The Role and Safety of Registered Nurse in Healthcare against Increasing Unlicensed Health Care Workers - Essay Example

Student’s name Institution Course Lecturer Task: How safe is the Roles of a Registered Nurse? Could the Registered Nurse be replaced by unlicensed health care worker? Date Introduction Nursing care is a crucial component of heath care delivery and determinant of the quality of care in health facilities given that they form largest proportion of healthcare profession and hence affect patient outcomes. Nursing includes health promotive and preventive services, caring for ill and disabled, providing palliative services, health education and research as well as managerial and adminstrative roles(ICN). This requires adequate knowledge, skills and experience to meet due to increasing demands and complexity of care. Nurses fall in various categories that include Registered Nurses(RN), Enrolled Nurses(EN) and unlicensed health workers who have a plethora of titles such as Patient Care Assistant (PCA), nurse aides or auxiliary nurses among others, (ANF, 2012). Whereas RNs and ENs have undergone extensive formal training, unlicensed health care workers such as nurse aids rely mainly on appreticeship and some basic formal education as their mode of training. There is a shortage of nursing workforce globally with Australia having a deficit of about 27% (Health Work Force, Australia, 2012) against an ever rising demand for health services. This has seen an increasing number of unlicensed health workers in provision of care. This has raised various issues not only regarding patient safety but also threatens the roles of registered nurses. This purpose of this paper is to explore the role and safety of RN in the healthcare against increasing unlicensed health care workers. It begins with this introduction and purpose and aims of the essay, then explores the role of a of unlicensed health workers and that of RNs, issues arising out of these two categories of nursing staff and whether a RN can be replaced by unlicensed health worker in the current health care set up and critically give an overview of the safety of the role of nurses. A conclusion regarding this topic is given at the end. Roles of Unlicensed health workers Unlicensed health workers exist under different titles and work across a spectrum within the health care settings in Australia such as hospital units, primary care centres, home care in residential aged and disability care, public health, schools among others (ANF, 2009). Unlicensed health workers are not licensed to perform nursing tasks may have basic training and may be certified. Given that to gain employment it is not mandatory for these workers to hold a qualification, the ANF has always stood for the fact that the educational preparation these unlicensed workers in nursing should be based on competency and prior experience and be conducted in an organized manner. This helps alleviate potential dangers health care delivery due to the vulnerability patients and other clients cared such as elderly, seriously ill and children. (ANF, 2007a). There has been an increase in use of unlicensed workers and reduced dependence on Registered Nurses (RNs). For instance between 2003 and 2007 the PC employment rose by about 17,500 to nearly 85,000 and that of both others such as Enrolled Nurses and allied Health workers rose to slightly over 26,000 (Martin & King, 2008). Hence there is need to set standards of education and scope of practice for them to ensure they have the necessary knowledge, skills and experience to ensure safe and competent care has also been of great concern, (ANF 2009). The roles and duties performed by these can be unlicensed workers can be done individually or upon delegation by RNs. RNs may assign tasks if the patients are stable such as those with chronic problems but in stable conditions and in situations that do not present potential risk of complications to the patients. Most of these tasks should be routine patient care, requiring no professional judgment and skills to undertake and are performed with a predictable outcome. The unlicensed workers can also perform or be delegated tasks such as those involving basic health and hygiene. These include bathing, feeding, patient ambulation, recording of vital signs and measures (e.g. weight), toilet needs and environmental safety issues. Others include clean catheterization, simple wound dressing and clean suction of chronic tracheotomies among others. They are limited in scope of duties and tasks like handling fragile patients such as those with acute illness and those in unstable states require ongoing assessment by an RN and cannot be delegated to unlicensed workers in this state. Situations that require a substantial scientific knowledge and technical skill such as peri-procedure evaluation, invasive catheterization, sterile procedures, parenteral therapy and nursing process that involves assessment, monitoring and evaluating, triage and education also require licensed nurses to perform them. Another limitation of unlicensed health workers is that they cannot reassign assigned tasks (Jones, J. & Cheek, J, 2001). Roles of RNs ANMB clearly stipulates the scope of practice by specifying roles, functions, responsibilities, activities and decision-making capacity that licensed nurses are competent and authorized to perform. Both registered and enrolled nurses are required to protect the health and safety of the public according to the legislation and regulation of the National Competency Standards. The domains of professional practice require RNs this to work in accordance with the legislative framework of professional and ethical nursing that entails critical thinking and analysis during patient care. Nurses should conduct comprehensive and systematic nursing assessment, collaborate with interdisciplinary team and maintain a therapeutic relationship with the patients. The following aspects of the nursing process are performed by the RNs. It begins with a comprehensive assessment that includes data collection, analysis and interpretation of data. Nursing judgment made is based on the assessment process. The RN uses clinical reasoning and knowledge, evidence-based outcomes, and research as the basis for making interventions. Planning after assessment is done and includes, making a nursing diagnosis, setting goals and implementation of nursing plans as well as assessing the outcomes. These services provided by the RN require high level of judgment and skill basing them on the principles of biological, physical and social science. Such include administration of medication, parenteral feeding, invasive procedures such as inserting catheters, sterile procedures, perioperative assessment and care and patient education (Chaboyer E et al, 2008). RNs have a role in error detection in patient care and hence maintaining