The Role of Registered Nurses Day in Australia: Delegation and Planning - Term Paper Example

The RN’s Day: Delegation and Planning Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Lecturer Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx August 10th, 2012. Abstract The role of registered nurses (RNs) in Australia has had a rapid development in terms of attributes, functions and scope of nurses working in general medical practices (Carryer, Gardner, Dunn & Gardner, 2007). Moreover, a registered nurse plans, assesses, evaluates and implements nursing care assisted by other individual/s and department so as to achieve the objectives of the other health results. This paper provides an evaluation and discussion of the roles of a registered nurse in Australia (Watts et al, 2004). In the discussion, the delegation and planning of nursing activities are put to light in respect of the medical practices provided. In addition, the competencies of an enrolled nurse which are the determinant of the nursing activities to be assigned are discussed. The schedule of the shift is also design to provide the assistant nurses and other team members with a timetable of activities and time to be undertaken. Therefore, a RN assumes the leadership role so as to coordinate health care and nursing both within and across distinct disciplines with the aim of maximizing the outcomes. To achieve these, a RN must make consultation with other relevant health professional, community of nurses, supporting teams and service providers (Gardner et al, 2008). Table of Contents Table of Contents 3 NC Board of Nursing 2010 Delegation and Assignment of Nursing Activities; Position Statement for RN and LPN practice, available online at: http://www.ncbon.com/uploadedFiles/Practice/Position_Statements/DELEGATION%20AND%20ASSIGNMENT%20OF%20NURSING%20ACTIVITIES%201-2010.pdf Retrieved on 17th Jury 2012 15 Rothrock, J 1998 .The RN First Assistant: An Expanded Perioperative Nursing Role. New York: Lippincott Williams & Wilkins 15 Watts, I., Foley, E., Hutchinson, R., Pascoe, T., Whitecross, L. & Snowdon, T. 2004 .General practice nursing in Australia. Royal Australian College of General Practitioners and Royal College of Nursing, Australia: Canberra 15 Glossary of Terms ANMC Australian Nursing and Midwifery Council BP Blood Pressure D&C Dilatation and curettage EN Enrolled Nurse RN Registered Nurse RNs Registered Nurses OT Operation Theatre IMI  Innovative Medicines Initiative Introduction This paper provides an evaluation and discussion of the roles of a RN in Australia. In the discussion the delegation and planning of nursing activities are put to light in respect of the medical practices. In addition the competencies of an EN which are the determinant of the nursing activities to be assigned are discussed. The schedule of the shift as is explained in table 1 is provided as the guide and also designed to provide the assistant nurses and other team members with a timetable of activities and time to be taken. In addition, the paper will look at the delegation of nursing activities in health centre. The paper will also highlight how as a RN one delegates his/her daily nursing activities to an enrolled nurse. Finally, the shift plan in table 1 directs us to the activities that are to be carried out by the RN and the EN. Throughout this paper, we are going to emphasize on effective communication between the nurses and other medical practitioners in the medical institution. Discussion Delegation According to Australian standards of practice for RNs as contained in N6.03 (1), every RN is responsible for planning, intervention and evaluation in order to promote health (Rothrock, 1998). The collection of data is gathered from the patients, mostly those with vital signs and the information are used to plan, assess and evaluate care. In delegation, the EN will assist in various procedures such as responding to a patient’s signal when necessary and notifies the required nurse on the next procedure, assists in the admission and discharge of a patient, and transfer of patients. Furthermore, the EN will help is dressing and undressing of patients if need arises, assist in bathing the patients (Marquis & Jorgensen, 2008). She will also help in measuring fluid intake and output of the client while she records them in an appropriate form. In addition, EN and the 3rd year student will collect urine, stool and other sputum specimens of the client as per professional’s requirement. EN and the 3rd nurse will also assist in feeding the patients as well as making and preparing the clients beds. It is important for the EN and the student nurse to help in that require less problem solving situations, and removal of protective devices such as the bed cradles, footboards and side rails (Carryer, Gardner, Dunn & Gardner, 2007). RN can however delegate duties to EN where there are minimal chances of harm, minimal nursing activities; also controllable tasks that can be done in the absence of a RN. Some of the indirect activities that an EN can perform include cleaning. In cleaning, the EN can clean various places An EN can however organize on the materials required in a certain shift but should be like equipment found in hospitals and store them in their respectable places, clean the environment in which the any operation are any medical activity was taking place, clean any patient area once they have been transferred or discharged, in case of any surgery carried out, the EN is expected to take care of the area in which the operation took place (Keleher, Joyce, Parker & Piterman, 2007). In the cleaning activities the EN is expected to remove anything that has been used and is of no more importance, remove any spoilt meals in the kitchen, and ensure that the garbage bins are always empty; answerable for any typical patience response required by the RN (Rothrock, 1998). An EN has a duty to deliver in time all the meals to the patients admitted, any equipment required by the RNs and the medical practitioners, and finally to obtain any medical results that are to be gotten from the laboratory (Rothrock, 1998). An EN can