Competencies, Experience, and Knowledge as a Novel Graduate Registered Nurse - Essay Example

Nursing Professional Portfolio Student’s Name Institutional Affiliation Nursing Professional Portfolio Summary Statement This professional portfolio is product oriented and will demonstrate my competencies, experience, and knowledge as a novel graduate registered nurse (RN) that meet the national competency standards framework which is central in the provision and delivery of safe, competent care by RNs (Australian Nursing and Midwifery Council [ANMC], 2005). These standards are the basis of my performance assessment by my learning institution as a new graduate and by the respective territorial regulatory authorities that would consequently lead to acquisition of a practicing license as a RN in the respective states. The competency standards highlighted by the ANMC shall be justified and supported by proof of my experiences, knowledge and skills I have developed so far. Competency 1 This competency standard requires RN to practice as per the stipulated legislation regulating health care and the nursing practice (ANMC, 2005). Statement of justification/plan The RN is expected to abide by the common law and other relevant legislation. This respect for the law and regulations includes awareness of legislation that direct nursing practice, ability to explain nursing practice under the common law, adherence and understanding of legal requirements for medicines and legal implication of nursing practice and nursing interventions, understanding legislation guiding the area of health and the care of individuals, and recognition of unprofessional practice as regulated by privacy legislation (ANMC, 2005). The state laws governing health practitioners were paramount during my undergraduate education and practice. This included the “Health Practitioner Regulation National Law (WA) Act 2010” administered by Western Australia Government (2010) that protect any person seeking health services and ensure that provision of is by competent, duly registered personnel. Other regulations include the Aged Care Act 1997 that governed my brief practice in aged care facilities. Under this competency standard, RN are expected to accomplish their duty of care by using nursing interventions according to prescribed practicing standards and after comprehensive and correct assessment, elaborating requirements of care with other health care team members, and understanding the need to prevent harm (ANMC, 2005). Lastly, this standard of competency requires RN to recognize and suitably respond to unprofessional practice by utilizing interventions or alternative interventions that prevent the compromise of care or the law, preventing re-occurrence of incidents of unprofessional practice, and deciding on the appropriate measure needed in specific circumstances (ANMC,2005). Throughout my practice, I have exhibited excellent medication administration skills and competency in the course as evidenced by my assessor’s positive remarks. This included identification of indication, verification of the validity of medication order and performance of appropriate hand hygiene before administering medication (Appendix 1) Evidence Summary Clinical Evaluation Rating Scale Appendix 1 Medication administration - Oral medicine Competency 2 RN is required to practice in accordance with the ethical and professional framework of nursing (ANMC, 2005). Statement Justification. This competency standard requires RN to be guided by the codes of ethics and conduct of the nursing profession that may include non-discriminate provision of services, excluding personal values and attitudes when interacting with others professionally, understanding and respecting other’s rights, seeking guidance in encounters bordering on moral conflict, and consulting with the other health professionals in ethically constrained situations (ANMC, 2005). These ethical requirements have also been reiterated in the “Codes of Professional Conduct for Nurses in Australia” that outlines minimum set of standards expected from RN while practicing, informs the community of what it should expect from Australian nurses, and provides a basis for evaluating nurses by employee, regulatory or professional bodies (Nursing and Midwifery Board of Australia [NMBA], 2008). In accordance with this competency standard, I have demonstrated ability to integrate and apply ethical principles and code of conduct in a case study of a patient who was in his terminal stage of cancer. The patient had a valid ‘Not for Resuscitation Order', when he got into a cardiac arrest. The ambulance crew tasked with bringing him to the hospital tried to resuscitate the patient without considering the order as the patient's daughter wanted the resuscitation to proceed despite the order. The issue brought dissenting views in the hospital management team, but I opined that the ambulance crew failed to respect the patient's autonomy by proceeding to resuscitate the patient despite the NFR. It turned out that I was right after the hospital's emergency team concluded that indeed the