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NRSG355 Clinical Integration:

Towards Professional Practice

Module 4 – Professional Practice: Time Management, delegation, scope of practice

Scope of Practice/ Delegation/Advocacy

Over the course of your undergraduate degree you have been taught about your scope of practice as a student and the scope of practice of registered nurses under many different frameworks – legal, ethical, practical and so on. It is now time to consider how the change in your roles will influence your scope of practice. Historically the scope of practice of nurses was clearly defined. In the current contemporary model of health practice the professional boundaries between the health professions is becoming increasing blurred (Fedoruk & Hoffman, 2013 p24). The issue is further compounded due to the scope of nursing practice expanding with roles such as advanced practice nurse, as well as the increase in semi-independent practitioners in community settings.

In this time of transition you must be careful that you understand the scope of practice of the role you aspire to, that of an experienced practicing Registered Nurse and the role you are about to undertake that of new registered nurse. Benner describes the new graduate as an advanced beginner one who is competent but relies on the rules they have been taught to guide them in their practice. Advanced beginners are seen as nurses who have a wide theory base of practice but are still developing the ability to make content dependant judgements (Benner, 1984 p 21-22). This means that you should not set the bar too high for yourselves and realise that you are still learning and developing the clinical judgement skills that can only come from exposure to clinical situations, known as experiential learning. If we take Benner at her word then it takes at least 2-3 years of clinical experience following registration as a registered nurse to be deemed competent and even then she says the competent nurse will lack speed and efficiency (Benner, 1984 p 26-27).

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ACTIVITY 1 Access the following summary of Benner’s stage of clinical competence and consider these along with the NMBA competencies and decision making tools. Then, consider what your priorities for your final semester are and consider what skills you need to consolidate that will assist in you making the transition from student to registered nurse. Reading: Benner’s stages of clinical competence Reading: NMBA Nursing Standards for practice (2016) Nursing and Midwifery Board of Australia. (2013). A national framework for the development of decision-making tools for nursing and midwifery practice.

Role of delegation The ability to delegate is an important skill that all nurses need to understand whether you are a CEO or a newly registered nurse. Delegation is about understanding your own and others time management, prioritisation issues and your own scope of practice. It must be clearly noted that delegation is not about someone getting rid of work, the process should be mutually supportive and have clear aims to improve outcomes (Pearce, 2006). You must also remember that while you can delegate tasks that you are the person who remains accountable for the outcome. So you must fully understand the scope of practice of the person you are delegating too.

Access the following journal article which outline 10 steps to effective delegation and consider as a newly registered nurse who you might delegate too, most likely they will not be junior staff, but more senior staff or team members. As a registered nurse you will often need to delegate to Division 2 nurses or AIN’s who may have been working longer than you. How would you approach these nurses and how would you ensure that all tasks are completed.

ACTIVITY 2: While you are out on placement, observe how other staff delegate, who delegates and what forms of communication they use to effectively delegate. As basis for this observation please read: Reading:

Pearce, C. (2006). Leadership resources. Ten steps to effective delegation. Nursing Management, UK, 13(8), 19.

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Role of Advocacy Nursing as defined by the ICN:

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles (ICN 2010).

The term advocacy presents the newly registered nurse with a number of conflicting issues. What is advocacy? Are we talking advocacy for individual patient’s rights, nurse’s rights, or advocacy for the wider community on issues of public health, advocacy for equity of health care access? You have looked at the term advocacy throughout your undergraduate education in both clinical and ethical context.

Point 2.4 of the National competency standard for registered nurse (2006) state that nurses should “advocate for individuals/groups and their rights for nursing and health care within organisational and management structures”. This clearly states that the role of advocacy can take many forms and encompasses an individual’s right to advocacy as well as advocacy for the broader community. Further 2.4.3 goes on to express that nurses have a duty to advocate for individuals to ensure that individuals are given information that facilitates informed decisions (ANMC, 2006). The next time you are out on clinical placement during your final semester consider how you advocate for your patients. Make a note of your interactions for a day and consider did you advocate for your patients. Did you just allow them to rest for half hour by negotiating with other health care team members, did you intervene on their behalf with medical doctor to clarify point of care, did you encourage your patient to speak up and ask the important questions or did you just listen to them. Advocacy does not have to be all bells and whistles and you will be surprised on completion of this exercise how often you act as an advocate for your patients. ACTIVITY 3: Readings: Read the following articles to further your understanding of advocacy.

Choi, PP. (2015). Patient advocacy: the role of the nurse, Nursing Standard, 29 (41) 52-58. While the following article is dated 2002, it still contains information that is relevant and pertinent to your role in understanding patient advocacy.

Schwartz, L. (2002). Is there an advocate in the house? The role of health care professionals in patient advocacy. Journal of Medical Ethics, 28(1), 37-40.

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Professional Boundaries Another important consideration in understanding scope of practice and delegation is an understanding of professional boundaries within practice. It is difficult sometimes when nurses are fulfilling their role of duty of care to see where the boundaries are. The following guide by the Australian Nursing and Midwifery Council (ANMC) 2010 includes a flow chart and guide on professional boundaries. Please read these carefully.

Australian Nursing and Midwifery Council (ANMC). (2010). Professional boundaries for nurses

Whilst this resource is American it provides a clear explanation of professional boundaries with examples in a simple language which is easy to understand.

National Council of State Boards (2014) A nurse’s guide to professional boundaries.

* e-Portfolio Assessment Re-cap

As part of this module please undertake the following activity and upload your answer into your e- Portfolio. Please remember that this forms part of your assessment for this unit.

You are a Registered Nurse on the afternoon shift on a short-stay (24 hours) surgical ward. One other RN, an EN and three AINs are also on duty. The NUM is off sick and the other RN is acting as NUM as well as taking a patient load. The ward is full: there are 22 patients, 14 of whom went to surgery in the morning, and 8 are going on your shift. Half of these patients have intravenous access and require antibiotics at some time during your shift.

ACTIVITY:

Using your knowledge and experience of various patient allocation models (e.g. total patient care, team nursing and task allocation), outline how you would allocate the staff to the patients. Include in your discussion your rationale for the model of allocation chosen and the scope of practice of the various staff.

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References: Module 4

Australian Nursing and Midwifery Council (ANMC). (2010). Professional boundaries for nurses Retrievedfrom:http://www.nursingmidwiferyboard.gov.au/Codes- GuidelinesStatements/Professional-standards.aspx

Benner, P. (1984). From novice to expert: excellence and power in clinical nursing practice. Menlo Park Ca: Addison-Wesley.

Choi, PP. (2015). Patient advocacy: the role of the nurse, Nursing Standard, 29 (41) 52-58.

International Council of Nurses (2014). Retrieved from: http://www.icn.ch/

National Council of State Boards (2014) A nurse’s guide to professional boundaries. Retrieved from: https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf Pearce, C. (2006). Leadership resources. Ten steps to effective delegation. Nursing Management UK,

13(8), 19.

Schwartz, L. (2002). Is there an advocate in the house? The role of health care professionals in patient advocacy. Journal of Medical Ethics, 28(1), 37-40.

Image:

ANMC sign retrieved from: https://www.library.uq.edu.au/blogs/hsl/2010/05/26/australian-nursing- and-midwifery-council

Novice to expert retrieved from:

http://zoerosedaviesphotography.wordpress.com/2013/01/06/from-novice-to-expert/