Posted at 21.10.2018
The aim of this essay is to explore and discuss important aspects of the roles and responsibilities of the newly qualified nurse. It will discuss a synopsis of different type of roles and duties including transition. The roles and obligations of a professional nurse include essential professional skills such as leading in care management and care delivery situations as well as maintaining standards of care. The focus of the essay will be on two chosen roles of newly qualified nurses (delegation and patient group direction). It'll discuss the meaning of the concepts and their importance for nurses, and offer some practical contextual examples. It will also discuss the rational of chosen roles
A new qualified nurse likely to be competent to work in all environments and situations. This emerging healthcare system requires a registered Nurse workforce in any way levels post initial registration capable of critical reflective thinking to be able to create this system. With registration comes a shift in professional accountability together with wider clinical management and teaching responsibilities. On becoming a qualified nurse, the expectations and dynamics of relationships changes fundamentally. Suddenly the newly qualified nurse is the main one who got to know the answer whether it is a query from an individual, a career, a work colleague or students. The newly qualified nurse will face many challenging situations where they must lead care delivery. This includes dealing with care management within the team, dealing with patients/service users, dealing with other professionals, and dealing with the mandatory needs of the complete workplace environment. The NMC requires a student nurse to show professional and ethical practice, be competent in care delivery and care management and show personal and professional development in order to become listed on the register NMC (2010). It is recognized that nurses should discover some form of preceptorship and supervision in their role for an interval of four months time NMC (2006)) once qualified. Even in this period of preceptorship, there are new expectations and challenges faced by the newly qualified nurse.
Mooney (2007) discovered that newly qualified nurses were confronted with assumptions from others that they should know everything. This is also a high expectation they had of themselves. In meeting the NMC standards of proficiency the nurse must have demonstrated the relevant knowledge and skills in order to practise in their career. However, it is important to discover that not every nurse knows everything about everything in their career especially if they are really practising in highly specialized fields. What they want is usually to be in a position to develop and adjust to changing situations. Therefore, for the nurse it is impossible to know everything but they should have developed the skills to learn relevant information, reflect on it, and apply this with their practice. In essence they should have learned how to learn. There is a great deal to be learned once qualified, especially related to a nurse's new region of work and a great deal of the development needs to take place face to face.
The study by Jackson. K (2005) suggested a successful transition requires the nurse to build up a self-image highly relevant to the change in status to be able to do the job and they meet up with the expectations with others with appropriate support. Mooney (2007) also highlights that the duties faced by most newly qualified nurses weren't patient contact centred. There were a lot of duties related to contacting and dealing with other professionals and services. These brought anxieties related to the tasks that could be faced as the nurses would become increasingly senior in their roles with others expecting them to supply the actions and the answers in complex situations. This highlights how the connection with nursing of transition from student to newly qualified nurse can be daunting. In the current environment there can be an expectation that nurses have a preceptor one qualifying for aid in these transitions however the literature still suggests there is a difficulty in the transition process for such professionals. Hole. J, (2009) found that individual accountability, delegating duties without appearing bossy plus some challenging clinical situations such as death and dying and specialised technological roles were found to be stressful by qualifying nurses. Issues of the preceptorship of newly qualified nurses become apparent and important in dealing with the transition from supervised student to autonomous practitioner.
The approach taken throughout the others of this essay is to give a discussion of the main theories, concepts, and issues related to the roles and tasks of delegation and PGD for newly qualified nurses. It'll discuss the meaning of the concepts and their importance for nurses, and offer some practical contextual examples. The rational of choosing these two roles are because: Firstly delegation is an enormous newly qualified nurses concern. According Hole. J, (2005) newly qualified nurses are not competent to delegate tasks to another person and they end up overloading themselves. This is because an accountability issue or not knowing the staffs well as they is not used to the ward. Secondly, it is a legal requirement that newly qualified nurses have to have knowledge of PGDs to be able to work within legal and ethical frameworks that underpin effective and safe medicines management NMC (2010). For this reason, Personally, i was interested and picked them to discuss in order to develop my understanding and prepare me to successfully make the transition from student nurse to a registered professional.