ambulance crew were wrong by not abiding by the patient's NFR. Appendix 2 has a report I wrote about the case study including the applicability of the ethical principles. Evidence Summary Rating scale in clinical evaluation. Ethical Principal and Teamwork Report. Appendix 1 Appendix 2 Professional practice Respect of patient’s autonomy Competence 3 This standard requires RN to “practice within an evidence-based framework” (ANMC, 2005). Statement of Justification Under this competency standard, a RN should understand the significance of research in enhancing health outcomes (ANMC, 2005). This entails the RN appreciating current research in their field of practice and actively participating in research, and utilizing evidence-based care. The RN should also exhibit analytical skills when evaluating health information while making sure that that information is accurately documented for future utilization in research. Involvement in activities geared at quality improvement is also covered under this competency standard. My nursing care services are usually informed by evidence-based practice (Appendix 1). In renal unit while managing a patient with chronic kidney disease (CKD), the nursing care plan I came up with was informed by the latest evidence as I had done sufficient research to ensure that my plan meets all the nursing care needs of the patient. To come up with an effective nursing care plan required that I understand every significant detail about the disease and the patient. This is documented in the CKD report I wrote while nursing the patient (Appendix 3). The report was also part of my initiative to participate in an effective evidence-based management of the patient Evidence Summary Rating Scale in Clinical Evaluation. CKD management report Appendix 1 Appendix 3 Provision and Coordination of care. Nursing Care plan Competency 4 This requires RN to take part in continuous professional development and that of others (ANMC, 2005). Statement of Justification RN are expected to use available evidence, guidelines and standards in examining nursing performance and be involved in professional development that includes seeking or identifying additional knowledge especially when handling situations that seem unfamiliar (ANMC, 2005). I have always consulted or researched in situations that am not conversant to ensure that the expected standards of services are maintained or improved. This is illustrated in the research report I have undertaken to effectively address aspects of care in nursing (Appendix 1, 2, 3). Summary of evidence, Rating Scale in Clinical evaluation. CKD Report Appendix 1 Appendix 3 Provision and coordination of care. CKD report Competency 5 This requires that RN should carry out a “comprehensive and systemic assessment” (ANMC, 2005). Statement of Justification This entails the use of appropriate evidence-based assessment tool to obtain and collate data about the psychosocial, physiological, cultural, physical and spiritual elements of an individual (ANMC, 2005). It also involves accurate analysis, presentation and interpretation of assessment data. A comprehensive nursing assessment requires excellent communication skills which vary depending on the individual being assessed. Aged individuals may have undergone physiological alterations that impair some of their senses, therefore, requiring the RN to consider such normal ageing setbacks in communication and utilize suitable communication skills. I have done excellently in nursing assessment as shown in Appendix 1 individualizing my assessment depending on the client. Summary of evidence Rating Scale in Clinical evaluation Appendix 1 Provision and coordination of care Competency 6 This standard requires RN to ”plan nursing care in consultation with” significant individuals and the interdisciplinary team members in health care (ANMC, 2005). Statement of Justification Teamwork has better health outcomes than independence in the performance of various interlinked health care duties (Newhouse & Spring, 2011). This includes the determination of time-based priorities concurred with other inter-professional team members for meeting health needs of patients or groups of individuals, establishment of timely, realistic goals related to individuals’ health outcomes, utilization of appropriate resources in accomplishing health outcomes, and planning for continuity of care (ANMC, 2005). When providing nursing care services, I have always worked as a multidisciplinary team to achieve the expected health outcomes such as in my rotation in aged care facility and renal unit where the need for a multidisciplinary team was emphasized and applied in managing a patient with CKD (Appendix 1, 3, & 4) Summary of evidence. Rating scale in Clinical evaluation. CKD report RN in Aged Care facilities Appendix 1 Appendix 3 Appendix 4 Provision and Coordination of Care Role of Interprofessional team Collaborators with RNs Competency 7 The RN is expected to “provide a comprehensive, safe and effective evidence-based nursing care to achieve identified individual or group health outcomes” (ANMC, 2005). Statement of