NUR 1004 : Being a Professional Nursing : Nursing and Midwifery Board

Being a professional nursing

Introduction:

Being a nursing professional means having the skills and abilities to carry out nurses roles relevant to the profession. Every qualified nursing practitioner is supposed to be licensed which means that they hold the power to exercise their nursing skills and make decisions based on their judgment and understanding of the nursing situation (Wilkinson, Rance, & Fitzsimmons, 2017). Student nurses require the medical form filling clinical skill and the communication non-clinical skill to work well in their setting. Therefore, practitioners need to be guided by a code of practice that defines their profession and the standards established by the Nursing and Midwifery Board of Australia. This essay reflects on the importance of medical form filling skill and communication skills during transition to practice.

Critical analysis

One clinical skill that I require as a beginner nurse is administration of patient’s medical forms within the clinical setting. As a practitioner nurse, administration of all forms of medication is one of the vital skills that I need to manage. This skill is based on capturing patient data by administering different forms to patients. The forms can include capturing of basic information like demography, medical history and the signs or symptoms that the patient feels (Burns & Poster, 2008). The information filled in the forms is part of the overall decision making that will be made on the patient. For example, patient allergies have to be captured well to avoid drugs that the patient can react with. According to Boxer & Kluge (2000) one positive aspect that this skills gives me is the ability to be keen on detail which improves the ability to capture all patient details critical for decision making. Administration of medical forms requires every patient detail to be captured including signs and symptoms. The practitioner is supposed to verify patient information for accuracy before feeling in the form. However, one weakness of this skill is there may be challenges in administering the form if the practitioner is not skilled well. Therefore, the practitioner needs to study the forms well to be able to meet the required clinical standards.

New nursing practitioners also require the non-clinical skill of communication within medical settings. This entails passing, receiving and sharing information within the workplace where documentation means gathering information and recording it according to the required. This makes it easy for other practitioners to interpret what the nurse has written (Campbell, Shepherd, McGrail, Kassell, Connolly, Williams & Nestel, 2015). Communication allows the practitioner to interact with patients and at the same time share information with other practitioners about the patient. The practitioners also use communication skills to share information with other practitioners. In a clinical environment, practitioners have to pass information to patients and their families and at the same time share information with fellow practitioners. With the use of proper communication skills, practitioners are able to pass information from one level to another. One strength that this skill offers is that it leads to provision of reliable information within clinical settings.  Clinical outcomes are dependent on communication skills that increase clinical outcomes. However, one weakness that this skill offers is that if the message is not framed well, it can be wrongly interpreted thus leading to poor outcomes or distortion. This can compromise the clinical outcome thus affecting the expected results. Further, Higgins, Spencer & Kane (2010) suggest that the non-nursing skills of confidence is important in ensuring that the practitioner believes in knowledge acquired and the individual ability to make decisions.

Discussion of theories

Several theories have been presented to explain the process of being a nursing practitioner. The Dreyfus’ model of skill acquisition is based on acquiring skills through formal instruction and practicing. The model exists on four binary qualities of recollection, recognition, decision, and awareness. The qualities lead to five nursing roles of novice, beginner, competent, proficient and expert.  In each of the stage, the student acquires skills that make them more competent and with time they depend less on the abstract principles but rely more on concrete experience based on the nature of the task (RaleigH, DClinPrac, & Allan, 2018). The novice individual relies more on nursing knowledge without connecting to practice thus the work they do is unlikely to be satisfactory (Freunda, Everettb, Griffith, Hudond, Naccarellae & Laurant , 2015). The competent level individual has good working and background knowledge of the practice that they work in and they are fit for the purpose that they do thus see their actions in terms of the long term goals of the organization. The proficient level expert has in an in-depth understanding of the discipline and the area of practice thus sees the overall picture of how they fit their actions with the rest of the organization (Burns & Poster, 2008). Lastly, the expert level is based on being authoritative with knowledge of the discipline and tacit understanding of the practice which enables the practitioner to see the overall picture and alternative approaches to be taken.

Benner model presents five stages of clinical competence that an individual passes through. The stages are designed from the Dreyfus model that focusses on the acquisition and development of skills through the stages of the novice, advanced beginner, competent, proficient and expert (Alligood, 2014). The levels reflect three aspects of skilled performance of reliance on abstract principles, change in the learner's perception of the nursing situation and change from the detached observer to an involved practitioner engaged in nursing situations.

These stages are the novice, advanced beginner, competent, proficient and expert. The novice lacks the experience of nursing situations that they need to perform thus they need to be taught rules to perform. The rules that such practitioners apply are universal rather than context based. The advanced beginner can demonstrate marginally acceptable performance through coping with real-life situations that teach them how to apply principles of nursing. This means that the practitioner at this level begins learning how to apply nursing principles (McEwen & Wills, 2014). The competent stage is where the nurse has been on the job for over two years and can view their actions in terms of long-range goals. At this level, the practitioner develops plans based conscious, analytical and abstract. The competency at this stage is important in achieving competence efficiency and organization. The proficient stage is the performer stage where the practitioner learns from typical events that they engage in thus making them recognize the expected normal picture (McCarthy, Buckley, Engel, Forth, Adams & Cameron, 2013).

