Question:
Should Registered Nurses Be Held Accountable For Their Own Practice?
Registered Nurses (RNs) are fundamental in the delivery of care in a wide variety of settings. RNs deliver and coordinate patient care, patient education, provide advice and emotional support. This assignment aims to shows that registered nurses should be held accountable for their own practice. The paper will first define the key terms that will be used throughout to support this argument. Then the assignment will go on to discuss the accountabilities of RNs nurses based on the nursing standards for practice, authority regulations and the standards established by the Nursing and Midwifery Board of Australia (NMBA).
An RN is an individual, who has attained the required or prescribed education, exhibits proficiency to practice, and is registered under the Health Practitioner Regulation Nation Laws as a registered nurse in Australia. RNs undertake tertiary level degrees (Jacob, Sellick, & McKenna, 2012).
Accountability means that nurses are liable or answerable to the patients in their care, nursing regulatory authorities, their employer and the general public (Battié & Steelman, 2014). For RNs, accountability cannot be delegated.
Delegation is the professional relationship that prevails when a registered nurse delegates activities of their nursing practice to another health care professional such as student, nurse, enrolled nurse (EN) or a person who is in another discipline other than nursing. Delegation aims to meet client’s needs and enable access to readily available care delivered by the right person (ANMF, 2015).
Enrolled nurse (EN) is an individual who delivers nursing care with the direct or indirect supervision of an RN. This person has attained the required education level and exhibits proficiency to practice under the Health Practitioner Regulation Nation Laws as an enrolled nurse in Australia. EN is trained at vocational education level (Jacob, Sellick, & McKenna, 2012).
Documentation is written or electronically generated information that elucidated the condition of a patient or the type of care or service delivered to that patient. The client information is gotten through the nursing process (NMBA, 2015).
As regulated health care providers, RNs should be accountable for their own practice. In Australia, RNs are left to practice “unsupervised” and do not deliver care for or on behalf of any other healthcare professionals (Australian Nursing Federation, 2011). This aspect differentiates RNs from other nurse practitioners who are often supervised when delivering care. An RN should directly or indirectly supervise enrolled nurses when they work in general practice. Indirect supervision occurs when the RNs can be easily contacted but are not involved in direct supervision of the ENs as they perform their duties (Daly, Speedy, & Jackson, 2009). The RNs might be away from the care setting, but should be available for constant, direct communication with the ENs. The absence of proximity needs solid processes to be instituted for the direction, support and supervision of the activities of ENs. While ENs are responsible for their own action in practice, the RNs are accountable for their decisions made in practice. In a general practice setting, nurses offer multidisciplinary care. They collaborate with other health professionals to offer care with a focus on a positive outcome for all patients (Australian Nursing Federation, 2011).
Accountability and responsibility are fundamental for RNs, but they are different aspects. Responsibility is the obligation to conduct tasks and roles applying sound professional judgment and being liable for all the decisions made in practice. (Kraak, Swinburn, & Lawrence, 2014) RNs have greater responsibility due to the scope of their practice.
Based on the standards of practice outlined by the Nursing and Midwifery Board of Australia (NMBA), RNs are accountable professionally and legally for their own practice. Besides, RNs are accountable to their clients, the public and their regulatory body as well as supervisory authority. In legal accountability, RNs are liable for making sure they have suitable professional indemnity insurance (PII) (NMBA, 2017). Patients expect RNs to hold PII, which would help to address any risk in case there is corroborate the claim of professional negligence. RNs achieve accountability by having autonomy to practice. Autonomy is having the capacity to make decisions within the profession. It also entails having the right as well as the responsibility to perform according to the standards of nursing practice. RNs practice autonomy since they the ability to use critical skills in practice. Also, they have the knowledge and motivation to practice based on the institutional, legislative and personal factors.
For effective accountability, RNs need continuous critical thinking and evaluation in the context of thoughtful sustenance and creation of constructive relationships. As such, RNs should continue to advance professionally and sustain their capacity for professional practice. RNs are liable to deliver safe and coordinate quality nursing practice. Their practice entails comprehensive analysis, designing of a plan, implementation and appraisal of outcomes. In their practice, RNs are accountable for the delegation and supervision of nursing roles to enrolled nurses (ENs) and other healthcare professionals (Lee, Goeman, Johnson, Thorn, Koch, & Elliott, 2015). Thus, the primary accountabilities are supervision and delegation. Other kinds of accountability are referral and documentation of practice. An RN who delegates duties to another health professional such as ENs is accountable to their decision to delegate. Also, the RN is accountable for delegating the duties to the right person, monitoring the performance of the duties and assessing the outcomes. The delegation decision is made should be made by the RN and the person who will perform the delegated duties (ANMF, 2015). In the process of delegation, the RN should access the risks and capabilities. Competency evaluation and teaching might precede the delegation.