also be assigned clerical tasks such as answering calls in the enquiry desk, placing calls in case of emergencies, sort and deliver any mails and assist in the charges required in billing of patients. However, it is worth noting that RNs can only delegate duties and activities that they ‘own’ on a daily basis and they have to make sure that it is completed (NCBN, 2010). Here, the RN will be called by other professionals for consultation to answer question that may be of interest to them. The EN will thereafter be checking the patient on a half an hour basis and during each attendance to the patient, she should record the progress. If from her competency the EN feels that the Mrs. William needs some extra attention by professional, she should record that with other details of the patient. Moreover, since the patient is from the OT, it is important to for the RN to attend to her at some interval. Still on Ms. Hannah, the blood transfusion will be done by RN with help from other professionals in that area. Bed 17 will be attended by the EN since the client in it is not medically ill. Again, the EN will only be there for a while to check on how he is doing as he awaits the nursing home placement. However, it is advisable for RN to check on the client’s condition before the end of the shift. The client on bed 18 is stressed though he is doing well from the records on 0900 hours. Since there has been no record of cardiac arrhythmias, the EN will report it if the monitor records them. Bed 19 will be attended by RN and the 3rd year nursing student. Finally, on the last bed (20) the client will be injected at 0700 hours and throughout the shift on an hourly basis by the RN because the task requires a professional and the patient requires constant monitoring because of BP problem. As mentioned in N6.3 (3), RN is mandated to delegate part of his/her tasks after making sure that the assistant to delegate the duty to be competent (NCBN, 2010). The RN must therefore review the educational preparation and other demonstrated abilities of the person to be supervised and in this case the enrolled nurse. Regardless of the fact that the administration of the organization suggests on which nursing duty to be delegated and to whom the activity is delegated to, it is upon the RN who is ultimately responsible for making the decision whether and under what conditions the delegation is to occur. In that respect then, if the RN is aware that the enrolled nurse or any other assistant are not prepared well in terms of education, experience and training such that he/she can safely perform the delegated nursing duty, then the RN will not delegate the duty (Rothrock, 1998). During the round to the patient, the RN should assess the competency of every nurse who is under him or her. With that, the RN will be in a better position to delegate responsibilities and tasks appropriately and according to every person’s competency so as to ensure the work is done perfectly (Rothrock, 1998). The need to delegate some of the activities is to ensure that the tasks do not accumulate waiting for one person to attend to it. The EN will undertake these tasks because it is within her competency to execute the duties safely and perfectly (Porrit, 2007). It is noted that one mistake in the line of duty can cost a patients live. Therefore, the RN will organize for an extra bed in the same ward so as to ensure that the patient is comfortable after operation or any other major treatment. The delegated nursing care activities will require supervision which is more direct. RN will in that case be available at all times in the area of work of EN and respond to any assistance which may be requested by the EN. On the other hand, the delegated care activities will require a general approach of supervision (Skelton‑Green, Simpson, & Scott, 2007). In that respect then, the RN will record the shift happening at the end of the shift. Direct supervision will constant be negotiated with other health team members according to level of complexity of the client’s illness and attention required (ANMC, n.d.). Before every delegated nursing activity is commenced, RN will communicate formally with other team members so as to collaborate effectively. This will be done by giving the leader of the each team a copy of the nursing activities delegated to the EN which indicates the time when the activity will be undertaken. By so doing, the RN will be acting within his/her mandate as provided for by the roles and functions (Skelton‑Green, Simpson, & Scott, 2007). Planning In order for a registered nurse to work effectively, there need to come up with a shift planner (QG, 2008). The following are the things that should be considered when planning for a shift Planning. To be successful in effective communication with the patients, there is need to first know how to address fellow workmates (Keleher et al, 2007). For any reporting of test results, the RN will test the results by having the receiver of the results read back what has been submitted to them. This will be done to verify the information. Another way of good communication is being assertive where concern is shown. Instead of saying that I need another nurse, the RN would say that it will be necessary if other nurses helped in treating a patient. This shows the EN the importance of other people around. The patient receiving endoscopy (bed 19) should receive counseling. Again, patient should not receive any food for about 6-8 hours. Explain to the patient about the possible outcomes of the operation. This is done psychologically by counseling and mentally by explaining the possible outcomes. Shift plan Table 1 Time 0700 0800 0900 1000 1100 1200 1300 1400-1530 Activity Bed 20 to be injected on an hourly basis. All patients to receive breakfast. Check on the patient’s progress Bed 18 to be monitored on his telemetry and recordings to be taken after every one hour and medicine to be given. Bed 20 to be administered with Amoxicillin 1g q6h and injected with IV therapy of 1000ml of normal saline. Bed 19 to be prepared for endoscopy All patients to receive lunch. Bed 16 to