Reflective assignment - Scope of practice

Answer

Reflection on Nursing Scope of Practice

Nurses are considered critical workforce in the healthcare sector. This is based on the host of roles and responsibilities from assisting physicians to administering emergency care. Various categories of nurses exist with each group having specific roles that are outlined in the healthcare organizational practice. Upon going through the required training, both theoretical and practical, and satisfying the registration board of nurses, a nurse becomes registered under this professional body which reflects on their competence to conduct their stated duties. New registered nurses are an essential arm in the nursing staff although they face a number of challenges while transitioning to practice (Logan et al., 2017). In the current dynamic environment, the demand for nurses remains unshaken, and in fact, it is more critical than previously as a result of increased healthcare conditions. It is therefore critical to develop effective strategies that are aimed at enhancing their transition to actual practice. Such include being placed under registered nurses with vast experience. To further enhance nursing practice, it is important to identify some of the setbacks in the sector and developed efficient mitigation strategies therein. Identifying these challenges is centered on observation and experience. For graduate registered nurse (GRN), enhancing their transition improves their competence which further results in delivering the central healthcare goal of the quality patient outcome (Pennbrant et al., 2013). This paper entails a reflection on the scope of practice based on my experience in the healthcare practice including analysis of the situation, synthesis, and application. The reflection is based on the Bain’s 5R’s framework.

Analysis and Knowledge

The scope of practice in health care entails all the roles and responsibilities that are governed by licensure and certification. According to the American Nursing Association, the scope of practice is based on what, who, when, how and why the nursing practice is being conducted in a given approach (Ironside, McNelis, & Ebright, 2014). Broadly, the scope of practice involves the patient’s needs based on the evaluation of the condition and the implemented intervention plan. For instance, while a Nursing Practitioner (NP) has the mandate to order for diagnosis test, the Registered Nurse (RN) is limited by their scope to request for tests and prescribe medication (Smolowitz et al., 2015). In Bain’s 5R reflection framework, the first aspect is ‘reporting’ which involves prescribing the trigger such as the issue involved (Ryan & Ryan, 2013). The second ‘R’ stands for ‘responding’ where one develops their personal response to their observation or issue. This also incorporates the questions, feelings, and observations regarding the issue or situation (Etscheidt et al., 2012). ‘Relating,' which is the third ‘R’ involves the theoretical understanding based on the situation. This includes connecting with the issue based on the skills experience, and understanding. As a result, one reason out the situation based on the significant aspects, theory, and experience. Finally, Brin’s framework suggests that conclusions should be drawn and a future plan developed.

            My trigger emanates from the distinction in the roles of an Enrolled Nurse (EN) and Assistant in Nursing (AIN) which I relate to transition of a GRN to actual practice. Each of these nurses should effectively understand their responsibilities which are as governed by their work description and organizational culture and structure (Ruth Jacob et al., 2013). For an AIN, the NSW health system values them for their role in nursing practice which is to provide their support to the ENs and RNs in delivering patient care in a general setting. The scope of practice of these nurses is that they should only work under the supervision of EN or RN and that their actions should be effectively monitored (Gray, 2016). The EN on the other hand work under the delegation and direction of the RN or NP in providing care. Their roles as described below involve conducting nursing assessments, planning care, and evaluating the general healthcare.

In my nursing experience, I have observed these nurses working in ways they are against their scope of practice. On several instances, I have noticed the EN allowing untrained AIN to not only give medication to the patients but also conduct diagnoses such as checking the blood sugar levels in the aged care setting. Notably, this cannot only be a challenge to the nurses but also the patient. My response towards the situation is that such actions present an opportunity for errors in delivering care. For instance, the untrained AIN may administer the wrong medication which may further compromise the patient’s health. Also, while taking the blood sugar levels, there are specific protocols which should be followed which ensure profound results. For the untrained AIN, they may be not conversant with all the procedures thus may do these tests in the wrong manner. The lack of supervision of the AIN by EN is against the scope of practice which is a major risk factor to both the patient and the healthcare provider. While a patient may lose his or her life or develop other complications, the medical practitioner is held accountable for their actions.

Comprehension and Synthesis

GRNs as aforementioned are faced with several challenges which aid them in transitioning to the reality of practice. In actual field, nurses are under extreme pressure based on the need to operate efficiently in a field described as lean, with regulatory oversight and more consumerism. This pressure implies the need to have nurses who can work in the presented tassels (Craft et al., 2017). The dynamic healthcare environment reflects the increased nurse demand and with the limited experience by the graduate nurses, most of the challenges they face occur simultaneously such as lack of effective mentors, diversity in the workforce, anxiety in performance and bullying. Logan et al. (2017) note that as a result of pressure in this realm based on a healthcare sector dynamism, GRNs’ scope of practice may be challenged. In my experience, transitioning into actual practice presents a challenge especially when the EN or RN is less concerned with the work done by the GRN or demonstrates poor supervisory. It is apparent that majority of these GRNs are still not well established in conducting their roles. This implies that they require effective supervision as they transition which will enable them to acquire the given experience.