The accountability of nurses to delegation is different from allocation or assignment of duties, which entails requesting another health care professional to care for a certain patient on the presumption that the needed activities for consumer care are usually within that individual’s roles and scope of practice. RNs should understand that most of the similar elements concerning competence analysis and supervision that are pertinent to delegation also require being regarded in relation to assignment or allocation. The accountability for delegation for RNs is broad and requires observing various responsibilities. To sustain the required standards of care when delegating roles, RNs should embrace responsibility in various contexts. The first liability is teaching the person who will conduct the delegated role (Berman, et al., 2014). However, the role of teaching might be performed by another competent healthcare professional. Competence evaluation is a fundamental aspect of the accountability for delegation among the RNs. They should also offer assistance and support as well as clinically-focused supervision. These liabilities are aimed towards ensuring that the person to whom the delegation is being made recognises and understands their role and is ready to accept the delegation. After the delegated roles have been completed the RNs should evaluate the outcomes and reflect on practice. Another form of accountability for RNs occurs during referral. Often primary health care responsibilities are transferred to another more qualified health professional or health service provider. The RN is accountable for their decision to refer a patient to another health service provider. As a result, the RN might be required to continue offering professional help and services collaboratively in the process of referral (Australian College of Nursing, 2015).
RNs have professional accountability for documentation. According to the professional standards, RNs should document timely and right reports of assessment, decisions about a patient’s condition, treatment and outcomes. Documentation is fundamental for RNs because it serves three main purposes; facilitates communication, enhances safe and right nursing care and meet legal and professional standards. Through documentation, RNs communicate to other health care professionals their nursing assessments, diagnosis and the treatment plan for a certain client (McKenzie & Porter, 2007). When an RN documents the care they deliver, other health care professionals can review the documentation and make their own contributions to safe and right care. The documentation further offers medical data for workload management and research. Documentation shows that a nurse has applied nursing skills and knowledge as outlined by NMBA. Hence, documentation acts an evidence of legal proceedings and practice (Stevens & Pickering, 2010). RNs are accountable to their employer. When seeking employment, the nurses are given a set of guidelines and principles that should govern their practice. They should adhere to these guidelines in all their practice. In case they breach the guidelines or exhibit negligence, the RNs would be accountable to their employer.
RNs exhibit these accountabilities by following the nursing standards of practice. The standards of practices are classified into four domains including professional practice, critical thinking and appraisal, provision and coordination of care. Professional practice relates to ethical, legal and professional liabilities which require expression of a competence knowledge base, accountability for practice and practising according to legislation impacting nursing and health care. The professional practice also requires protection of personal and group rights. It can be thought as the observation of human rights and human dignity. There are several tenets of the professional practice which guide the practice of RNs. The nurses should observe the legislation governing their practice and fulfil the duty of care (ANMAC, 2013).
Critical thinking and analysis is another theme that causes RNs to be accountable in their practice. RNs should conduct self-evaluation, be accountable for their professional development and exhibit the value of research and evidence for practice (Ross, Barr, & Stevens, 2013). They should practice within an evidence-based framework. RNs are accountable for identifying the relevant research on enhancing individual or group health outcomes. In doing so, they should utilise the best available evidence, nursing knowledge and respect for values of their clients. The demonstration of analytical abilities in assessing health information and research evidence is required in offering care (Nurisng and Midwifery Board of Australia (NMBA), 2017) Each nurse should be involved in nursing research and participate in ongoing professional development.
The third domain is the provision and coordination of care. Under this standard of practice, RNs coordinates, organise and provides nursing care that includes the analysis of personal or groups, designing and implementation and appraisal of care (Ehrlich, Kendall, & John, 2013). The last domain that guides nursing practice in Australia is collaborative and therapeutic practice. In this theme, the nurses establish, sustain and conclude professional relations with individuals or groups. Additionally, this theme emphasises on the competencies that RNs should exhibit when offering care. The nurses should also understand the contributions of Interdisciplinary health care team (Edmonds, Cashin, & Heartfield, 2016).