justification This competency standard requires RN to appropriately manage and utilize resources while providing nursing care, confidently and effectively perform nursing procedures, and monitors individual responses after interventions in order to adjust care appropriately (ANMC, 2005). I have demonstrated this during my clinical experiences as documented in my clinical skills competency such as the evidence-based blood pressure measurement (Appendix 1) Summary of evidence Rating Scale in clinical evaluation Appendix 1 Blood pressure measurement. Competency 8 This standard is about evaluation of the progress of health outcomes as a team (ANMC, 2005) Justification of evidence After administration of care, individuals should be followed up to ensure that the expected outcome is not compromised. This may necessitate occasional revision of care plan relative to the evaluation data. Any new information arising during the administration of care should be communicated to the rest of the interdisciplinary team members (ANMC, 2005). After administration of care such as medicine administration, it has always been my prerogative and initiative to monitor patients for their response to medication therapy while looking out for any adverse drug reactions or events. I was certified competent by supervisor under this standard of competency (Appendix 1) Summary of evidence Rating Scale in Clinical Evaluation Appendix 1 Provision and coordination of care Competency 9 Establishment, maintenance and effective deduction of therapeutic relationships (ANMC, 2005). This includes identifying goal-directed therapeutic relationships, appreciation of professional boundaries, employing effective communication techniques and strategies, provision of sufficient health care information to individuals to enable them make an informed decision, and according the individuals a safe and secure environment (ANMC, 2005). Maintaining such relationship is central in team work and provision of comprehensive care, an aspect I have always exhibited (Appendix 1). Before administration of nursing care, I have always endeavored to provide patient education such as before medicine administration and blood pressure measuring, and allow them to understand the care been provided to them as evidenced by my competent report on clinical skills (Appendix 1) Summary of evidence Rating Scale in Clinical Evaluation Appendix 1 Clinical Skills competency. Collaborative and therapeutic practice. Competency 10 This standard requires RN to work together with the interdisciplinary health care team in providing an exhaustive nursing care (ANMC, 2005). Provision of evidence-based patient care requires the participation of every health care team member. One of my clinical experience was in an aged care facility where I was tasked with medication administration and management in the aged care facility. To perform this responsibility I had to work in coordination with other allied staff members such as pharmacists, physicians, dentists, enrolled nurses, and care partners who all had specific, but related roles to play. Adverse drug reactions identified had to be communicated to the physician and pharmacist to enable a review of the medicine (Appendix 4). My supervisor’s feedback attests to my competency under this standard (Appendix 1) Summary of evidence Rating Scale in Clinical Evaluation. RN in Medication administration Report Appendix 1 Appendix 4 Collaborative and Therapeutic Practice. Collaborators with RN and care partners. Career Goals and CPD After my graduation as a RN, I intent to maximize the knowledge I have acquired during my graduate studies and implement an evidence-based nursing care as per the standards prescribed above by the ANMC. I have always loved nursing practice and this will only be the beginning of my long nursing career journey. Among the most salient goals I have set include achievement of optimum core nursing features and characteristic that are identified with a successful nurse, committing myself to continuous empowerment of my knowledge through further studies and provide optimal nursing in renal unit. After travelling back to my home country, I shall practice for a year according to the definition and characteristics of nursing, I shall strive to consider an autonomous and collaborative care of groups, individuals, families that are either sick or well (International Council for Nurses [ICN], 2014). I shall promote health, control and prevent illnesses, provide appropriate standard care to ill, disabled or dying individuals (ICN, 2014). Moreover, it shall be my responsibility to advocate and promote a safe, healthy environment, promote research, be actively involved in structuring health policy and systems while providing the necessary education to individuals, communities or professionals (ICN, 2014). After one year of practice in my home country, I shall come back to Australia in 2017 and advance my studies towards becoming a urology nursing practitioner (NP) to fortify my knowledge in the practice of urology. During this time, I plan to continue practicing and mastering