The roles and responsibilities of a registered nurse when delegating nursing care
A registered nurse obtains a license from the Australian State or Territory
Nurses Act or Health Professionals Act to practice in Australia. (ANMC, 2005). Of superior competence and reliability, she practices alone and interdependently. Accountability and responsibility makes her the right person to delegate nursing care to lesser qualified nurses under her supervision. Evidence-based nursing care is provided to individuals of all ages and cultures. Promotion and maintenance of health, preventive care, rehabilitation needs and palliative care are managed by registered nurses. Goals and health outcomes are achieved with the collaboration of the multidisciplinary health team. The registered nurse becomes indispensable to the health care system with her knowledge about and capacity to respond to individuals different in ethnicity, cultures, spirituality, socio-economic factors and beliefs about illnesses (ANMC, 2005). Leadership qualities set her apart from other staff in coordinating and ensuring the best possible health outcomes. Her competencies lie in her profession where she functions much in compliance with the relevant legislations and safe-guarding human rights. Critical thinking, self-analysis and experience assist in evolving a thoroughly competent and reliable professional. Her contributions to the developing health care requirements and her ability to contribute to the multidisciplinary team through the development of relationships are commendable. However her competence is questioned due to the dire shortage of professional nurses (Jones, 2002). Severe stress is experienced by the registered nurses due to the workload and heavy responsibilities. The agency nurses who are enrolled increase the responsibility of the remaining staff. Inability to use their high efficiency and expertise in patient care could also disillusion qualified nurses and cause them to leave the profession (Duffield et al, 2008).
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Adhering close to the legal requirements for medications, she knows exactly which medicines can be prescribed by her and which need the prescription of a doctor. Nursing interventions can have legal implications and she demonstrates her awareness in her calculated actions. Upkeeping confidentiality is another of her pre-occupations. Recognised standards of practice are maintained by her. Patients should be protected from harm and on no account is she ready to compromise on their care. She is familiar with alternative strategies for interventions and looks out for behavior which can be bad for the patient’s health. Unsafe practices are condemned by her. Greater autonomy raises the accountability of nurses and education should be focused on improving the liability attitudes; it should essentially be an attitude-oriented education (Kim et al, 2007).
Ensuring that her personal values or beliefs do not interfere with her practice, she is able to understand the cultural or ethnic differences among her patients; cultural competence is essential for any professional who desires to be efficient in her calling (Ethnic Communities Council of Victoria, 2006). Complying with their cross cultural behaviour, she adapts to their requirements in values, beliefs and biases. Innovative changes in practice, organizational policies and other current knowledge are always known to the nurse and further enhance her competence. Upholding the dignity of her office, she accepts the dignity of others with grace, promoting and protecting their interests under her care. Keeping up with research evidence, she uses her new knowledge in keeping her practice safe and effective. Professional development results from her sharing information with her colleagues and higher-ups. She prioritises her workload according to the urgency of requirement and responds suitably to emergencies.
