Unit 8 The Roles and Responsibilities of the Registered Nurse PDF

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Unit 8

The Roles and Responsibilities of the Registered Nurse

Emma Bushnell

Introduction The NHS was founded in 1948 after publication of The NHS Act (1946). At the time, nurses were trained on the job in hospitals, were often regarded as assistants to doctors with little responsibility and were almost always female. Shortly after the introduction of The NHS Act (1946), nurse education was stripped from hospitals and moved into universities, transforming the career into an all-graduate profession. Nurses were taught to encourage their patients to lead healthier lives by providing information and support. This came about after Government statistics revealed many patients were suffering with preventable illnesses related to poor lifestyle choices. The Evolving Role of a Registered Nurse Multiple policies and legislations were introduced and updated after 1990 which impacted the roles of registered nurses, patients, and the wider community as a whole. Starting with the NHS and Community Care Act (1990) which gave nurses more responsibility for business procedures and budgets, including management. As a result, NHS hospitals and community trusts learned to manage themselves from within. This started a snowball effect of changes for nurses, midwives, and the wider community. Between 1992 and 1999, the Department of Health reviewed policies leading to nurses being given rights to prescribe medication for minor illnesses and injuries in health promotion and palliative care roles. This new responsibility was well received in the medical industry, Nurses were able to make more of a contribution to the patient’s outcome. Starting in 2000, prescribing nurses were working in A&E departments and GP practices and by 2003, the Government added a further 60 drugs to the Nurse Prescribers’ Formulary, including drugs for diabetes and asthma introduced in 2002. The Modernisation Agency was founded in 2001 to redesign and expand the skills and roles of all health professionals. This professionalisation allowed nursing roles to be matched with skill and competency and the outcome has been an improvement in patient care and job satisfaction. Nurses would be assessed on their honesty, competency, ability to problem solve and coordinate care, as examples. Shortly after, in 2010, the NMC Standards for Pre-Registration Nursing Education (2010) would prepare nurses to take on a range of roles including leadership positions. The NMC standards would also dictate that nurses will respond to changing needs, developments, priorities, and expectations in rapid changing environments. Nursing and Midwifery Council, (2010). Clinical Commissioning Groups were introduced after the Francis Report (2013) indicated stronger leadership and open communication systems would create safer healthcare environments and improve quality of care for patients. CCGs replaced Primary Care Trusts and became responsible for commissioning primary care services and some specialised hospital services. This meant nurses would need to carry out risk assessments and adhere to other safety policies as part of their role. In April 2020, the Government announced they would clear over £13bn of NHS debt. Being debt-free will allow the Trusts to develop their infrastructure, their staff and update their technological resources, as well protecting their resources while operating emergency responses during the covid19 pandemic. Later in 2020, the Government pledged to train 50000 new nurses and confirmed 40 hospitals will be built by 2030. Department of Health and Social Care, (2020). Each of these events in time has built upon the standard of competence required for a registered nurse. The Royal College of Nursing (RCN) sets out four key areas of competence: professional values, communication and interpersonal skills, nursing practice and decision-making and leadership

Unit 8

The Roles and Responsibilities of the Registered Nurse

Emma Bushnell

management and team working. Newly qualified nurses are more prepared than ever before as they develop specialist expertise and clinical experience from the very beginning of their career. Specialist expertise has been developed in response to the changing needs of patients and the general population, as well as innovations in healthcare policies and provision. Examples of relatively new nursing roles are advanced nurse practitioners, emergency care practitioners, clinical nurse specialists and nurse consultants. These roles were created to increase efficiency, support career progression, reduce waiting times and improve the patient’s outcome.

