Professional Nursing practice Topic 01 Controlling Unpredictability of

Professional Nursing practice Topic 01

Controlling Unpredictability of health Laws Civil law Parliamentary law & statues Client rights Professional standards Nursing Boards Nurse patient relationship Clinical standards GCP Organizational policies and protocols

The Register and Roll • The 1999 Act established a single register which records all persons that have met the entry to practice requirements for the registered nurse • The roll records all persons who have met the entry practice requirements for the enrolled nurse.

The Enrolled nurse • Is a second level nurse who works under the supervision of the registered nurse

National Standards • The Australian Nursing and Midwifery Council (ANMC) facilitates national standards for statutory nurse regulatory authorities. These define the minimum core competencies and expected standard of behavior/ conduct of all nurses

National Standards • ANMC National Competency Standards for the Registered Nurse and Enrolled Nurse • ANMC Codes of Professional Conduct for Nurses in Australia • ANMC Codes of Ethics for Nurses in Australia

Board Endorsed Standards • There a number of standards that have been developed by national professional nursing/ midwifery organizations. • These can be endorsed by the Nurses Board

Board Standards • The Board has developed standards which apply to the practice of nursing/midwifery and development of education programs leading to registration and enrolment • Board standards reflect the Nurses Act, Regulations and contemporary regulatory practices

Board Standards 1. Standard for Medication Management 2. Standard for the Use of Restraint 3. Standard for Therapeutic Relationships and Professional Boundaries 4. Standards for Approval of Education Courses 5. Standards for approval as an Education Provider

Board Standards 6. Standards for Authorization for an Enrolled Nurse to practice without the supervision of a registered nurse 7. Professional standards statement for Nurse Practitioner Practice

Direct supervision • Means that a registered nurse is present and works with the enrolled nurse observing and directing his or her activities. • The proximity of this supervision is such that immediate intervention is possible if problems occur. • The registered nurse is able to observe and monitor the execution of the enrolled nurse’s activities and retains accountability.

Indirect Supervision • Means the registered nurse is not present and supervision is provided by other than direct observation, of an enrolled nurse by a registered nurse. • The absence of proximity of the registered nurse requires processes being in place for the direction, guidance, support and monitoring of the enrolled nurse activities. The registered nurse retains accountability

Professional Nursing practice Part I – Professional Nursing bodies Part II- Scope of Practice Part II – competency standards for EN and RN

South Australia • There are two professional bodies that guide nursing practice in South Australia: 1. The Nurses Board of South Australia (NBSA) 2. The Australian Nursing Federation (ANF SA Branch)

NBSA • Is the statutory body responsible for the administration of the Nurses Act and maintenance of registration records • In administering the Nurses Act it fulfils a particular purpose by providing a set of standards that deal with qualifications, duties and responsibilities within the State.

NBSA • Some of the activities of The Board includes: • Accountability – The Board requires practicing nurses to maintain registration and enrolment annually with an emphasis on the importance of ensuring competence

NBSA • Education • The Board determines the educational preparation of nurses through approving courses that lead to registration and enrolment

NBSA • Conduct and Competence • The Board ensures that people applying for registration and enrolment have the competence, character, mental and physical capacity expected of the profession.

Investigation and adjudication • The Board investigates reports about nurses’ conduct, competence or incapacity and hears matters determining the outcomes to protect the public interest

The ANF • Is the largest industrial body representing the interests of nurses in Australia. • The South Australian branch of this organisation is a State Registered Union which represents nurses industrially and professionally – just and the ANF does in other states

ANF • The ANF has a dual role, which combines professional and industrial responsibilities • The ANF has had a major impact on the development of nursing as a profession

ANF • Has provided nurses with guidelines and contribute to the development of the Australian Nursing Council (ANMC) standards for the Registered and Enrolled Nurse • It has also developed standards for self appraisal and the relevant documentation for nursing care to be measured

Legal Context • The creation of a set of standards within nursing has had a major impact on the degree of accountability and responsibility of both registered and enrolled nurses and has helped define their roles • With these guidelines in place, the legal system is then provided with parameters within which nursing is performed

You as an Enrolled Nurse • As an enrolled nurse, your role and function are defined by the Nurses Board, ANF, your job description and the health unit’s policies and procedures. • How you practice these guidelines is influenced by your level of responsibility and accountability.

Nurse’s contract with society • Nursing exists to satisfy a fundamental need of humanity. • Nurses are in a position to be aware of injustices in the health care system and the political arena; therefore, they have a duty to set an example and become involved.

Nurses’ professional role • Nurses want the rights and privileges that accompany their professional role, but they do not always want the responsibilities that accompany these rights. • It is not enough for nurses to simply care for patients; they must advocate, educate and set and example to the public

Nurses’ professional role • Many nurses do not want theses rights of responsibilities preferring instead to focus on clinical tasks only. • What is wrong with this? ? ?