Recognising the limitations of enrolled nurses and unlicensed care workers, she shares her work cautiously. Aware about the scope and extent of delegation to these lesser qualified personnel, she takes care not to load them with responsibilities that cannot be accounted for by them. However she knows that delegation and supervision of other personnel who cannot take responsibility for some of their actions in providing care is necessary due to the shortage of registered nurses. If she feels concerned about some delegation, she can raise her doubts at the right forum. Enrolled nurses and unlicensed carers are safe in her hands. Delegating caring jobs or interventions according to the qualifications or capabilities of the person to whom she is delegating a job, she then supervises the work being done, teaching the carer or enrolled nurse as required. She abides by the legislation and organizational policies which allow the delegation. Effective and timely supervision would be entailed in the monitoring of the delegated job being done. Techniques, direct and indirect, would be employed by her to coach or mentor the delegated carer. Documenting the work delegated, she provides support to the carer ensuring optimal nursing care to the patient. Accreditation is another powerful manner of controlling the quality of any profession (Cherry and Jacob, 1999)
What the responsibilities of the registered nurse in the scenario were when considered delegating medication administration responsibilities to the enrolled nurse
“Highly developed and advanced collaborative and team building skills” are required of the nurse leader envisioned for 2020 (Huston, 2008). This is not evident in Tony’s behaviour. He has not confirmed the performance level of the enrolled nurse, crossed the borders of his responsibilities and forgotten his duties by the ANMC standards for a moment and compromised his delegation powers. He is actually allowed to delegate the jobs that can be competently done by the delegated enrolled nurse. Only those aspects of care may be delegated as can be permissible based on the role, functions, capabilities and learning needs (ANMC, 2005). He has to teach the delegate and assess competence (Queensland Nursing Council, 2005). Clinically focused supervision must be made of the job delegated. Client outcome has to be monitored and evaluated. Tony has experienced one or more of the effects attributed to busyness by succumbing to his weakness of delegating a job he should have done himself: “missed opportunities, compromised safety, emotional and physical strain, sacrifice of personal time, incomplete nursing care and inability to find resources” (Thompson et al, 2008). The enrolled nurse feigns ignorance about the procedure. Tony does not pay attention to her appeal and insists that she do it away from his supervision. Though he claims that he is accountable and responsible for whatever the enrolled nurse does in replacing the syringe driver, the job would be done away from his eyes and may be done wrongly too. Legislation and organizational policies do not allow Tony’s action (ANMC, 2005). Tony has to remember the ethics of responsible nursing before delegating a job (Daly et al, 2006). The consequentialist theory states that an action cannot be merely right or wrong morally; it has to be judged by its consequences (Daly et al, 2006).
Legally, morphine comes under the Health Regulation Act of 1976 where the drug is only given to a registered nurse with the relevant Drug Therapy Protocol endorsement (Queensland Nursing Council, 2009). Possession, administration and supply of the controlled drugs under the DTP can be only be done after obtaining an authorization from a higher authority like the Queensland Nursing Council which established the Nursing Act of 1992 (Queensland Nursing Council, 2009). Moreover only a qualified competent registered nurse with the DTP can administer morphine, not an enrolled nurse who is delegated. Tony made the mistake of just demonstrating the method of changing the syringe driver without actually making her do it at any time (ANMC, 2005).
The enrolled nurse has the right to complain to a responsible supervisor or manager of the unsafe practice that she has been delegated (ANMC, 2002). She has understood that her action may not be ethical and she cannot be accountable or responsible for the job delegated. Knowing that her profession has ethical, legal and professional responsibilities like any other and she is as responsible for providing safe, effective and optimal health outcomes as anyone else in the health care system, she can also refuse to do the job (ANMC, 2002). Tony is liable to be proceeded against for his unethical and unprofessional conduct.
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Australian Nursing and Midwifery Council, (2002). Web.
Cherry, B and Jacob, S.R. (1999) “ Contemporary Nursing: Issues, Trends and Management”, Mosby Publication, St. Louis, Missouri (1999).
Daly et al, (2006), “Contexts of Nursing” Churchill Livingstone, Elsevier.
Duffield, C. (2008). “Nursing work and the use of nursing time”. Journal of Clinical Nursing. 17(24):3269-3274, 2008. Blackwell Publishing.
Ethnic Communities Council of Victoria, (2006). “Cultural Competence Guidelines And Protocols” The Australian Government.
Huston, C. (2008). “Preparing nurse leaders for 2020”. Journal of Nursing Management. 16(8):905-911, 2008, Blackwell Publishing.
Jones, L. (2002). “Nurses Quit Australian Hospitals in Record Numbers”.
Kim, K-K et al, (2007). “Perception of legal liability by registered nurses in Korea”. Nursing Education Today, Vol. 27(6), p. 617-626.
Thompson, D. et al. (2008). “The relationship between busyness and research utilization: it is about time”. Journal of Clinical Nursing. 17(4):539-548, 2008, Blackwell Publishing.
Queensland Nursing Council, (2009). Web.
Queensland Nursing Council, (2005). Web.