Roles and Responsibilities of the Newly Qualified Nurse - Essay Example

? Critical discussion of the roles and responsibilities of the newly qualified nurse Introduction The purpose of this study is to explore and provide an in-depth analysis of the bearing and significance of the roles and responsibilities of newly qualified nurses. The focus of the discussion is on an overview of the various roles and responsibilities of newly qualified nurses, as well as the transition process from training institutions to professional practice. In professional practice, newly qualified nurses are expected to exemplify competence and expertise in health care provision and management. This discussion will essentially focus on the role of a newly qualified nurse in regard to delegation of responsibilities, and Patient Group Direction (PGD). Delegation in essence is the ability to pass to a willing and available second party the authority and responsibility to undertake a given task. As defined by the NPC, Patient Group Direction refers to administration or supply of licensed medicine in definite medical situations certified by a pharmacist, doctor or dentist. The essence of this study is to explore the connotations, significance and implications of these responsibilities of nurses while providing realistic and practical illustrations in professional practice. Of critical significance in health care provision are the associated professional, legal and ethical implications, of which this paper seeks to provide a comprehensive overview before arriving at a conclusive summary on prospects and professional development of a newly qualified nurse. Critical discussion on the roles of the newly qualified nurse The transition from college to professional practice presents a dramatic shift in experience and expectations. This then demands deliberate and timely skill and psychological preparedness to make a successful transition into professional practice. The responsibility of newly qualified nurses are diverse; they are generally expected to be health care providers, delegators, educators, counselors, collaborators, agent of change, medical researchers, and patient managers and advocates (Clark and Lang, 1992). The requirement of NMC is that a certified nurse ought to exemplify skill, competence and ethical conduct in provision of health care. These are prerequisites and indicators of the commitment and initiative of the nurse in both professional practice and personal development (Ellis and Abbott, 2010). In practice, a qualified nurse becomes part of intricate relationships involving colleagues, patients and the leadership of the institutions that employs them. The success of newly qualified nurses in professional and personal development is largely dependent on how the nurses handle their personal and professional relationships (Northcott, 1999). Healthcare care provision presents major responsibilities and challenges that demand not only professional competence but also excellent interpersonal abilities that enhance a mutually supportive and professionally enabling work environment (DOH, 2007). To be registered by NMC, the requirement is that a nurse be able to demonstrate the above skills and competencies with minimal supervision. It has, however, been acknowledged that newly qualified nurses may lack in practical experience and confidence to deal with the enormous challenges presented in health care provision (Glasper, 2010). To this end, the NMC acknowledges that new nurses should receive mentorship and supervision for at least four months in a transitional programme. The challenge faced by newly qualified nurses, as observed by Kennedy (2008), is further compounded by the unprecedented assumptions and expectations from older nurses that new nurses have what it takes in skill and expertise to meet the challenges of their new roles. Of more practical significance in a reflective and realistic perspective is that new nurses develop the ability to adopt and learn faster on the job. As acknowledged by Darley (2002), personal initiative and accountability of new nurses and their ability to delegate some duties that are beyond their abilities would substantially reduce the challenges of complex clinical circumstances and intricate technological applications. Rationale for role choices Delegation of duties to senior or older staff by new nurses may not be practically easy to achieve. The essence of this paper is to discuss delegation as a major challenge that greatly undermines the overall performance of newly qualified nurses. As Herten (2009) points out, newly qualified nurses often overburden themselves or make errors in provision of medical care owing to their inability to delegate some duties to colleagues. This forms the basis of this study on the concept of delegation in preparation of a newly qualified nurse for an effective transition from college to a successful health professional (Seaward, 2006). From 2003, PGDs have become a common practice in NHS. Institutions that use PGDs have the responsibility of ensuring that professionals that are mandated to develop and implement PGDs have due authorisation, knowledge, skills and experience to undertake the responsibilities and roles that are of significance in effective management of health care provision (McErlane, 2006). Newly qualified nurses do not necessarily have to have specific qualification to use PGDs, but they must be thoroughly assessed by organisations that engage them and certified to have appropriate training and competence to effectively discharge duties in PGDs (Tappen, Weiss, and Whitehead, 2004). Delegation In consideration of the sensitivity and significance of provision of medical care to patients, there is very limited room to make errors as most