Nurses’ professional role • This mentality is dangerous for nursing • It will prevent nursing from progressing to a higher professional level. • If the main focus of the profession is task-orientated rather than visionary, nursing will lose the battle for patient orientated health care and greater respect for the nursing profession

Leadership • Having visionary nursing leaders in strategic positions in health care facilities, professional organisations, and in local and national offices, increases the influence of nurses and therefore, their objective in the health care political arena

Ethical obligations • On community and national levels nurses have an ethical obligation to promote human rights awareness and influence health care policies.

Benchmarks • Rules of guidelines we work under, standards we meet. • Nursing is regulated by many legislative acts and regulations ( as listed on NBSA website) • All nurses must be particularly well aware of the implications of The Nurses Act 1999 and the Consent to Medical Treatment and Palliative Care Act 1995.

Nurses Board • What is it’s function under the Nurses Act 1999 • To nurses • To the public

Key Terms and what do they mean to your practice • Supervision • Accountability • Responsibility

What are national standards • ANMC standards for EN’s • ANMC Code of Professional Conduct • ANMC Code of Ethics for Nurses

Board Endorsed Standards • Reflect the Nurses Act, Regulations and contemporary regulatory practices

Policies and Procedures • Organizational policy and procedures are essential to guide nursing practice within that particular organisation. • They protect your practice within the workforce.

Policy and Procedure Statements: How important are they? • Take these seriously • Often failure to follow protocol that gives the court cause to review nursing practice • Take care reading them – responsibility for failing to do so will lie with the practitioner Linda Saunders 7/12/04

Impact on Enrolled Nursing Practice • Regulates the profession. Currently not all health professionals are regulated. • Only registered or enrolled nurses are entitled to be called ‘nurse’ • Nurses must function in accordance with Nurses Act and legislation. • Nurses must have an understanding of the legal implication which effect their practice

Impact on Enrolled Nursing Practice • Be aware of standards for restraint • False imprisonment • Tort of negligence • Duty of Care • Vicarious Liability

Impact on Enrolled Nursing Practice • Conduct nursing in a way that can be ethically justified according to code of ethics and professional code • Respect the rights of individuals • Accepts accountability and responsibility for own actions within practice • Assess their own practice

Impact on Enrolled Nursing Practice • Maintain own professional development • Practice in a safe manner • Maintain professional confidentiality • Ensures informed decision making • Verifies consent for procedures • Aware what constitutes assault/ battery • Understands advocacy • Can identify the moral commitments of the profession.

Review of the Nurses Act • The Nurses Act is currently under review • Consultation is underway with all colleges of nursing and general nurses and midwives

Key Issues for inclusion of amendment • A separate midwifery register • Regulation of students of nursing • Definition of nurse practitioner • Authority for prescribing of medication for nurse practitioners and midwives • Definitions of delegation, direct and indirect supervision

Key Issues for inclusion of amendment • Evidence for continuing competence and scope of practice • Review of the composition of the Board • Review of authorization of enrolled nurses without supervision • Review of investigation and formal proceedings and processes

Why change? • The Minister for Health has requested a review of professional registration Acts. • The Medical Practice Bill 2004 and Podiatry Practice Bill 2004 have both been tabled in the House of Assembly in 2004. • It is likely the new Act will be changed to the Nurses and Midwives Act

Hot topics Taken from a talk by Linda Saunders 7/12/04

We now work in an environment • That has alternative models of care from traditional hospital focus • What are they? Linda Saunders 7/12/04

Alternative care models • Impact of day surgery. Less time to access patients • Primary health care. Linda Saunders 7/12/04

Advances in Technology • The Internet • Research : legal implications Linda Saunders 7/12/04

Fear of litigation • Most health professionals fear being sued • Personally and professionally devastating • No more at risk than other members of the community • All have a responsibility to avoid causing personal and property damage • Most litigation in health care settings attributed to unsafe practice, negligent delegations or supervision of staff. Linda Saunders 7/12/04

Medical Litigation Explosion or Media Sensationalism • 555 million Medicare services a year • 1. 1 million hospital admissions • At any one time 450 claims for all kinds of medical negligence in Australian courts collected over 2 -3 years • Obstetric litigation expensive and protracted due to the extent of time a claim can be made and the need to investigate time from conception to birth • 4% get to court • 1% get to hearing Linda Saunders 7/12/04

Case of Sophie Heatcote • Registered nurse on night duty at Wilcannia Hospital • Death in custody of Mark Anthony Quayle • Follow policy • Document clearly • Maintain a professional demenour Activity – read the case http: //books. google. lk/books? id=ga 0 PYFkd. AV 4 C&pg=PA 4&dq=Case+of+Soph ie+Heathcote&hl=en&sa=X&ei=3 Tx. RUZ 71 Kourr. Aevt. YHACw&ved=0 CCs. Q 6 AEw. AA#v=onepage&q&f=false

Go through a day at work • Go through the tasks you will perform in a single working day • Eg take handover • Perform ADL’s • Administer medications • Document • Speak to relatives • Admit and discharge patients • Patient education

What legal and ethical parameters impact on your day to day practice?

ACTIVITIES Read all extra reading regarding Professional Nursing practice

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