The RNs in Australia are governed by multiple professional standards in their practice. Firstly, they should be practised according to the Code of Professional Conduct for Nurses in Australia. Secondly, nurses should adhere to the Code of Ethics for Nurses in Australia. This standard is pertinent to all nurses in different levels in Australia. The purpose of the Code of Ethics is to determine the fundamental ethical standards and values that guide nursing profession. Also, it offers nurses a reference point from which to deliver professional care (Zahedi, et al., 2013). Thirdly, there is ICN Code of Ethics for Nurses which decide professional standards in Australia. Fourthly, professional nursing is governed by the NMBA Competency Standards for Registered Nurses. Finally, professional nursing is governed by the NMBA National Framework for the Development of Decision-Making Tools. There are, however, other standards that have been endorsed and published by the NMBA. RNs in Australia are required to exhibit the understanding and application of these nursing standards in practice. Based on the Health Practitioner Regulation National Law Act 2010, a nurse can be punished for incompetence or negligence, which is a failure to exhibit accountability (Attorney-General’s Department, 2014). Besides, failure to comply with the provisions of this Act can be viewed as lack of accountability.
Conclusion
This assignment has argued that RNs should be held accountable for their own practice since they do not offer care on behalf of any other healthcare professional. The RNs should be accountable to the patients, the public, their employer, and regulatory authorities. Specifically, the RNs are accountable for delegation of certain aspects of their nursing practice, referral of patients, and documentation. Also, they are liable for ongoing professional development, critical thinking and analysis and promotion of patient-centred practice. The RNs are accountable for their own practice because they are governed by nursing standards for practice. Conclusively, RNs should demonstrate competence in nursing practice because they are answerable for their decisions.
References
ANMAC. (2013). Review of Accreditation Standards: Registered Nurse Re-entry to the Register Programs and Entry Programs for International Qualified Registered Nurses Seeking Registration in Australia. Canberra: Australian Nursing and Midwifery Accreditation .
ANMF. (2015). Delegation by registered nurses. Retrieved 9 17, 2017, from https://anf.org.au/documents/policies/G_Delegation_RNs.pdf
Attorney-General’s Department. (2014). Health Practitioner Regulation National Law Act 2010 . Retrieved 9 17, 2017, from https://www.legislation.sa.gov.au/LZ/C/A/HEALTH%20PRACTITIONER%20REGULATION%20NATIONAL%20LAW%20%28SOUTH%20AUSTRALIA%29%20ACT%202010/CURRENT/2010.5.UN.PDF
Australian College of Nursing. (2015). Nursing in General Practice: A guide for the general practice team. Canberra: Australian College of Nursing.
Australian Nursing Federation. (2011). Fact Sheet 7. Retrieved 9 17, 2017, from https://anmf.org.au/documents/reports/Fact_Sheet_Snap_Shot_General_Practice_Nurses.pdf
Battié, R., & Steelman, V. M. (2014). Accountability in Nursing Practice: Why It Is Important for Patient Safety. AORN Journal , 100 (5), 573-541.
Berman, A., Snyder, S., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T., et al. (2014). Kozier & Erb’s Fundamentals of Nursing Australian Edition. Pearson Higher Education AU.
Daly, J., Speedy, S., & Jackson, D. (2009). Contexts of nursing. Elsevier Australia.
Edmonds, L., Cashin, A., & Heartfield, M. (2016). Comparison of Australian specialty nurse standards with registered nurse standards. International nursing review , 63 (2), 162-179.
Ehrlich, C., Kendall, E., & John, W. (2013). How does care coordination provided by registered nurses “fit” within the organisational processes and professional relationships in the general practice context? Collegian , 20 (3), 127-135.
Jacob, E., Sellick, K., & McKenna, L. (2012). Australian registered and enrolled nurses: Is there a difference? International journal of nursing practice , 18 (3), 303-307.
Kraak, V., Swinburn, B., & Lawrence, M. (2014). Distinguishing accountability from responsibility: an accountability framework. American journal of public health , 104 (6), e2-e3.
Lee, C. Y., Goeman, D., Johnson, A., Thorn, J., Koch, S., & Elliott, R. (2015). Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: the Workforce Innovation for Safe and Effective (WISE) Medicines Care study. BMC health services research , 15 (1), 460.
McKenzie, G., & Porter, T. (2007). Clinical companion: Medical-surgical nursing. Elsevier Health Sciences.
NMBA. (2015). Framework for assessing standards for practice for registered nurses, enrolled nurses and midwives. Retrieved 9 17, 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Frameworks/Framework-for-assessing-national-competency-standards.aspx
NMBA. (2017). Professional indemnity insurance arrangements. Retrieved 9 17, 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Professional-indemnity-insurance-arrangements.aspx
Nurisng and Midwifery Board of Australia (NMBA). (2017). Registered nurse standards for practice. Retrieved 9 17, 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Ross, K., Barr, J., & Stevens, J. (2013). Mandatory continuing professional development requirements: what does this mean for Australian nurses. BMC nursing , 12 (1), 9.
Stevens, S., & Pickering, D. (2010). Keeping good nursing records: a guide. Community eye health , 23 (74), 44-45.
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