Delegation is the procedure where responsibility and authority for performing a task is used in another individual who accepts that authority and responsibility. However the delegator remains in charge of the task, the delegate is also accountable to the delegator for the obligations assumed. Delegation can help others to develop or improve their skills, promotes teamwork and boosts productivity Sollivan. E. J et al (2009). Therefore, delegation is the area where newly qualified staff experience huge difficulties. Often they don't feel confident enough to ask someone else to take action for the kids. Consequently, they try to do every one of the work themselves and finish up leaving late or providing significantly less than satisfactory standards of care. Other members of staff will not mind if they delegate tasks to them, as long as they apply the basic rules such as ensuring that it is something they are really competent to do. When delegating, the delegator remain responsible for that care if he/she do not delegate appropriately as explained by NMC (2008). Additionally it is important that the delegator explained plainly what it is he/she want them to do and why because he/she might genuinely busy or is it just something that he/she does not wish to accomplish.
Hole. J, (2005) explained that As long as he/she asks the other member of staff in a courteous manner and adhere to the rules, there will be few problems. However, there may continually be someone who has the to react in a poor way to his/her request. These people are often known for this type of behaviour and it ought to be dealt with swiftly by their manager. This sort of reaction experience should be discussed with the member of staff or if he/she not feels confident enough to do this, he/she should talk to the manager.
As mention above this is a difficult skill for a newly qualified nurse especially initially. They will need to get to learn the other staff before they'll feel truly comfortable delegating to others in the team. They could feel guilty about asking others to do tasks which they feel that they must be doing themselves. What they need to realise is the fact they can not possibly do everything themselves and they will need to work as a team in order to provide good patient care. The brand new qualified nurses may feel that they cannot ask others especially HCAs who have worked on the ward for a long time to do things for the coffee lover. The nurse will most likely feel self-conscious and embarrassed.
The answer is that it is not what the nurse asks them to achieve that are important. It really is how he/she asks them. Good communication is the main element to successful delegation. The nurse should take a few minutes to go over with the HCA/student with whom he/she is working who'll be doing what throughout that shift. Share the workload and be realistic. Which means newly qualified nurses should never overload themselves carefully they do not think they can give. The member of staff would rather really know what their workload reaches the start of the shift so that they can organise their time effectively. When the delegator has to ask them to undertake extra work during the shift, they will find this difficult. So the delegator should keep communicating with them during the shift, and if he/she is organized with relatives or an acutely ill patient, he/she should inform them and make clear that he/she will try to help them as soon as possible.
When the new qualified nurses are delegating, it is important to ensure that this is suitable as it is their responsibility to ensure that the employee to whom they delegate is competent to perform the task. Which means that if indeed they delegate a task to a worker who is not competent and they perform the duty wrongly, they may be accountable for the harm caused to the patient. Although the member of staff responsible, they remain accountable. For example, they can not assume that the HCA/student with whom they are working is competent in the skill of measuring and recording a patient's blood circulation pressure. Just because the member of staff spent some time working on that ward for a period, this will not mean that they are taught correctly. They need to evaluate their competence to perform the duty before they allow them to do this independently. They can then justify their delegation of that skill if possible.
Patient Group Direction (PGD) is "a written instruction for the supply and/or administration of your accredited medicine (medicines) in an determined clinical situation signed by a doctor or a dentist and pharmacist. It applies to a group of patients who might not exactly be individually identified before presenting for treatment" NPC (2009), page 11. Basically, a PGD is the supply and/or administration of an specified medicine or medicines by named authorised health professionals for a group of patients requiring treatment for the problem described in the PGD. The health professional must be registered.