The Nursing and Midwifery Council (NMC) “Better and safer care for people is at the heart of what we do, supporting the healthcare professionals on our register to deliver the highest standards of care.” NMC, (2019). The Nursing and Midwifery Council (NMC) are the regulatory body for Nurses and Midwives in the UK. Founded in 2001 under the Nursing and Midwifery Order established by Parliament. The purpose of the NMC is to “maintain a register of nurses, midwives and health visitors, through setting and monitoring standards of education, practice and conduct, and through handling complaints about misconduct and unfitness to practice of those on the register”. Thewlis, S. UK Parliament, (2003). To be entered onto the NMC register, newly qualified nurses must meet the NMC’s eligibility requirements to take the Test of Competence. Once confirmation of eligibility is received, applicants must register and pay to take the test with Pearson VUE. Since April 2006, registered nurses have been required to confirm they are fit to practice by renewing their registration every three years and it is their own responsibility to do so. High standards must be met to revalidate their place on the register including 450 practice hours and 35 hours of CPD, five pieces of practice-related feedback, five written reflective accounts, a reflective discussion with NMC registrant, a health and character declaration, appropriate professional indemnity and insurance arrangements and confirmation that all requirements have been met. NMC, (2019). The NMC regularly publishes guides to ensure all registrants are kept up to date with changes and are reminded of their commitment to the NMC Code. The NMC Code “The Code contains the professional standards that registered nurses, midwives and nursing associates must uphold… This commitment to professional standards is fundamental to being part of a profession.” NMC, (2015). The Code exists to hold NMC registered nurses, midwives, and nursing associates accountable for their actions, particularly when they fall short of their professional standards. The Code is written in law. Occurrences of poor staffing, unprofessional attitudes or limited resources are examples of circumstances where professional working could be compromised, these should be raised as a concern to the employer, the professional body, or a union. Failure to comply with the NMC Code can result in disciplinary actions by the regulatory body or prosecution. Examples of allegations against nurses include misconduct, bad character, and lack of competence. The NMC published guidance of the professional duty of candour in June 2015, which states “every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress.” NMC, (June 2015).

Unit 8

The Roles and Responsibilities of the Registered Nurse

Emma Bushnell

Clinical governance within the NHS monitors education and training, clinical auditing, clinical effectiveness, research and development and risk management to improve standards of clinical practice. Nurse leaders use clinical governance to ensure patients receive the best standard of care. For example, systems are put in place to reduce risks, audits take place to measure quality of service, training is given to ensure staff have relevant and up to date knowledge and can learn new skills, and to ensure staff are supported in their clinical environments. Communication Communication skills are reiterated throughout the NMC Code (2015) as it is one of the most important skills for a nurse to possess and practice. Registered nurses are required to communicate clearly, listen, and respond, while supporting individual needs and rights of the patient. This encompasses communicating in a way which can be understood, meets the language needs of the patient and their family and, importantly, being culturally sensitive at all times. Nurses are required to obtain and record consent which is both informed and understood and should explain to people about how that information will be used. Information sharing can only be tolerated within the law, set out in Section 5 of the NMC Code. Nurses are taught to demonstrate three key aspects of effective communication: professional communication, provision of information, and handover. Additionally to this, nurses need to consider both verbal and non-verbal communicative forms, including body language, tone of voice and facial expressions. These are important for both patient care, interaction with family members and, also, with other members of staff.

Multidisciplinary Teamwork Multidisciplinary teams are fantastic for patient outcomes for many reasons. For example, crossfertilisation of ideas, professional knowledge and expertise can be shared and facilitated. This collaboration of special skills, knowledge and expertise all contributes to meeting the holistic needs of the patient. Healthcare settings require many different care and medical disciplines to work together. It is imperative for communication skills, in particular, of all staff to be at their best, as without this, the team may not work well together and may not meet the need of the patient. The key to successful teamwork in a multidisciplinary team starts with an agreed approach in which everyone works within their own scope of practice. Each member must be committed to support the team and cooperate with mutual respect. There should be a focused goal and an agreed framework to review progress towards that goal. Finally, the team should have a coordinator responsible for overseeing the treatment plan for the patient. Holistic Models in Nursing Care The nurse’s role in the multidisciplinary team is more than just caring for the patient. Registered nurses use different tools to work in partnership with the patient, making the patient central to the care they receive. Charlotte Kratz MBE, editor of the first UK textbook on the nursing process, described the nursing process as a systematic approach. Today, nurses follow a path of interrelated stages to coordinate