be prepared for surgery. Bed 17 to be attended at this time for physical exercises. Clients to receive medicine To work well, there has to be effective communication with the other members. That is by letting out an issue that has been disturbing as early as possible. This is because if problems are kept by an individual, it will affect their interaction with both team members and the patients. Being respectful of other nurse’s opinion will also affect their communication (Carryer, Gardner, Dunn & Gardner, 2007). This concerns the way of listening, contributing to issues discussed in the work place and the body language use. They all add up to demonstrating the respect towards people. There will also be ways of overcoming conflict in the workplace with other workmates. It will be done by making sure that there is proper negotiation with other nurses to ensure that a conflict created has been diffused. This will be enhanced by building a strong relationship with the team members and offer assistance in a sincere way. Making sure that full accurate information of the patients who have been admitted is very essential as it ensures that critical information on all patients is noted and medication is offered on time by the incoming nurses. By giving out the patient’s information in a verbal report, it helps put more emphasis on the records of the patient. The RN would ensure that they delegate their responsibility on the specific care that should be given to each patient and ensure that proper procedures are taken in handling each patient (Byrne et al, 2007). RN should also ensure that any bills or payments supposed to be made during that day are done promptly to ensure no delay of services that are being offered from outside. These payments will also include payment of services to the patients (Porrit, 2007). In the time management plan, RN would ensure that all medication to the patients have been administered on time and any staff who was absent during the shift has familiarized themselves to ensure understanding of the medication. In arranging the plan, RN should ensure that all nurses are allocated the tasks that they are best suited for. In doing all this it will ensure that RN has delegated all duties and have properly managed their time (QG, 2008). To facilitate effective communication between both the patients and the other nurses, the RN should ensure that they come up with strategies like: making proper interviews with the patient to know their specific needs, listening keenly to what they may require in their servicing and informing the patients of the specific care they will be offered (Kozier, 2008). They should also ensure that they document a care plan that will be attached in the patient’s chart of health analysis. Reporting the patient’s condition to the other nurses is very important as it would help the nurses treat each patient as an individual hence special attention is given (Keleher et al, 2007). Using both verbal and nonverbal communication on the patient’s reactions would also help in effective communication. Conclusion In conclusion, the nursing profession in Australia has been on the spotlight to improve the primary care services. However, the current funding model of general practice mainly depends on nursing activities allocation. It is certain that a RN delegate’s only nursing tasks and activities that are under him/her meaning that he/she must first own the tasks. Nevertheless, the allocation is limited and controlled by the type of care needed by the client. In addition, it depends by the competency level of the person the task is to be delegated. Therefore, the nursing activities delegated in this paper are under RN and EN consults the registered nurse in case she needs any kind of assistance. The planning is done after proper consultation with other team members so as to avoid overlapping and attending to a client twice. The planning is also done as one of the functions of RN. It is worth noting that though the duty roster is prepared for the activities to been done during a given shift, the activities may change due to the unforeseen events that may crop during the shift. Workflow Diagram References Andre, K. & Heartfield, M. 2007 .Professional portfolios: evidence of competency for nurses and midwives. Sydney: Churchill Livingstone, Elsevier Australian Nursing and Midwifery Council 2007 National Framework for the Development of Decision-making Tools for Nursing and Midwifery Practice, adopted by the NMBA 2010 Australian Nursing and Midwifery Council (n.d.) 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New Jersey: Prentice Hall Marquis, B & Jorgensen, C 2008 Leadership Roles and Management Functions in Nursing: Theory and Application. New York: Wolters Kluwer and Lippincott NC Board of Nursing 2010 Delegation and Assignment of Nursing Activities; Position Statement for RN and LPN practice, available online at: http://www.ncbon.com/uploadedFiles/Practice/Position_Statements/DELEGATION%20AND%20ASSIGNMENT%20OF%20NURSING%20ACTIVITIES%201-2010.pdf Retrieved on 17th Jury 2012 Porrit, J. 2007. Policy development to support nurses in general practice: an overview. Contemporary Nurse. Vol.26 (1), pp. 56‑64 Queensland Government 2008 Nursing Workload Management: Human Resource Policy, available online at: http://www.health.qld.gov.au/qhpolicy/docs/pol/qh-pol-180.pdf Retrieved on 17th Jury 2012 Rothrock, J 1998 .The RN First Assistant: An Expanded Perioperative Nursing Role. New York: Lippincott Williams & Wilkins Skelton‑Green, J., Simpson, B & Scott, J. 2007 .An integrated approach to change leadership: Canadian Journal of Nursing Leadership. Vol. 20 (3), pp. 1‑15 Watson, C (n.d.) Assessing leadership in nurse practitioner candidates: Australian Journal of Advanced Nursing Volume 26 Number 1, available online at: http://www.ajan.com.au/Vol26/26-1v2_Watson.pdf Retrieved on 17th Jury 2012 Watts, I., Foley, E., Hutchinson, R., Pascoe, T., Whitecross, L. & Snowdon, T. 2004 .General practice nursing in Australia. Royal Australian College of General Practitioners and Royal College of Nursing, Australia: Canberra Read More