sufficient skills and understanding the responsibilities of RN and urology nursing practitioner in this field. Objective Rationale Strategy Evidence 2015 To continue improving and perfecting on my practice skills. Nursing is an evolving profession and new evidence is always emerging to support the provision and coordination of care. My seniors are mostly an edge above me in experience and learning from them is fundamental to improving my skills and making me a better nurse each day (ANMC, 2005). I shall actively participate in nursing care activities and I shall be open to guidance and corrections. I shall not be hesitant to consult where am in doubt and work with other team members like MD, pharmacists, nutritionists, and other cadres in health profession. Evidence of my input and effort in clinical practice shall be from my fellow staff members and the head of the nursing department whom I shall request to give me feedback for the period I was engaged with them. 2016 To concentrate and practice more in renal unit of mention the hospital name. I intend to further my studies in urology as a nursing practitioner. A hands on experience in the renal unit will smoothen my study in this area and help me associate with nursing practice in renal unit during my further studies (ICN, 2014). I shall liaise with the departmental heads to allow me sufficient time to work with other health professions in the renal unit A report and recommendation from the head of nursing department renal unit and attendance records in the unit. To attend the following yearly CMEs in my country: Organ and Tissue Donation Awareness and Urological nursing The current medical education (CME) offer new knowledge and information in specific fields that I may not yet have come across. Attending these CMEs will enable me to be up to par with the latest development in urological nursing (ANMF, 2013). The CMEs are usually carried out yearly at mention a place in your country. I shall request for permission to attend seconded by the head of the nursing department in renal unit in mention the hospital A certificate of participation from the coordinators of the CMEs will confirm my participation in the CMEs 2017 To advance my career to become a urology nursing practioner Becoming a nursing practitioner in urology will empower with sufficient knowledge and enable me to contribute better and much more towards the management of urological patients (McKenzie, Fitzpatrick & Sheehan, 2012). I shall travel back to Australia and enroll in the University Mention name of the university A degree certificate awarded after successful completion of the program. Reflection in Practice Critical Incidence I had an experience with an 81-year-old man newly diagnosed with chronic kidney disease CKD. He had hearing difficulties associated with his progressive ageing, and he was not proficient in English. He had been admitted while in the late stage 4 of the diseases where his renal function had extremely deteriorated and his blood sugar were high attributable to his uncontrolled diabetes. The patient had symptomatic manifestation of uremia that required that dialysis be instituted as soon as possible. This patient, therefore, required the intervention of the interprofessional team in managing the disease. He was admitted and a plan of care that included lowering of blood glucose levels was began. While in-patient, I was tasked with administration of medication including his insulin at a dose of 10 IU. However, I could not find insulin syringes but after informing a RN colleague about it, the RN assisted me to administer the insulin by using a tuberculin syringe saying that it is similar to insulin syringe the only difference between its units marked in cc rather than IU. The RN went ahead and drew 1 cc of insulin using the tuberculin syringe and administered to the patient. After 30 min, I came back to check on the patient and noticed he could not respond to speech and pain. I immediately called the emergency team, and it was ascertained that the patient was in a hypoglycemic state after been given an overdose of insulin. Learning Outcome. Medication errors occur in the course of practice, but sometimes their gravity can be adverse to the health of an individual. The patient had the right to receive safe medication therapy. Nursing as a career emphasizes the need to use evidence-based practice in the provision and administration of care to patients. The RN overlooked this during that moment and did not attempt to confirm the relationship between the two syringes from different sources of latest literatures including books and scholarly articles before proceeding to administer the insulin to the patient. Literature shows that the two syringes are not exactly the same. Tuberculin syringe is calibrated in cubic centimeters (cc) while insulin syringe is calibrated in IUs. Insulin to be administered was the short acting actrapid insulin whose strength is 100 IU/ml meaning that 10 IU would require extraction of 0.1 ml of insulin. One cc is equivalent to 1ml meaning that 0.1 ml would have required the extraction of 