The Impact of Inter-Professional Working on Professional Responsibility - Assignment Example

How does inter-professional working impact on professional responsibility and accountability in the clinical setting? Discuss in 2,000 words with reference to your clinical experience (Learning Outcome 1, 2 & 3). Word Count: 2,111. Introduction Accountability is our legal liability for our own actions which makes us answerable for the care we give to our patients, while responsibility is our obligation in accomplishing our tasks (Kelly-Heidenthal, 2003). We healthcare professionals are accountable and responsible for our own actions in the clinical setting, but since we don’t work alone in the clinical setting, we interact and work together with other professionals who exert influence to each other’s own accountabilities and responsibilities. This paper will discuss the impact of inter-professional working on professional responsibility and accountability in the clinical setting with reference to my own clinical experience. It will address the importance of maintaining a healthy inter-professional working environment to promote a collaborative approach to safe and effective healthcare delivery. This paper will explore how professionals work together in promoting quality care delivery, the value systems in the scope of practice. Inter-professional Work In almost any healthcare setting, two or more professionals (of different professions) work together in the clinical setting. The nurse depends on the doctor in prescription of medications; the doctor needs the nurses’ help in carrying out his orders, and the nurse needs other professionals to lessen her load. Inter-professional collaboration is inevitable as we depend with each other in performing our own duties for better patient outcomes. Preparation for inter-professionalism begins at student years (Morison, Johnston and Stevenson, 2010). In the clinical setting, we professionals are not independent with each other. How we work with other healthcare team members influences our own professional accountabilities and responsibilities, like how the nurse’s accountability intertwines the unlicensed assistive personnel’s (UAP) accountability when the task is delegated by her to him. Our own accountabilities and responsibilities are dependent to each other as well while working as a team. Inter-professional work impacts our professional accountabilities and responsibilities, which can either, be positive or negative influence to ours. An example of a positive influence is my experience in transferring a patient from the chair to the bed. The nurse asked for my help in assisting the patient for she is unable to do it alone. As a student nurse, I and my clinical instructor are accountable, but the nurse is also accountable for delegating the task to me. She supervised me well so that we will be able to perform our tasks properly. On the other hand, an example of a negative influence is when the doctor instructed the staff nurse whom I worked with to give an NSAID drug (paracetamol) even if he knows that the patient was allergic to it, and manifested allergic reaction (she was accountable since she gave the drug the doctor ordered, though the doctor knows his own accountability should any harm happened to the patient). As we can see, there are issues that may arise while we are working together with other professionals, wherein our accountability and responsibility for the patient is affected. Issues in Inter-Professional Work Conflicts. Inter-professional conflict is inevitable as many professionals work together (Brown et al, 2010), and when it happens, this has an impact on the accomplishment of patient goals (Savage et al, 2009). My nurse proctor shared his experience about a minor conflict with other staff nurses regarding his long charting. The patient is just a day before his graduation when he became a victim of drunk driving. On his charting, he placed every single detail about the patient, including the psychological impact of the event to his well-being, so he had his charting for more than one page. This became an issue in the hospital, when they told him that it was too lengthy, yet nothing is wrong about the things he written therein. However, the conflict didn’t last long, for he just accepted to do the things just like how they do. What he knows is that he would be accountable if he will not document all those details to the chart. Although the ‘standard’ charting includes only clinically-relevant data, he reiterates the importance of looking the patient as a whole rather than just a being with an illness. Another instance is when I was assigned by my clinical instructor to lead my colleagues, as part of our staffing rotation, and had a conflict with one of them under my supervision. I was given the responsibility to ensure that my team is doing our responsibilities. So I went to check on the chart, and the vital signs record she must complete is still empty. I approached her about it, but she became angry and said, “Can’t you see I’m busy?” Good thing she still did something about the entries and she apologized afterwards. Mistrust. Another issue in inter-professional work is on how a professional trusts other professionals, perceiving that others do not understand their roles (Larkin and Callaghan, 2005) which have a tendency to do the work by themselves. A nurse talks about her experiences during her first years of being a new registered nurse. She is reluctant to delegate tasks to student nurses, fearing that we might not be able to do things properly since she retains the accountability in ensuring the accuracy of the data in the chart. Though we are the ones plotting the vital signs, she is always suspicious with the values we had written in the chart. She usually retakes the vitals herself, and found the values to be most often far from what she got. How can she accept a temperature of 34 degrees centigrade? How can she believe a blood pressure of 110/80 mmHg knowing that the patient is hypertensive? There are instances wherein we shortcut the pulse measurement by measuring it in 15 seconds then multiplying by four, and she told us to do it in one full minute for patient has an irregular pulse. She realized that she just endured the pressures of constantly double-checking their work but she haven’t done something about it like teaching us the proper techniques of getting the vital signs, which is her responsibility at all (though it is a primary duty of our clinical instructor). Her mistrust might have rational basis, but she should have informed our clinical instructor of the things she observed with us. Another instance is about another nurse who is in doubt whether other personnel can do the task or not. As a licensed intravenous therapist, it is her work to insert intravenous cannula to the patient, as well as regulating the drip rate. She is with other health care professionals like midwives who assist her. During the time she was inserting the IV cannula, she is having difficulties in hitting the vein, which either became phlebitic or extravasate. A midwife, also licensed to insert IV, presented herself that she can do it, but the nurse was reluctant to hand her the task. Other nurses are telling her to hand the IV insertion to the midwife, so after some seconds of hesitation, she