Role of Registered Nurses
Discuss about the Reflecting On My Nursing Placements.
Working as a Registered Nurse, I had to actively work with patients, developing and implementing care plan for them and administering medicine (Griffiths et al., 2016; Smolowitz et al., 2015).
During my placement as a professional nurse, I had the opportunity to develop an understanding about the various roles a Registered Nurse has to and helped me to develop critical thinking skills. This aspect has been implied in Standard 1 of NMBA that requires nurses to cortically analyze nursing practice (Nursing and Midwifery Board of Australia, 2016). While working with patients, I was able to learn about the importance of an effective therapeutic relationship with patients which is based on both a professional and personal approach, which is a part of the NMBA Standard 2 (Parry et al., 2015; NMBA, 2016). I was able to develop my skills to perform comprehensive assessment of the patient, involving strategies of primary and secondary assessments, as per NMBA Standards 3 and 4 (NMBA, 2016). I often had to prepare care plan for patients by implementing my knowledge into practice which is a part of Standard 6 of NMBA (Bobay et al., 2018; NMBA, 2016; Auerbach et al., 2014).
I understood that to ensure further improvement in my professional skills and competencies I need to further develop my understanding of the patient conditions and how it affects the wellbeing of the patient (Kankaka et al., 2017).
While working in the Emergency Department, I had the opportune advantage of being mentored by an efficient educator who guided me through my professional journey as a Registered Nurse.
The experience in the emergency department helped me appreciate the importance of collecting comprehensive information from the patients after their admission such as past medical history, lifestyle and medications, as is implied under Standard 4 of NMBA (NMBA, 2016). My ability to perform primary and secondary assessment on the patient proved to be an added advantage in the process and ensure compliance to Standard 4 of NMBA. However the first week was very challenging for me, as I came across new experiences and challenging situation and critically analyze and evaluate the practice as per Standard 1 of NMBA (NMBA, 2016; Carter & Jones, 2017).
I was able to provide a satisfactory performance, developing my skills and competencies in the emergency department. This helped me utilize Standard 3 and 7 of NMBA that implies maintenance of professional capacity and evaluating outcomes of practice (NMBA, 2016; Farrell et al., 2015).
Development of Critical Thinking Skills
In the first week of my placement in the Emergency Department, I was entrusted to take complete responsibility of care delivery for a patient from the point of admission until their discharge, which included preparing care plan and discharge plan for the patients. The initial days were very challenging due to the fast paced environment in the emergency ward compared to surgical or medical wards and also due to a lack of prior experience in the emergency department (Hensel et al., 2018).
I developed competencies in reviewing patient information (such as medical history, medication charts) and clinical documents, which helped me identify the care goals and care needs and helped to relate the patient condition to the problems presented by the patient, and implement Standard 4 and 5 of NMBA (Haas & Swan, 2014; NMBA, 2016).
By the end of the week I was able to implement the best practices guidelines in my professional work, and significantly improved my competency to work in the emergency department and as a result, my confidence grew further. This was in accordance to Standard 1 and 7 of NMBA (NMBA, 2016; Tycon et al., 2017).
In the third week of my placement I had the opportunity to gather experience on wound dressing and wound care. One of my patients presented with a head wound. The wound was 3 cm deep, freshly cut with continuous bleeding, as I was assisting a doctor who cleaned up and dressed the wound before and after suturing it (Griffiths et al., 2016).
The doctor supervised me while I performed the sterile technique for wound management. I followed the hand hygiene practice before starting to clean and dress the wound and maintain a sterile environment (Smolowitz et al., 2015).
I was successful in implementing and maintaining a clean and sterile environment, which prevented the risks of any infections, and thus promoted timely healing of the wound, as was implied under Standard 6 of NMBA that recommends safe and appropriate response to the patient (NMBA, 2016; Parry et al., 2015).
Working in the Emergency Department gave me more opportunities to administer medications to the patients, compared to the other departments where I worked. This also included setting up intravenous channels and collecting blood (Bobay et al., 2018).
This experience helped me develop my skills further in the safe administration of medicines and using effective techniques to set up IV channels and collect blood from the patients. I gathered in depth knowledge about appropriate medications in context to the patient’s condition and how the medication works, including the possible side effects or consequences of using the medication. The Standard 4 of NMBA implies the need for comprehensive assessment which I was able to follow (NMBA, 2016; Auerbach et al., 2014).
Therapeutic Relationship Building
I was able to develop my knowledge about medications and its effects in a more comprehensive manner, working in the emergency department; this was supported in the Standard 3 of NMBA. As per my supervisors, I was able to perform effective care assessment, planning and intervention as well as educate the patient to an adequate level (Kankaka et al., 2017).
In the second week of my placement, my educator entrusted me to take complete care for one patient, since I was in my third year of nursing and have developed enough confidence to handle the responsibility. I developed a complete plan for the patient, from admission to discharge (Carter & Jones, 2017). The NMBA Standard 5 implies the development of care plan for patient, which I was able to utilize in my work (NMBA, 2016).
My responsibility was to constantly monitor his vital signs and heart rate as per the Standard 4 of NMBA that recommends a comprehensive assessment of patient (NMBA, 2016). I also had to document any change in the vital signs and alarm the doctors in case of any worsening of the condition. When the hart rate increased I had to send the patient for DCR. This gave me an exposure on how DCR worked as well as understand the importance of monitoring the vital signs (Farrell et al., 2015).