Unit 8

The Roles and Responsibilities of the Registered Nurse

Emma Bushnell

multidisciplinary teamworking, including assessment (or data collection), nursing diagnosis using clinical judgement, planning with nursing interventions, implementation and validating the care plan and continual evaluation. The success of the nursing process depends on the quality of the relationship built between the nurse and the patient but is thought to achieve effective inventions and positive patient outcomes overall. Virginia Henderson, honorary fellow of the RCN, categorised nursing activities into 14 components based on human needs, this became known as Henderson’s Theory, or Needs Theory. These activities stem from Maslow’s Hierarchy of Needs and allow nurses to assess the patient with a holistic approach that covers their physiological, psychological, spiritual, and social health needs. Conclusion Towards the end of the 19th century and throughout the beginning of the 20th century, many medical advances were made. As medicine has progressed, so has the roles and responsibilities for those working in medicine and healthcare industries. Nurses strive to work in partnership with their team, across multiple disciplines, and with patients and their families. The NMC provides framework and guidance for nurses throughout their career and exists to enforce a standard of competency across the nursing industry. The year 2020 presented many challenges for the NHS and nurses, in particular. It will be interesting to see what happens next for the future of the NHS and the nursing profession with the introduction of 50000 new nurses and 40 new hospitals. Recommendations The main objective of this essay was to define the roles and responsibilities of registered nurses in multidisciplinary teams. One of the limitations faced during the research stage of planning this essay was the amount of information available. I found that the nursing industry has experienced many changes as more and more policies come into force from the Government. The government website has been particularly useful to create a timeline of events. In future study I would like to conduct interviews with Nurses to find out their personal experiences of the changes over the years.

References Department of Health and Social Care. (2020). New funding to double nursing apprentices and help deliver 50,000 more nurses. [Online] Available at https://www.gov.uk/government/news/newfunding-to-double-nursing-apprentices-and-help-deliver-50-000-more-nurses (Accessed 18/02/2021) Nursing and Midwifery Council. (2010). Standards for pre-registration nursing education. [PDF] Available at https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-preregistration-nursing-education.pdf (Accessed on 04/02/2021) Nursing and Midwifery Council. (2015). The Code. [PDF] Available at https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (Accessed on 14/02/2021) Nursing and Midwifery Council. (June 2015). Openness and honesty when things go wrong: the professional duty of candour. [PDF] Available at https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/openness-and-honestyprofessional-duty-of-candour.pdf (Accessed on 14/02/2021)

Unit 8

The Roles and Responsibilities of the Registered Nurse

Emma Bushnell

Nursing and Midwifery Council. (2019). Revalidation; How to revalidate with the NMC. [PDF] Available at https://www.nmc.org.uk/globalassets/sitedocuments/revalidation/how-to-revalidatebooklet.pdf (Accessed on 14/02/2021) Thewlis, S. UK Parliament. (2003). Memorandum by the Nursing and Midwifery Council. [Online] Available at https://publications.parliament.uk/pa/ld200304/ldselect/ldconst/68/68we53.htm (Accessed on 14/02/2021). Bibliography Grant, A. and Goodman, B. (2018). Communication and Interpersonal Skills in Nursing. 4th ed. [ebook] SAGE Publications. Available at: https://www.perlego.com/book/1431724/communicationand-interpersonal-skills-in-nursing-pdf (Accessed on 14/02/2021) Lister, S., Hofland, J. and Grafton, H. (eds.) (2020). The Royal Marsden Manual of Clinical Nursing Procedures. 10th ed. [ebook] Wiley. Available at: https://www.perlego.com/book/1504082/theroyal-marsden-manual-of-clinical-nursing-procedures-pdf (Accessed on 12/02/2021) McCormack, B. and McCance, T. (eds.) (2016). Person-Centred Practice in Nursing and Health Care: Theory and Practice. 2nd ed. [ebook] Wiley. Available at: https://www.perlego.com/book/992015/personcentred-practice-in-nursing-and-health-care-theoryand-practice-pdf (Accessed on 12/02/2021)...