just did as they say. The insertion of the IV line was successful, so she learned that learning to trust another is essential to effective inter-professional relationship. Communication Issues. Communication failures may influence the quality of patient care (Hewett et al, 2009; Macleod, 2006). There was a time when my nurse colleague had bad terms with our doctor. He gathers preliminary data, which is more of patient assessment data, the subjective and objective complaints. He had written there something that only a doctor can judge, a medical term. After the doctor read the chart, she became very angry as her voice echoed the emergency room about his mistake. This made him heavily offended by the doctor’s behaviour, and this lead to their communication barrier. Whenever he has something to refer to that doctor, he had to ask for help from another nurse. This process delays referral of emergent cases and puts patients at risk. Another situation is when I was caring for a patient with multiple organ failure. He was admitted in the emergency room, hooked to cardiac monitor and closely monitored. Then I noticed that the EKG monitor reveals a flat line (asystole), so I called my clinical instructor about it. As the hospital announces a “code blue”, all doctors from the hospital came (since it is a hospital policy). What happened is that they crowded around the bed, making it very difficult for emergency room nurses to revive the patient. The nurses had a hard time to tell the doctors to step a little bit backwards. After some more minutes, a senior resident came just to drive the doctors away and direct the revival process. The patient died. Still, nurses can not blame the doctors since it is their responsibility to “be there” as a hospital policy. One more instance is when I worked with a doctor who oftentimes works on her own, making decisions right after she finished writing on the patient’s chart. We really have lots of things to do that time when she suddenly announced that she is to transfer her patient to another hospital in a few minutes. We haven’t even carried out the orders she wrote there, and there was still no nurses’ charting. She wants us to prepare immediately while we do the charts, and when she was a little bit delayed, she yelled for us to hurry up. Should she communicate to us her plans before she wrote them down, we should have prepared in advance. We know we are accountable if we don’t carry out all the order she made, but her own accountability prevails, so we just did the nurse charting while riding on the ambulance. With these issues backed up by personal experiences, the impact of inter-professional collaboration on accountability and responsibility can either be positively or negatively influenced. Enhancing Responsibility and Accountability through Inter-Professional Working Resolving the issues in inter-professional collaboration is the first step in enhancing the responsibility and accountability of each professional. Jones and Jones’ (2010) suggested trust, team meetings, shared objectives and autonomy to improve inter-professional work: Trust. Building trust helps professionals perform their respective duties wherein they are accountable of. Being a student, we require close supervision by our clinical instructor and the staff nurses in administering medications. I built their trust by showing them that I know what I am doing, so time came when the nurses simply reminded us about the medication we are going to give, though still under the supervision of the clinical instructor. Team Meetings will facilitate improvement of accountability of all professionals in the team by addressing their concerns and solving them altogether. Before, the nurses still have a vague discharge instructor form. The nurses raised the problem during the meeting, voicing out their concerns about those patients who do not return for follow-up, those who seem to forget everything that was told to them about what they should do right after discharge, and the need to return when untoward signs and symptoms appear. The end result is the implementation of a more detailed discharge instruction form. The accountability is enhanced by minimizing untoward incidences after the patient’s discharge. Shared Objectives. Members of the inter-professional team must be aware of each other’s objectives in enhancing their own accountability and responsibility. Whenever I am in doubt of a doctor’s order, I always have it double-checked first before I carry it out. I tell it first to my clinical instructor, then to the staff nurses. I often encounter a confusing or an uncertain order, and I am aware of the doctor’s accountability just as I am aware of mine, so I do the initiative to clarify the order to the doctor according to the staff nurses’ recommendation. Autonomy. Related to getting trust, this allows the professional to act on his own based from what he is accountable and responsible of, but not necessarily independent from the other. The doctor does not have to make an order to perform tepid sponge bath to an unconscious patient. Nurses do not need to remind us to take the vital signs and do bedside care. As long as we are doing well, we learn our accountability when we are permitted by the staff nurses to do simple nursing procedures by ourselves under the clinical instructor’s supervision. Conclusion The impact of inter-professional working on professional responsibility and accountability in the clinical setting depends on how the inter-professional collaboration was implemented, which can either positively or negatively influence accountability and responsibility. Conflict. Mistrust and Communication Failures are issues that must be resolved to enhance the accountability and responsibility. Clinical experiences are integrated in discussing the concepts. Trust, team meetings, shared objectives and autonomy (Jones and Jones, 2010) will facilitate the improvement of accountability and responsibility in inter-professional collaboration. References Brown, J et al 2010 Conflict on interprofessional primary health care teams – can it be resolved? Journal of Interprofessional Care. http://informahealthcare.com/doi/abs/10.3109/13561820.2010.497750 Hewett, DG et al 2009 ‘Intergroup communication between hospital doctors: implications for quality of patient care’, Social Science & Medicine, vol. 69, no. 12, pp. 1732-1740. Jones, A and Jones, D 2010 ‘Improving teamwork, trust and safety: an ethnographic study of an interprofessional initiative’, Journal of Interprofessional Care. http://informahealthcare.com/doi/abs/10.3109/13561820.2010.520248 Kelly-Heidenthal, P 2003 Nursing leadership & management, Delmar Thomson Learning. Larkin, C & Callaghan, P 2005 ‘Professionals perceptions of interprofessional working in community mental health teams’, Journal of Interprofessional Care, vol. 19, no. 4, pp. 338-346. Macleod, A 2006 ‘The nursing role in preventing delay in patient discharge’, Nursing Standard, vol. 21 no. 1, pp. 43-48. Morison, S, Johnston, J & Stevenson, M 2010 ‘Preparing students for interprofessional practice: exploring the intra-personal dimension’, Journal of Interprofessional Care, vol. 24, no. 4, pp. 412-421. Savage TA et al 2009 ‘Rehabilitation team disagreement: guidelines for resolution’, PM&R, vol. 1 no. 12, pp.1091-1097. Read More