patient safety. These errors could be made by other nurses and other healthcare staff (Rodgers et al, 2008). This can be in general wards, theatres and critical care units and require keenness, knowledge and experience. The RN is also responsible for reasonable and prudent decisions regarding assignments and delegation of duties and supervision during patient care with patient safety in mind and hence has to make judgments considering the competence and abilities of those to whom the assignments or delegation is made (Jones, J. & Cheek, J, 2001). Compared to unlicensed workers, the RN can practice independently and takes the responsibility is accountable in the entire process of patient care and is takes liability for legal consequences that arise. This accountability extends to those tasks assigned to other staff under them. This also ensures patient safety is observed during care. RNs also provide palliative care to patients, these entails meeting their physical, psychosocial, and spiritual needs and providing education about issues at the end of life in line with ethical implications that may arise at this time (Heidrich, 2007). There are complex needs in the health care due to patients with multiple needs such as increasing age, patients with comorbidities and others changes such as new therapeutic interventions, technological demands and increasing litigations among others. These serve as are compelling factors for nurses to update their knowledge and competence levels to meet expectations and is therefore an important role and attribute of RNs, (Levett-Jones & Bourgeois, 2007). Issues arising from unlicensed health workers in nursing care The necessary competencies and requirements to join RN practice in Australia have been formulated by setting goals for the Australian health workforce, (WOW 2011, NSW NA 2011). These include professional practice in accordance with ethical and legislative frameworks, use of critical thinking and analysis, provision and coordination of care and maintaining therapeutic relationship and interdisciplinary collaboration. From the above review into roles of both RN and unlicensed workers and with this competencies in mind several issues arise between them. Competition By allowing unlicensed health care workers to do nursing work seems to threaten the RN roles. This includes reduction in employment of RNs and also a reduction of remuneration. With increasing use of unlicensed workers to provide care , the total employment of RNs dropped about 1,600 to 22,400 against a tremendous increase in the unlicensed workers use between 2003 and 2007 (Martin & King, 2008). Patients’ Safety issues Given no specific levels of educational preparation required to do the work, they pose a risk to the community. Despite cost reduction associated with their employment, this has to be balanced against the risks, especially when dealing with elderly, ill and frail, and those with multiple comorbidities. RNs ability to practice competently is affected by this environment that consists of regulated and unregulated workers, (NSW NA) Legal issues There is a standard of care that patients are entitled to during care irrespective of who offers this. The existence of this duty of care demands that necessary knowledge, skills and experience influenced by the level of education, training and experience is available in order to fulfill roles as per ethical and legal requirements (Cox, 2006). Registered nurses usually retain overall responsibility during of nursing care in the wards and especially delegated duties. Legal issues and accountability problems arise due to lack of clear scope of practice for the unlicensed workers and may leave all liabilities to RNs (ANF 2009, NSW NA). Regulation There is no clear identity of these workers, no clear framework regarding where they should work and the scope services they should offer given their increasing number in the health sector workforce. Regulatory issues arise regarding the standards and level of education and training, competency and accountability as well as employment arrangements. Absence of mandatory qualification in order to gain employment increases the vulnerability to patients and RNs regarding safety and legal issues respectively. The establishment of a comprehensive regulatory framework to manage this issue is necessary to ensure the required knowledge, skills experience and character to provide safe and competent care is available (ANF 2009). From the roles and issues that have been discussed above, it is clearly that the unlicensed health workers lack the knowledge, skills and experience to practice in all the areas of nursing care independently. They can at best co-exist with RNs under who they mostly work. This clearly shows that RNs still have a key role in nursing care despite the threats posed by proliferation of unlicensed workers in the field. Conclusion In the presence of complex needs of nursing care amidst the underlying demand of nurses, the responsibility of the RN in providing safe, compassionate, and comprehensive care to patients and families cannot be replaced given the areas that demand knowledge and skills; despite the increase use of unlicensed health workers who cannot replace RNs in some of these critical areas. Unlicensed health workforce is present in various healthcare environments and they support and supplement areas of deficits in nursing care. This is not without concomitant consequences such as safety, legal and regulatory issues just to mention a few. Therefore, not appreciating the part played by unlicensed workers is an understatement. However, with the available substantial evidence that demonstrates a direct correlation between the quality and quantity of care the patients and nursing staff, that shows that in presence of qualified nursing staff the better the health outcomes for patients. Ensuring better work environment in nursing care where staffing mix of both regulated and unregulated workers exist , as well as improve patient care and safety should be on the priority. Policies and regulatory frameworks to guide the roles and scope of practice for the unregulated workers should also be considered to help achieve the overall nursing care goals. References Amanda Adrian. 2009. Balancing risk and safety for our community: unlicensed health workers in the health and aged care systems. Australian Nursing Federation: Canberra Australian Institute of Health and Welfare (AIHW). 2005. Nursing and midwifery labor force 2003. National Health Labor Force Series, Report No. 31. Australian Nursing Federation (ANF). 2007a. Assistants in nursing or midwifery and other unlicensed workers (however titled) providing aspects of nursing or midwifery care. ANF position statement. Retrieved 9th October 2013. Australian Nursing Federation, ANF. 2007b. 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