we see everyday as nurses, though most of us would like not to admit that. Reporting to management is the least of our responsibilities in these cases. These ethical issues are well dealt with in the code of ethics. The Code of Ethics for Nurses in Australia (ANNC) was drafted from the principles and standards of the United Nations. It is a long document but important for this paper are the fact that it states that nurses value ethical management of information and patients and that human rights and professional conduct are important to them. It also states that the culpability for misconduct lies not only with the person who has committed the misconduct but with those that are aware and do not report it. (Code of Ethics, Australia). IV Conclusion The New Australian National Nurses Registration comes into being with many hopes. The nursing shortage has over the recent past gotten very severe and was continuing to be more severe with the aging of this population of nurses. RN's are in short supply in Australia as well as the rest of the world. This dictates that the RN will know her scope of practice and be able to use a logical process if she is in question. She must also learn strong leadership skills and the ability to use delegation. Delegation has become a mandated proficiency in nursing throughout the world for RN's. It will soon be and in some cases already is the most important competency to be learned. Competency levels were not well monitored in the past and the expectations for competency in every state was different. The competency level of all nurses is expected to improve with the mandate of the same competency levels and the use of portfolios. There is also the expectation that with less blurred lines between the levels that more young people will want to be nurses and pursue the career. It is the beginning of the solution to the nursing crisis in Australia which is very important to that healthcare system at this time. Anderson D, Gardner G, Ramsbotham J et.al., 2004 Developing nursing competence and capability. Australian Journal of Advanced Practice 26(4);70-86. Available at http://webebscohost.com/ehost/pdfviewer/pdfviewervid=4&hid=8&sid=bf703of Bagg J, 2004 Rural nurse practitioners in South Australia: recognition for registered nurses already fulfilling the role. Australian Journal of Rural Health 12(3) 3-5. Available at http://search.ebscohost.com DOI:10.1080/0260/370500056727 Chapman J, Gaff J, & Toomey R et.al, 2005 Policy on lifelong learning in Australia. International Journal of Lifelong Education 24(2): 99-122. Available at http://search.ebscohost.com DOI 10.10890/02601370802568390 Dierckx de Casterle B, Izumi S, & Godfrey N, 2008 Nurses' responses to ethical dilemmas in nursing practice: meta-analysis. Journal of Advanced Practice Nursing 63(6): 540-549 Available at http://webebscohost.com/ehat/resultsadvanced DOI 10.1111/j1365-2648.2008.04702.xj Forsythe L 2009 What you need to know about national registration and accreditation. Queensland Nurse 28(6): 22-4. Available at www.cinahl.com/cgi-bin/refsvcjid=5978&accno=2009022216 Gibson T., & Heartfield M. (2005). Australian enrolled nurses have their say-part 2: scope of practice. Contemporary Nurse: A Journal for the Australian Nursing Profession. 19(2); 126-36. Available at www.cinahl.com/cgi-bin/refsvcjid=5978&accno=2010505595 Jones J & Hoffman T, 2005, I had to act, Australian Journal of Advanced Nursing: 23(1); 4-18. Available at http://www.esbcohost.com Accession no. 18354334 Kenny A., & Duckett S. (2004). An online study of Australian enrolled nurse conversation. Journal of Advanced Nursing. 49(4). 423-431. Available at http://webebscohost.com/ehat/DOI 10.1111/j1365-2648.2004.03306.x McCrink A, 2008. Nurses and their commitment to the ethic of caring. Dowling College Papers. 205. Available at http://www.webebscohost.comDOI10.1191/0969733004ne6670a McEwan B. (2008). Defining the scope of practice of enrolled nurses in medication administration in Australia. Collegian 15(3); 93-101. Available at http://www.ebscohost.com Meister L, Health J, & Andrews J et.al. 2002 Professional nursing portfolios: a global perspective. MedSurg Nursing 11(4): 177-182. Available at http://www.ebscohost.comaccession7116241 Mills J. 2009 Professional portfolios and Australian registered nurses' requirements for licensure: developing an essential tool. Nursing and Health Sciences 11(2): 206-10. Available at Http://www.ebscohost.comDOI10.1111/j.1442.2018.2009.00457.x Monteverde S, 2009 The importance of time in ethical decision making. Nursing Ethics : 16(5); 315. Available at http://www.ebscohost.com Nayda R & Rankin E. 2008. Information literacy skill development and life long learning; exploring nursing students' and academics' understandings. Australian Journal of Advanced Nursing; 26(2): 27-33. Available at http://www.ebscohost.com Accession number 35894000 Pincombe J, McKellar L, Grech C. 2997 Midwifery education in Australia: requirements for assessment. British Journal of Midwifery 15(2): 98-101. Available at http://www.cinahl.com/cgi-bin/refsvcjid=1450&accno=2009569755 Read More