The Registered Nurse shall provide initial and ongoing assessments of the patient and the findings must be properly documented in the patient’s medical record for each shift (Dumpel & JNPC, 2004). He or she shall provide planning, supervision, implementation, and evaluation of the nursing care to each patient as well as responses to the treatment plan (Dumpel & JNPC, 2004). The Registered Nurse shall also provide the assessment, planning, implementation, evaluation of patient education, particularly discharge teaching of the patient (Dumpel & JNPC, 2004).
Furthermore, he or she shall assess the efficacy of the care plan by direct observation of the physical condition and behavior of his or her patient as well as the sign and symptoms of illness, reaction to treatment through collaboration with patient and the health team members, and change the plan of care as necessary (Dumpel & JNPC, 2004). The Registered Nurses shall follow the instruction of the physician about the prescribed treatment, prepare the patient during operations and post-operation care, and assist in patient rehabilitation.
He or she shall regularly communicate to the physician about the needs of the patient for timely discharge procedure (Claywell & Corbin, 2002). Principles of Registered Nursing Scope of Practice Decisions The main motivation for making decision concerning a care activity is to attain the patient’s health needs or to improve health outcomes (Nurses Board of Victoria [NBV], 2007).
The Registered Nurse is responsible for making professional judgments about an activity that is beyond his or her scope of practice and for making referral or consultation to other health care team members (NBV, 2007). He or she is also accountable for decisions made in selecting the most appropriate person to perform an activity from the nursing plan of care (NBV, 2007). Furthermore, decisions related to nursing practice are best made in a context of collaborative planning, risk management and evaluation (NBV, 2007).
Delegation, Supervision and Accountability of the Registered Nurse Some concepts relating to the role of the Registered Nurse as a collaborator of care include the accountability, delegation, advocacy, and respect for self and other health care team members (Claywell & Corbin, 2002). Delegation is defined as the process of designating duties or tasks to a qualified person (Claywell & Corbin, 2002). The Registered Nurse must learn to base his or her judgments on the most qualified individual for the job (Claywell & Corbin, 2002).
According to the Australian Nursing and Midwifery Council (ANMC), the Registered Nurse’s responsibilities for maintaining a high standard of care when delegating include the assessment of competency; teaching; provision of guidance, support, and clinically-focused supervision; outcome evaluation; reflection on practice; and giving assurance that the person who receives the delegation activity understands his or her accountability and is willing to accept the delegation.
The accountability of the Registered Nurse means that he or she must make sure that the nursing and medical plan of care is executed, evaluated, and altered in order to achieve the best outcomes of the patient’s health (Claywell & Corbin, 2002). The Registered Nurse is accountable for inappropriate delegation such as delegating an assignment beyond an individual’s qualifications or scope of practice (Claywell & Corbin, 2002).
Clinically-focused supervision involves the provision of education, support, and guidance for individuals who are doing the delegated activity; guiding the performance of the individual; and monitoring and evaluation of outcomes. Evaluation of the Effectiveness of the Nurses’ role Doran, Sidani, Keatings and Doidge (2002) developed the Nursing Role Effectiveness Model to examine factors influencing the performance of nurses’ role, which was anticipated to impact the attainment of patient outcome.
The authors mentioned that patients perceived the independent role performance of nurses as more effective on units where nurses have little autonomy but more time to provide care. A higher quality of nurse communication was achieved by units where nurses had higher level of autonomy and education, less hospital experience, and less role tension (Doran et al. , 2002). The coordination of care was seen more effective on units where nurses reported higher level of hospital experience and education, less autonomy and less role tension (Doran et al., 2002).
Moreover, the independent role performance of nurses was linked with improved functional status of the patient and lower mood disturbance at hospital discharge (Doran et al. , 2002). Employer Expectations of the Registered Nurse The employer expects that the Registered Nurse follows the four domains of the ANMC’s National Competency Standards: professional practice, critical thinking and analysis, provision and coordination of care, and collaborative and therapeutic practice.
The professional practices refer to the professional, ethical, and legal responsibilities of the Registered Nurse who requires showing a satisfactory knowledge base, accountability for practice, performing actions in compliance with legislation influencing nursing and health care and the protection of rights of an individual or group (ANMC). The critical thinking and analysis domain refers to professional development, self-appraisal, and the importance of evidence and research for nursing practice (ANMC).
The provision and coordination of care refers to the assessment, planning, implementation, and evaluation of care, while the collaborative and therapeutic practice refers to the professional relationships with individual or groups and competencies relating to the nurse’s contribution to the interdisciplinary health care team (ANMC). The Registered Nurse must also follow the Code of Professional Conduct. He or she must practice in a safe and competent behavior and in compliance with the agreed standards of the nursing profession and with laws related to the nursing scope of practice (ANMC).
He or she must demonstrate respect to the dignity, values, culture, and beliefs of an individual and support to the individual’s health, informed decision-making, and well-being (ANMC). The Registered Nurse must also willingly promote and maintain the trust that is already existing in the relationship between a nurse and an individual (ANMC). In conclusion, it is very important that the Registered Nurse Division 1 follows the competency standards, professional code of conduct, organizational policies and procedures, and legal requirements in order to deliver the best quality of care to patients.
The Registered Nurse must understand that he or she plays various roles in the achievement of positive health outcomes. He or she has must understand his or her major responsibilities in clinical practice and professional and educational responsibilities for the development of self and participating in various programs that will help advance his or her knowledge and skill in nursing. The Registered Nurse must also demonstrate his or her ability to accept and perform managerial responsibilities application to his or her level of nursing experience.
References
An Bord Altranais (2000). Review of scope of practice for nursing and midwifery: Final report. Retrieved June 21, 2009, from http://www. nursingboard. ie/GetAttachment. aspx? id=62e44d8e-bdb9. Australian Nursing and Midwifery Council. National competency standards for the registered nurse. Retrieved June 21, 2009, from http://www. nmb. nsw. gov. au/… /23/Competency_standards_RN. pdf. aspx.