0.1 cc of insulin using the tuberculin syringe instead of 1 cc. I also learned that appropriate consultation and working as an interprofessional team is paramount to effective care. The RN should have consulted the hospital pharmacist to clarify the equivalency between the two syringes as advocated in team work and working as an interdisciplinary team. The pharmacist was in a better position to understand the relationship between the two syringes. From this incident, I understood and have always been vigilant about using evidence based care in practice and always consulting appropriately when facing unfamiliar situations. This is an issue that has been engraved in my mind, and I plan to pass on to student nurses and others who may be working under me at any given time. Such nursing care errors are detrimental to the health of a patient and are against the principle of maleficence that requires nurses to avoid doing harm to the patient as much as possible. Such errors may also ruin the reputation of a practicing nurse and even result to legal suites that may lead to withdrawal of a nurse’s license. The repercussions can be damaging to a nurse’s career, hence, the need to be vigilante at all times and utilizing every available evince to facilitate and guide nursing practice. Significance in the Interprofessional team Therefore, the role of the interprofessional team in every day to day practice can never be underestimated. It is paramount that health care staff work as a team with common objectives of care. As I look forward to graduating as a RN, teamwork shall be instrumental in my successful practice. The cadres in the health care professions such as medical practitioners, dentist, pharmacist, nursing practitioners, enrolled nurses, endorsed enrolled nurses, and community health workers all have their outlined roles to play in health care. However, their roles are interrelated and their cooperation is central in teamwork. Each team member has the responsibility to abide by the competency standards governing their profession. Similarly, as a RN I shall endeavor to work with them and do any requisite consultation to ensure that individual seeking care receive optimal care. I shall consult them where am in doubt and I shall work alongside them in providing effective patient care. Clinical and nursing care or advice provided by any member of the interprofessional team should be informed by research evidence and assumptions should not be used to guide practice to enhance beneficence as an ethical principle guiding health care practice. Each member of an interprofessional team is significant towards the provision of an effective, comprehensive patient care. Therefore, their advice is always instrumental and I shall make sure that I listen and accord them the respect they deserve. Consulting more than one member of the team is also important in fortifying the right choice of care to be provided to the patient. Accordingly, where necessary, I shall not hesitate to consult more than one member. As RN, I shall be tasked with monitoring and evaluating those working under me such as the enrolled nurses and endorsed enrolled nurses. In order to effectively perform this responsibility, I need to be sufficiently equipped and competent in my duties so that I lead by example. To lead the others requires that I comprehensively understand the requirements of my role as a leader and mentor. This includes giving accurate, evidence-based information where expected to do so and appropriately delegating responsibilities. Appropriate delegation may necessitate supervision to ensure a sustained provision of optimal care. I shall always be available for any consultation from the staff to whom I have delegated responsibility and in addition to encouraging them to be free to seek guidance when they in doubt to avoid adverse clinical mistakes or outcomes that might be devastating to the patient. References Australian Nursing and Midwifery Council. (2005). National competency standards for the registered nurse. Dickson ACT: ANMC. Australian Nursing and Midwifery Federation. (2013). Continuing professional development calender. Retrieved from http://www.nursing.edu.au/pdf/acn_cpd_calendar_january_july_2013.pdf International Council for Nurses. (2014). Definition of nursing. Retrieved from http://www.icn.ch/about-icn/icn-definition-of-nursing/ McKenzie, K.D., Fitzpatrick, P. & Sheehan, J. (2012). Tissue banking: Relationship with blood donor and organ donor card status. ISRN Urology, 2012, 1-3. Newhouse, R.P. & Spring, B. (2011). Interdisciplinary, evidence-based practice: Moving from silos to synergy. Nursing Outlook, 58(6), 309-317. Nursing and Midwifery Board of Australia. (2008). Code of professional conduct for nurses in Australia. Melbourne VIC: NMBA. Appendices Appendix 1: Clinical Evaluation Rating Scale (Kindly attach that rating scale here). Appendix 2: Ethical Principles and Teamwork Report (kindly attach the report here) Appendix 3: CKD Report (Kindly attach the CKD report here) Appendix 4: Role of RN in Aged care facility (Kindly attach the report here) Read More