medical situations require utmost accuracy and urgency. Nonetheless, it may not be possible for a new nurse to effectively handle multiple patients or tasks concurrently without compromising the standard of healthcare provided. It is in this regard that the ability of a new nurse to seek assistance in form of delegation becomes of critical significance (Young and Cooke, 2002). The challenge of delegation, especially for new staff, is a lack of sufficient authority and confidence to pass responsibility for a task to a colleague. In the process of attempting to undertake all the tasks at their disposal on their own, they end up providing service that is below the expected standards with more chances of making unwarranted errors (Hertel, 2009). Challenges that nurses face in the role of delegation can be largely attributed to not having acquaintances in the new working environment and the legal requirement that nurses have in-depth PGD knowhow to effectively work within the ethical and legal framework that exemplifies safety and effectiveness in management of the provision of health care. According to DOH (2007), the ddelegation of professional responsibilities in administration and supply of medicine must be in significant consideration of the safety, convenience and preference of the patients. The primary objective of health care facilities should then be to develop an organisational framework and processes that are cost-effective and enhance the quality of health care provided to patients (Law and Glover, 2000). To uphold and enhance the quality of health care provision, the Medicines Act has been enacted to ensure that practice that requires a PGD must meet regulation and control criteria or otherwise face criminal prosecution. As stipulated by NMC regulations, the process of delegation is largely subject to the significance of the task and the level of corporation between the parties involved. It is of fundamental importance that the person being passed the responsibility be made to understand the circumstances under which his or her help is required (Hertel, 2009). The delegator, however, bears the responsibility for successful accomplishment of the task. It should, however, be pointed out that the working culture of any institution is largely shaped by the leadership of the institution (Philadelphia Victorian Quality Council Secretariat, 2010). For hospitals to meet their mission and objectives, they have to lay down organisational and structural frameworks and processes that support their cause (Murray, 2005). Essentially, this calls for building of sustainable and well-coordinated teams. A leadership initiative to establish effective working teams is a fundamental ingredient that determines the quality of medical care provided by hospitals. To this end, it is mandatory for the leadership to undertake deliberate initiatives to develop common values and objectives by providing a framework where teams consistently work together with minimal disruption (Hertel, 2009). A new employee joining any organisation has a genuine concern for personal and professional development. They are expected to be mentored by senior and more experienced staff as part of their induction process (McCormick et al., 2004). Unfortunately, mentorship in public hospitals may not be as readily forthcoming as it would be in private hospitals. The advantage of joining private hospital as a newly qualified nurse is the commitment that private hospitals have to uphold professionalism, with higher chances of new staff having access to mentorship as they closely interact with already experienced employees. The process of induction is thus more systematic, dynamic and effective (Cartwright, 2002). In the interest of the development of their profession, newly qualified nurse have to be active in reviewing and developing of the practice while improving provision of medical care. They must reflect on their own professional performance, with the keenness to consult on personal and colleague performance (Kennedy, 2008). The process of delegation enables newly qualified nurses to be proactive in engaging in constructive critic of inappropriate practice. This involves developing personal networks that enhance their personal and professional development. More often than not, new employees have difficulty in career advancement because of having a poor fit with their colleagues and bosses. This situation is to a large extent minimised in private hospitals owing to the close interaction framework exemplified in these institutions (Howkins and Thornton, 2002). Patient Group Direction (PGD) Newly qualified nurses working under PGDs have the responsibility to exemplify competence in consultation and demonstrate effectiveness in supply and administration of PGD practice (Northcott, 1999). They must demonstrate sufficient knowledge and a deep comprehension of the legal matters pertaining to PGD practice. They also must have knowledge of document management and control while demonstrating good judgment on contents of PGDs. Newly qualified nurses are obliged to provide proof of education and training in PGD practice and management. They must demonstrate an in-depth understanding and comprehension of PGD service (Holmes-Bonney, 2010). They must have sufficient knowledge and knowhow of the processes and framework of governance in clinical institutions. They must demonstrate sufficient understanding and knowledge of legislation of primary medicine and the PGD legal framework (Bessie and Marquis, 2008). Newly qualified nurses have the duty to review and make diagnoses that facilitate generation of available options of treatment for patients and which are inclusive of follow-ups with PGDs. They have a responsibility for establishing relationships that exemplify