Competency in Nursing - Essay Example

Running Head: Competency in Nursing Competency in Nursing of As more and more develops take place in the nursing profession, the need to identify competency and its role in maintaining optimal health care practices is increasingly demanded and appreciated. Not only is the government and the hospital management responsible for maintaining competency, but also the nursing staff at the team level as well as the professional level are responsible to maintain the standards. The outlines of competencies have been extensively reviewed and formulated, with the result that the new policies are better structured on the health care system. The role of the nurse has now become a fundamental part in providing health care to the patients around the world. And while the nurses have come a long way in establishing themselves and their worth, there are still many issues that are still needed to be addressed. One of the issues that have become the centre theme in nursing care selection criteria is the "competency" of a nurse. Many areas come under the umbrella of the word competency, and this issue comprises of ethical and moral, professional and legal issues. It is hoped that by increasing the competency level of a nurse, more improved health care outcomes can be gained. Competency in nursing is essentially the attainment of a state where one's clinical knowledge and skills are recognised and developed so as to provide the maximum care to the patients. Not only does it requires the essential motivation on the nurse's part, but also requires a professional as well as an academic endeavor in the nurse. This is aimed so that the nurse not only is able to provide adequate nursing care to her patients or clients, but continues to do so by improving her skills via various post graduation studies and professional development programs. (Competency Based Practice, 2006) The point to consider is that the competency of a nurse is judged not on the basis of his or her theoretical performance, but on the practical clinical one while caring for his or her patients. This would require that the nurse be able to handle a variety of clinical situations with ease, and be able make correct decisions in order to provide the most proper treatment for the patient. Competency naturally therefore has a very far reaching influence in the nursing as well as the health care systems. (Competency Based Practice, 2006) To promote the concept in the United Kingdom, many guides have been introduced so that the nurses are better able to identify competency levels in themselves. Although with increased research in the area many forms of guides have been made available, the basic rules remain the same. Hicks (2002) aptly describes them as follows. "being patient centered, doing evidence based practice, providing equality, diversity and rights, able to handle specific interventions and practice expertise, improving patient care and effectiveness, developing individual and team effectiveness as well as a promoting a culture of effectiveness along with self and others, facilitating individual, group and team learning, clinical leadership and management in practice, managing settings and the service, research and evaluation in practice, and providing expert and process consultancy." (Hicks, 2002) Competency and Professional Nurse Any profession related to health care requires utmost dedication and a professional attitude at all times. In the same way, when a nurse enters into the clinical practice scenario, he or she automatically makes a commitment to the society as well as themselves to hold up to the professional requirements of the nursing care. In doing so, he or she also make the commitment to maintain their professionalism through constant learning and reevaluations. This dedication is mostly a personal conviction, but it is also required that the employer of the nurse make sure that his or her nursing staff is up to the standard. (British Dermatological Nursing Group, 2002) The nurse therefore becomes responsible for all the duties or activities he or she carries out, and in turn accepts accountability for all the events that take place regarding the patient's health while under his or her shift or care. There are many suggestions made in the guidelines to provide nurses an idea of proper professional attitude. It is important that the nurse be present for the patient's help or assistance when the patient is in need. This presence can vary according to the severity of the patient's condition, for example, the nurse will be required to be more observant and vigilant in critical care cases. In cases where the patient can not make decisions for him or her self, it becomes the nurse's responsibility to ensure the heath of the patient. Since the nurse is responsible for all his or her actions during the shift or patient care, it becomes extremely important that he or she maintains a proper log and account of all the procedures, medications, and changes in the regimes that he or she carries out. In time this attitude may become immensely valuable should an investigation ensue or in litigation cases where the nurse may need to defend his or her credibility. The nurse is to provide a calm and responsible, friendly and empathetic personality to the patient and the patient's family and should be able to handle all kinds of situations that can take place in the health care scenario. He or she must be able to identify and handle the various physical, mental and psychological states of the patient, and be able to provide the necessary support as the need be. Patients as well as the health care staff will appreciate the nurse more if the above mentioned suggestions are carried out since these actions clearly demonstrate the professional attitude of the nurse. A nurse during the day faces a variety of situations from moment to moment, and he or she must be able to handle these situations calmly, quickly and effectively. Now with the addition of providing emergency medical health to the patients if need be, these attributes become all the more important. The nurses are expected to "undertake comprehensive and accurate nursing assessments", maintain correct documentation with confidentiality, and