The practitioner at this level uses maxims as guides that reflect an understanding of the situation. Lastly, the expert level practitioner has an intuitive grasp of situations and zeroes in on the actual problem that the patient faces. This means that the practitioner relies more on experience rather than the use of principles.

Reflection

Rolfe’s model of reflection offers three steps for reflection through looking at what happened, what the situation means and what can be done as an action plan. According to the first stage, as I transition to a full-time nursing practitioner I believe I have gained enough knowledge for filling of medical forms with different patient’s within clinical settings. This strength is linked to the fourth standard of the Nursing and Midwifery Board of Australia standard of comprehensively conducting assessments on patient’s problems (Nursing and Midwifery Board Australia, 2018). This entails analyzing information and data from patients through the use of different assessment tools to collect relevant information and data about the patient. Further, my communication skills strength is linked to the second standard of engaging in therapeutic and professional relationships (Cashin, et al., 2015). Through communication skills, I am able to relate well with patients thus increasing clinical outcomes.

As I become a field practitioner the second stage of the model deals with so what which leads to what the experience means. From the nursing and non-nursing skill, I am able to work well within medical settings since I have the ability to relate well with the patients which create therapeutic relationships for collecting and analyzing medical information. Brown & Crookes (2016), suggests that practitioners keep on learning with the experience that they gather in the field as they move from one stage to another. This means that I have to improve my skills to become a more informed and experienced practitioner.

The last stage entails the steps that I will take to improve communication skills. Therefore, as I transition into a nursing practitioner, I have to undergo more training especially in the filling of medical forms and interpreting electronic data forms. This skill will improve my assessment ability which allows me to improve my data interpretation skills through increased ability to analyze different data forms like graphs and tables for patient data.  Therefore, as I transition from a student practitioner to a field practitioner, I have to strengthen my clinical skill of filling medical forms and non-nursing skill of communication to become a better practitioner who meets the two standards of the Nursing and Midwifery Board of Australia.

Conclusion:

The nursing practitioner must pass through different nursing stages before they can become experts in their field. As they pass through each stage, they acquire new skills and develop competencies that make them more informed and able to work in clinical situations. The practitioner moves from novice, beginner, competent, proficient and to an expert level which makes one informed and ready to work in any clinical environment. therefore practitioners need to make the effort of meeting the requirement of every stage while at the same time develop key skills that are important in meeting the nursing standards set by the Nursing and Midwifery Board of Australia.

References:

Alligood, M. R. (2014). Nursing theory: utilization & application. St. Louis, Missouri: : Elsevier. DOI: 10.1177/089431841141922.

Brown, R. A., & Crookes, P. A. (2016). What are the ‘necessary’ skills for a newly graduating RN? Results of an Australian survey. BMC Nursing, 15(23). https://doi.org/10.1186/s12912-016-0144-8

Burns, P., & Poster, E. (2008). Competency development in new registered nurse graduates: Closing the gap between education and practice. Journal of Continued Education Nursing, 39(2), 67-73.

Campbell, D., Shepherd, I., McGrail, M., Kassell, L., Connolly, M., Williams, B., & Nestel, D. (2015). Procedural skills practice and training needs of doctors, nurses, midwives and paramedics in rural Victoria. Advanced Medical Education Practice, 6, 183-194. DOI https://doi.org/10.2147/AMEP.S77779 

Cashin, A., Heartfiled, M., Bryce, J., Devey, L., Buckley, T., Kerdo, E., . . . Fisher, M. (2015). Standards for Practice for registered nurses in Australia. Journal of Advanced Nursing, 70(12), 256-266.

Freunda, T., Everettb, C., Griffith, P., Hudond, C., Naccarellae, L., & Laurant, M. (2015). Skill mix, roles and remuneration in the primary care workforce: Who are the healthcare professionals in the primary care teams across the world? International Journal of Nursing Studies, 52(3), 727-743. doi: 10.1016/j.ijnurstu.2014.11.014.

McCarthy, D., Buckley, B., Engel, K., Forth, V., Adams, J., & Cameron, K. (2013). Understanding patient-provider conversations: what are we talking about? 20(5), 441–448. Academy of Emergency Medicine,, 20(5), 441-448. DOI: 10.1111/acem.12138

McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing. Philadelphia: Lippincott Williams & Wilkins. https://zu.edu.jo/UploadFile/Library/E_Books/Files/LibraryFile_171030_28.pdf

Nursing and Midwifery Board Australia. (2018). Professional standards. Retrieved from Nursing and Midwifery Board Australia.

RaleigH, M., DClinPrac, R., & Allan, H. (2018). A qualitative study of advanced nurse practitioners’ use of physical assessment skills in the community: shifting skills across professional boundaries. Journal of Kidney Care, 4(5), 301-306. https://doi.org/10.1111/jocn.13613

Rolfe, G., Jasper, M., & Freshwater, D. (2011). Critical Reflection: In Practice: Generating Knowledge for Care. London, Palgrave Macmillan

Wilkinson, W. M., Rance, J., & Fitzsimmons, D. (2017). Understanding the importance of therapeutic relationships in the development of self-management behaviours during cancer rehabilitation: a qualitative research protocol. BMJ Open, 7(1). doi:10.1136/bmjopen-2016-