respect and mutual trust with patients. They ought to view consultation with patients as partnerships while exemplifying the underlying clinical principles on concordance (Bessie and Marquis, 2008). With an in-depth understanding of the medical condition under treatment, its progression and assessment of severity of the medical condition, newly qualified nurses should provide a comprehensive history of their patients in their evaluation of the physical condition of the patients (Salas et al., 2009). They therefore must listen to and understand the inherent expectations and beliefs of the patients. In administering medical treatment and care, they should put into perspective the patient’s linguistic, cultural and religious orientations and the implications in supply and administration of medicine (Swage, 2004). Nurses are obliged to be sensitive with the concerns and emotions of their patients. They must exemplify ability to adopt the consultation process to match the patient needs and requirements (Bessie and Marquis, 2008). Legislation on use of PGDs requires that it should be employed in consideration of specific needs of individual patients. In essence, the use of PGDs has got stringent professional reservations that are tailored to enhance safety of the patient in administering and supply of medicines (Hyde and Cook, 2004). Medical practitioners are hence required to exemplify utmost professionalism and accountability in care for patients with particular attention to the patients’ best interest. The interpretation of RCN on these requirements is that PGDs should only be employed in supplying or administering POMs to homogeneous groups of patients and in definite consideration of whether the groups meet the criteria and requirements for consideration and inclusion in the PGD program, such as national campaigns and programs for child and infant immunisation (American Nurses Association, 1991). In accordance with the statutory instrument, 2000a enactment, drawing up of PGDs is the mandate of doctors and pharmacists working with nurses that use them. Ratification of PGDs is also required from the health authority that is vested with the authority for control of supply and administration of this category of drugs (Humphreys and Lindberg, 1989). PGDs that are produced in England, for instance, must receive certification and authorisation from relevant health institutions by senior doctors and pharmacists, and nurses that are entrusted with their use are individually acknowledged in the PGD. As acknowledged by RCN, this is a benchmark for professional medical care practice, and adherence to these standards in all medical facilities in UK is highly encouraged (American Nurses Association, 1991). The NMC drug control and regulation standards in its medicine management framework require that drug administering through PGDs should not be delegated, and not even medical students are permitted to administer or supply drugs through PGDs. Notwithstanding, students are required to learn and acquire sufficient knowledge and understanding of the underlying processes and principles (Hertel, 2009). However, legislation on medicine points out that PGD must not be employed in administering General Sales List (GSL) and Pharmacy Only (P) medicine. For effectiveness in governance, specific procedures and protocol are upheld to enhance adherence to best practice (Henry et al., 2004). Health care professionals are required to keep clear records of all medicine that they supply and administer to every patient. In those instances when GSL medicines are to be supplied, they must be obtained from premises that are lockable and packaged in well-labelled packs that meet the standards and requirements of the GSL. Supply and administering of P medication will require a PGD from registered pharmacists only (Hertel, 2009). Conclusion The essence and objective of delegation, especially for a newly qualified nurse under induction into professional practice, is not necessarily to pass the burden of responsibility to the next colleague but to create an opportunity to learn faster from more experienced colleagues. The speed and effectiveness of new nurses in adjusting to professional practice is largely dependent on individual commitment in developing meaningful interpersonal relationships with colleagues and seniors. Apart from the role of nurses of treating patients, their primary responsibility is to protect the patients from any harm in the process of administering drugs. Delegation for newly qualified nurses in this regard refers to the confidence and modesty to seek support if they are unsure of the right thing to do. The dilemma that newly qualified nurses face, especially in regard to ethics and law, cannot be underestimated. Accountability, honesty and adherence to regulations and code of conduct are hence of utmost essence. Newly qualified nurses have an obligation to respect autonomy, which implies that they must ensure effective communication with their patients and colleagues, uphold trust and truthfulness, allow patients to exercise their right to make independent decisions, provide essential information to patients and colleagues and respect their patients’ choices and preferences. In essence, responsibility for newly qualified nurses means that it is their primary role to handle every situation in their mandate. This involves exemplifying high professional and ethical standards while being accountable for their actions, which entails developing the ability to justify their actions. This calls for commitment in making the right choices, for the right reasons and at the right time. The supposition that newly qualified nurse must know everything is nonetheless unrealistic. 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