provide accurate information to the patient about his or her condition along with the pros and cons of various therapeutic procedures. He or she must be ready to counter any "unexpected client responses, confrontation, personal threat or other crisis situations." (Competencies for the Registered Nurse Scope of Practice, 2005) Probably the professional attitude of the nurse undergoes extreme testing when he or she is addressing a patient who refuses treatment. The issue of informed consent binds the nurse into not enforcing a treatment option on the patient. (Aveyard, 2004) The challenge becomes extremely trying as well as delicate when a patient refuses a life saving the procedure. A professional nurse responds in these situations in a calm and assertive manner, by communicating with the patient the necessity of the treatment and the advantages and disadvantages it may provide. (Aveyard, 2004) He or she has the moral and professional obligation to establish communication with the patient, identify his psychology and address accordingly, and provide a basis for trust to the patient. Despite the efforts, if the patient still refuses treatment, then the nurse is entitled to provide a life saving treatment to the patient. Although there is a very fine line identifying in which conditions the nurse can give treatment without the patient's consent, it becomes a very serious litigation if the nurse does not give the necessary care when he or she was in the position to do so. (Aveyard, 2004) The introduction of the guidelines has made it very easy for the nurses to understand their role and therefore their responsibilities in the health care set up. And with time more and more new concepts are taking shapes which aim to improve the proven concepts and replacing the ones that need changing. One of the most popular concepts in this regard is the introduction of continued professional development or CPD in the nursing profession. CPD has been introduced with the aim that the nurses should continue their professional development through a variety of learning methods. In this way, not only the nurse is able to remember and fine tune his or her already present nursing skills, but is also able to adjust and learn new methods and new developments that are taking place in the health care setup. (British Dermatological Nursing Group, 2002) CPD can be attained through a variety of methods, which include peer supports, audits to assess the nurse's perceptions of prescription patterns, reviews, supervisions and reviews on recent advancements in the health care systems. (British Dermatological Nursing Group, 2002) The idea remains the same, to increase the professional competency of the nurse, and to improve the overall standard of health care in the nursing profession. When these programs are individual based, they provide the added component of addressing personal issues instead of generalized training sessions. By establishing a professional attitude, the nurse is not only able to establish his or her credibility and competency, but is also able to protect his or herself should the need arise. With the professional attitude the nurse is better able to make and carry out correct decisions, is able to account for his or her actions and in doing so is able to prove he or she is competent professional. Ethical Framework of Competency Ethics play a pivotal role in the health care profession. In the nursing care more than others, it is required that the nurse display ethical awareness and human affection for his or her work. In order to be competent, the nurse needs to have an internal desire and motivation, a personal awareness, reflection and self assessment qualities. Yeo and Moorhouse in 1996 identified the six ethical principals that encompass the competency of nurse health care settings. They are by far one of the most comprehensive principles that identify the ethical role of a nurse in clinical competency. ( Yeo & Moorhouse, 1996) The nurse is to display beneficence to his or her patients, especially in cases where the patients refuse treatments as mentioned above. He or she is also expected to display autonomy, demonstrating "free action, effective deliberation, moral reflection, authenticity, consent, competency, and limiting autonomy" ( Yeo & Moorhouse, 1996) Truthfulness, integrity, confidentiality and justice are the remaining ethical attributes of ethical competency. All of these attributes are especially required when addressing the patients about their conditions and treatments, and when addressing the families regarding the patient's health. The nurse is the primary source of comfort to the patients as well as their family members, and the amount of time a nurse spends with the patient is more than any other professional. The nurse in this way becomes a familiar face, a friend, a confidante, a carer, a provider and if the situation arises a life saver to the patient. Naturally, the relationship can only be based on trust and honesty and therefore it becomes the nurses' job to provide that to the patient. The nurse plays an extremely important role when advocating for the patients, and such actions require careful ethical considerations. It becomes the nurse's responsibility to identify the rights of the patients and make sure that they are properly provided and protected. The nurse addresses the issue when the patient refuses the treatment, and while it is the nurse's professional responsibility to provide the optimal level of care, he or she must identify the rights of the patients and comply with the patients' wishes. In this regard, it becomes the nurse's responsibility to be proficient in the ethical frameworks and the rights of the patients. One of the recent issues in ethical competency has been to identify and provide individualized care for patients who belong to different cultural backgrounds. The concept of "cultural competency" stems from the fact that different cultural groups have diverse traditions and beliefs and the treatments that they choose may be very deeply influenced with these beliefs. Such cases need to be addressed on one to one basis with the complete understanding of the historical background. To do otherwise is considered unethical and therefore