For the untrained AIN, as reflected in the situational analysis above, it is evident that their transition may be challenging to become an effective registered nurse. This can be analyzed by the difference and roles of both the enrolled and assistant nurse. As mentioned above, enrolled nurses aid the consumers with their daily activities while working according to the guidelines by the registered nurses (Du Toit, 2017). They responsibilities transcend from diagnosing a patient to administering medication and developing an effective management plan. In an acute setting, the EN works with the registered nurse team to not only direct the nursing interventions but also delegate them. Considering the role of the ENs and RNs to an AIN, they are tasked with ensuring that the untrained individual is working according to the set guidelines to achieve quality patient outcome (Fisher, 2017). Further, the EN is responsible for directing the AIN upon realizing any mistakes or challenges during their practice. Based on my experience on the ENs’ scope of practice, it is evident that it was against the set laws which challenges their competence and professionalism. The AIN similarly to GRN should be evaluated on their activities to avoid possible errors.

During the nursing transition from new graduate nurse to a professional, some of the challenges they face are dealing with complex conditions, lack of effective mentors, anxiety in their performance and bullying from different stakeholders including advanced nurses. As a result, their competence cannot be guaranteed which presents a major risk to not only them as the healthcare providers but also the patients. The supervisory aspect in the scope of practice should be based on every action by the AIN and GRN. Frankel & PGCMS (2017) notes that as a result of anxiety, the novice Nurses who are also exhausted and overwhelmed by the numerous clinical situations may result in attrition which may further result in errors among other challenges. In the above situation, for instance, the AIN is permitted to develop diagnosis for the patient as well as prescribe medication. Based on the attrition resulting from anxiety and being overwhelmed, it is apparent that these diagnosis and medication prescription may be wrong. Such errors may result in the patient developing other complications which may inflict more pain and in worst situations death. The effect on the nurses is based on the accountability and responsibility aspects as stipulated in healthcare practice (Smolowitz et al., 2015). The medical field is centered on human life thus healthcare providers should be accurate in delivering their services. In accountability and responsibility, nurses are expected to shoulder the consequences of their actions. Such include jail term or their licenses being revoked as a result of malpractices and errors.

Evaluation and Application

Vast literature provides information on how new graduate nurses can transition effectively for success in their profession. Among these strategies is mentoring programs which ensure all activities are according to their scope of practice. Wall (2016) notes that such mentorships are conducted in three major phases which are an initiation, collaboration and autonomous. In the initiation phase, this entails profound communication skills that establish interpersonal relationships between the graduate registered nurses and their mentors. In the collaboration phase, it is centered on the mentor and novice nurse working together while in the last phase, autonomous, it is achieved through giving the novice more independence. In the above situation, the mentorship approach was evidently out of the scope of practice. This is based on the AIN being provided with independence before efficient collaboration with the mentor. In addition, as a result of increased complexities in the healthcare sectors and dynamism in patient environment, GRN should develop critical thinking and decision making skills to avert the presented challenges (Phillips et al., 2014). This is achieved after vast experience while working in different situations. However, if the healthcare providers tasked with supervising these novice nurses are not present, the process of gaining the set experience is long and negatively affected thus reducing competence among these individuals which further challenges their transition.

The future of nursing is based on the demand for these professionals increasing based on the changing healthcare conditions as a result of globalization and modernization among other aspects. The current approach to training healthcare providers ensures they obtain all skills necessary for them to integrate with actual clinical practice (Pennbrant et al., 2013). These individuals are also equipped with leadership abilities, knowledge of the dynamic society and understanding of the importance of quality care. However, the transitional process is still a challenge if some of the issues as the ones identified above regarding the scope of practice are not evaluated and mitigated (Craft et al., 2017). Addressing such a situation is approached through ensuring a profound organizational culture and structure. This mitigates such malpractices where an EN allows the AIN to conduct any activities without effective supervision. Good organizational culture and structure also promote smooth transition of novice nurses to actual clinical practice. This is as reflected in effective mentorship where the EN and RN are responsible for supervising of the novice nurses to a point where they can be independent (Frankel & PGCMS, 2017). Besides, an effective organizational culture and structure ensure the scope of practice is abide by all nurses and that there is accountability for all actions.

In conclusion, the scope of practice in the healthcare sector is considered a critical element in defining the roles and responsibilities of the healthcare providers. Although different categories exist among the nursing staff, the newly registered nurses also referred as GRNs are noted to face a host of setbacks which are reflected in their transition into actual practice. Some of these challenges include bully from other nurses, lack of effective mentors, diversity in the workplace, anxiety in performance and coping with multiple and complex comorbidities. Essentially, these challenges usually occur simultaneously thus compounding the transitional aspect. The above discussion is centered on one of the major challenges affecting the new registered nurses regarding their scope of practice which entails lack of supervision, follow up and mentorship between the EN or RN, and AIN and GRN. This reflection is centered on my experiences were on a number of occasions, I have noticed the EN permitting the AIN to perform a number of activities such as conducting patient diagnosis and prescribing medication and taking sugar level for aged patients. These issues present a challenge to the nurses as they open up sources for errors which may negatively impact the health of the patient and competence of the nurses. Averting such a transitional challenge is centered on these nurses strictly ensuring they follow their scope of practice which is strengthened by organizational culture and structure.