The understanding helped me develop my skills and competencies in cardiac care, and develop my knowledge and skills to handle similar scenarios in the future. The supervisor’s feedback supported that I had developed my knowledge and competency in administration of medicine, and of pharmacology, which was in accordance to Standard 6 and 7 of NMBA, what recommends the need for developing care plan and provide appropriate and responsive treatment for patient (NMBA, 2016). However, I still need to be more conservative to the needs of the patient and administrating medication based on the assessment of patient needs more appropriately.
By the fourth week, I developed significant confidence in taking over the patient load and develop care plan for the patient. I was more independent and confident than before in my work and was able to take handovers from previous nurses during shift change. I also followed up with the doctors proactively and checked for any additional duties that I might have to follow for the patient. The doctors always provided supervision during collection of blood samples, placing of catheters, administration of medications, and setting up infusions for blood transfusions (Hensel et al., 2018).
Comprehensive Assessment Techniques
I was confident in the independent gathering of all relevant information by the 4th week of my placement, conduct all the appropriate assessments, and implement time management strategies to maximize my output. This experience proved to be a great learning lesson for me as I worked with multiple patients during this time in the ED. According to my supervisor, I was able to take care of the patient load, including assessment, admission and discharge. This was in accordance to Standard 5 of NMBA which implies developing a care plan for nursing (NMBA, 2016; Haas & Swan, 2014).
During the second week of my placement, I had the opportunity to educate a patient with asthma, who has been using inhalers for the last 1 year. The patients used to self administer the inhaler, and complained that he wasn’t able to completely inhale the dose (Tycon et al., 2017).
I educated the patient on the most effective way to administer the dosage using a spacer with the puffer and how it can improve the affectivity of the inhaler. I was able to develop a rapport with the patient and develop a therapeutic relation, which helped the patient to a great extent, and thus helped to utilize the Standard 2 of NMBA in my practice (Griffiths et al., 2016; NMBA, 2016).
The patient was quite happy with the information as it helped him to use the inhaler in a more appropriate way and he was able to take the full dose of the medication thereby maximizing the outcome of the dosage. My assessor agrees that I am very eager to learn, and have developed knowledge about pharmacology as well as pathophysiology and able to understand the patient’s needs and condition in a comprehensive manner, which is important according to Standards 4, 5, 6 and 7 on NMBA (NMBA, 2016; Smolowitz et al., 2015).
References:
Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2014). Registered nurses are delaying retirement, a shift that has contributed to recent growth in the nurse workforce. Health Affairs, 33(8), 1474-1480. DOI: https://doi.org/10.1377/hlthaff.2014.0128
Bobay, K. L., Weiss, M. E., Oswald, D., & Yakusheva, O. (2018). Validation of the Registered Nurse Assessment of Readiness for Hospital Discharge Scale. Nursing research, 67(4), 305-313. DOI: 10.1097/NNR.0000000000000293
Carter, M. A., & Jones, M. (2017). Nationwide Doctor of Nursing Practice/Advanced Practice Registered Nurse Survey on Roles, Functions, and Competencies. Journal of Doctoral Nursing Practice, 10(2), 108-112. DOI: 10.1891/2380-9418.10.2.108
Farrell, K., Payne, C., & Heye, M. (2015). Integrating interprofessional collaboration skills into the advanced practice registered nurse socialization process. Journal of Professional Nursing, 31(1), 5-10. DOI: https://doi.org/10.1016/j.profnurs.2014.05.006
Griffiths, P., Ball, J., Murrells, T., Jones, S., & Rafferty, A. M. (2016). Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study. BMJ open, 6(2), e008751. DOI: 10.1136/bmjopen-2015-008751
Haas, S. A., & Swan, B. A. (2014). Developing the value proposition for registered nurse care coordination and transition management role in ambulatory care settings. Nursing economic$, 32(2). Link: https://ecommons.luc.edu/nursing_facpubs/11/
Hensel, D., Cooper, R., & Craney, N. (2018). Operating Room Personnel Viewpoints About Certified Registered Nurse Anesthetists. Western journal of nursing research, 40(2), 242-256. DOI: https://doi.org/10.1177/0193945916682730
Kankaka, E. N., Murungi, T., Kigozi, G., Makumbi, F., Nabukalu, D., Watya, S., … & Serwadda, D. (2017). Randomised trial of early infant circumcision performed by clinical officers and registered nurse midwives using the Mogen clamp in Rakai, Uganda. BJU international, 119(1), 164-170. DOI: https://doi.org/10.1111/bju.13589
Nursing and Midwifery Board of Australia. (2016). Registered nurse standards. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), 403-420. DOI: https://doi.org/10.1016/j.ijnurstu.2014.07.003
Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., & Wood, L. (2015). Role of the registered nurse in primary health care: meeting health care needs in the 21st century. Nursing Outlook, 63(2), 130-136. DOI: https://doi.org/10.1016/j.outlook.2014.08.004
Tycon, L. E., Root, M. C., & Ersek, M. (2017). How to Survive as a New Palliative Care Advanced Practice Registered Nurse (FR475). Journal of Pain and Symptom Management, 53(2), 382. DOI: https://doi.org/10.1016/j.jpainsymman.2016.12.158
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