Implementing PGDs may be appropriate both in circumstances where groups of patients may not have been previously discovered for example, minor injuries and first contact services and in services where assessment and treatment follows a plainly predictable pattern such as immunisation, family planning etc. Professionals utilizing a PGD must be registered or equivalent members of these profession and act of their appropriate code of professional conduct. This differs from supplementary prescribers and independent prescribers who must successfully complete specific prescribing training and become appropriately registered before they may prescribe. However, organisations using PGDs must designate a proper person within the organisation. For instance, a clinical supervisor, line manager or General Practitioner to ensure that only fully competent, qualified and trained healthcare professionals use PGDs. Individual practitioners utilizing a PGD must be named
A Patient Group Direction allows specified registered healthcare professionals to provide or administer a medicine directly to an individual with an determined clinical condition without him/her necessarily seeing a prescriber. So, patients may present right to health care professionals using PGDs in their services without seeing a doctor. Alternatively, the individual might have been referred by a health care provider to another service. Whichever way the individual presents, the doctor working within the PGD is responsible for assessing that the individual fits the standards set out in the PGD. Generally, a PGD is not designed to be considered a long-term method of owning a patient's clinical condition. This is best attained by a healthcare professional prescribing for a person patient on a one-to-one basis.
Before a doctor may use a PGD, he/she must be named and also have signed the PGD documentation. This generally takes the proper execution of signatures and names on a list or individual forms that are mounted on the PGD itself or held by the service or organisation. Employees of NHS organisations authorising a PGD generally have indemnity attached to their status as an employee. This may also connect with non-NHS organisations. However, the organisations and employees involved should check that this is actually the case. In case the professional is in a roundabout way utilized by the organisation, he/she still must be assessed as competent to utilize the PGD and must have his/her own relevant professional indemnity or insurance. These issues have implications for service delivery when new staff begins, or agency staff are covering services. They might not be able to work under a PGD immediately or may be excluded because of their employment status. Service managers have to be alert to these issues and plan service delivery to support them.
The use of PGDs is widespread throughout the NHS and since April 2003, some non-NHS organisations have been able to use them suggested by NPC (2009). Organisations must ensure that staff in charge of the development / implementation of PGDs and the ones authorised to work under PGDs have the experience, knowledge and skills necessary to do it. Unlike supplementary prescribers, nurse independent prescribers and healthcare professionals using PGDs don't need to become specifically qualified to take action. However they must be assessed by their organisations as fully competent, qualified and trained to operate in just a PGD.
A suitably competent and experienced healthcare professional who'll be working under the PGD should be involved in the writing of the PGD, to ensure that the PGD meets the needs of the service. The role by RCN (2004) proposes that the rn must be assessed as competent in medicines administration, Should be trained to operate in just a PGDMust follow the 6 'R's of medicines administration Usually have to be qualified for at least 6 months Must assess the patient to ensure they fit the requirements as detailed in the PGD Must be sure the PGD meets the required legal requirements Cannot delegate the supplying/dispensing or administration stage to another rn or student nurse. There is absolutely no specific national training for healthcare professionals producing PGDs
The newly qualified nurses are not expected to have the ability to operate under a PGD until competent in medicines administration. However, they need to know about PGDs for his or her patient safety. For instance, if patient under PGD admitted to the ward, the nurse must be sure that the medicines not stopped. The NMC (2010) code of conduct outline that newly qualified nurses to be fully understood all methods of supplying medicines. This includes Medicines Act exemptions, patient group directions (PGDs), clinical management plans and other kinds of prescribing. They are anticipated to show knowledge and application of the principles necessary for safe and effective supply and administration via a patient group direction including a knowledge of role and accountability. And in addition demonstrate how to provide and administer with a patient group direction. The newly qualified nurses may be engaged with PGDs such as assisting and identifying areas where a PGD would offer more benefits when compared to a PSD, understand the principles and processes of PGDs and become fully conversant with all the current principles associated with dispensing and administering medicines they could also be employed in a number of settings where PGDs are used for example prison health care setting, nurse led service, walk in centres
In my conclusion, I have learnt the roles and responsibilities of newly qualified nurses and I have developed skills and professional knowledge to work well with others. The NMC (2010) code of conduct helped me how the laws and policies are setup to ensure safe and effective delivery of care directed at service users under a patient group direction. I am now prepared for the challenges I'll face on being truly a newly qualified nurse by giving the knowledge and skills required to become effective and accountable practitioners. Clinical decisions will still have to be made in regards to meeting the needs of individuals within my care. However, becoming a qualified nurse brings using its wider responsibilities to make and taking decisions related to the nursing team, other staff, and the task environment all together. These changes require a sizable shift from the knowledge of being students and a mentored supervised learner, so that it is essential that we am equipped with all the skills required to successfully make the transition.