the concept of cultural competency was introduced in the nursing care. (Burchum, 2002) Part of this problem has been solved due to the increased immigration of nurses from around the world, where they become extremely valuable in offering insights and suggestions in culturally sensitive cases. But much needs to be done. A nurse although may be able to understand the background of the patient, but he or she must also understand the ethical fabric of health care provision. It is in this regard that anthropology has been introduced in the nursing curriculum, so that the nurses are better able to tackle the ethical issues of difficult cases like these. (Burchum, 2002) Legal Perspective of Nursing Competency Negligence is claimed in the cases and conditions like duty for care, negligent action or omission, causation, forseeability, proximity and note damages. (Duty of Care and Negligence) Usually the level of competence and the case of negligence in any profession is determined by the laws that are set up for that particular profession. (Gaffeney, 2001) The laws are responsible to provide legal and legislative authority; and the regulations provide details to help in implementing laws. The laws work under three main domains, the statutory laws made by the congress or legislatures, the common laws evolving from judicial decisions and the administrative laws, which basically include various regulatory agencies. (Gaffeney, 2001) Based on the evidence and the type of negligence case, the nurse can be tried under any of these law systems, and for this purpose local nursing regulatory agencies are established to carry out their responsibilities. (Gaffeney, 2001) These involve handling regulations, carrying out proper investigations, and educating nurses about the legal frameworks and how to avoid and handle situations that can lead to litigations. It is in this regard that the Bolam test must be explained. The Bolam test is a sub set of rules which addresses claims regarding negligence of care in the medical profession. The set of rules stems from the 1957 case of Bolam vs. Friern Hospital Management Committee, and aims to determine liability of the different cases of negligence. The professional is required to match his or her professional skill to his or her peers. (Medical Negligence Claims) The treatment decision is weighed on account of the views of eminent doctors or nursing staff on what course of action they would have taken if presented with the same situation as the defendant. If the council finds appropriate testimonies that the treatment offered to the patient was correct, then the defendant is declared not guilty. The legal component of nursing competency is one of the most important one in identifying the credibility of the nurse. One small mistake in this area can seriously jeopardize the career of the nurse and can lead to litigation. The nurse therefore must be well versed in the legal aspects of nursing competency and care, and should ensure at all times that any action he or she undertakes does not destroy her credibility. A nurse should therefore always document the treatments he or she carries out and should have authentic reasons in any change in treatment regimes. He or she must always carry out procedures with the best of knowledge and the most accepted regimes. He or she must provide accurate medications, dosing and injections, and must maintain vigilance on the patient's conditions. He or she must inform his or her peers in any changes in the treatment schedules, regimes or therapies. He or she must ensure that the correct orders are followed and must double check, inquire and discuss to the relevant persons before instituting any changes. The nurse must be able to account for her timings, her routine, and her patient's health and conditions. The standards of practice address the various issues pertaining to the ethical, professional and legal areas of patient health care and can be a very helpful guide to provide optimal care. (Competencies and Standards, 2001) By taking such precautions, a nurse is able to protect him or her self as well as the staff, and is able to defend his or her actions should the need arise. To conclude, competency in nursing is the main factor in identifying the credibility of a nurse. And with time, its importance has proven to be very helpful in dealing with the various issues of patient care. By increasing and promoting the competency of a nurse, the overall effects on the health care system are promising. Many efforts are underway to define competence in the field of nursing in all its areas, including education and training, recruitment and selection, clinical and theoretical practice, every day issues, and ethical, moral, and legal issues. It is the responsibility of the nursing profession to understand the importance of self evaluation and competency in their profession and to put effort in improving the overall performance on the personal as well as on the practice level. References H. Aveyard, 2004. The Patient Who Refuses Nursing Care. Journal of Medical Ethics,2004;30346-350. British Dermatological Nursing Group, 2002 Continuing Professional Development. Site last accessed on November 17th, 2006 http://www.bdng.org.uk/prescribing/cpd/ Rosenjack Burchum, J. L. (2002). Cultural competence: An evolutionary perspective. Nursing Forum, 37(4), 5-15. Competency Based Practice, 2006. Site last accessed on November 19th, 2006. www.nursignaffairs.com Competencies for the Registered Nurse Scope of Practice, 2005. Competency Standards, 2001. College of Registered Psychiatric Nurses of B.C. Site last accessed on November 20th 2006. www.CRPBNC.com Micheal Yeo & Anne Moorhouse, 1996. Concepts and Cases in Nursing Ethics, 2nd Edition. Terri Gaffeney, 2001. Regulation of Nursing Practice. American Nurses Association. Site last accessed on November 19th, 2006 http://www.nursingworld.org/mods/archive/mod310/cerm102.htm Debbie Hicks,2002. An Integrated Career and Competency Framework for Diabetes Nursing. Site last accessed on November 20th, 2006http://www.diabetesnurse.org.uk/Downloads/Competency-Framework.pdf. Medical Negligence Claims- The Law. Site last accessed on November 19th, 2006. http://www.bookshed.net/law.html Read More