This assignment aims to evaluate and understand the significance and implementation of the NMBA standards of practice in the everyday activities of a registered nurse. This assignment highlights the various guidelines that are covered by the NMBA standards, what are the benefits of implementing them, the consequences of not implementing them and research evidence of the same.
The Nursing and Midwifery Board of Australia (NMBA) has laid down certain guidelines and rules for registered nurses which help understand the standards of practice they are required to adhere to as well as the quality and safety parameters of their roles (Cashin et al., 2017). These seven guidelines are the standards of practice that nurses have to adhere to and implement in their daily job activities. According to these guidelines – registered nurses have to be analytical and critical concerning nursing practices, establish a therapeutic and professional relationship with their patients, maintain the capability to keep practising, conduct comprehensive assessments, develop plans for their practice, provide safe, appropriate and responsive qualities of practice and evaluate outcomes to inform their practice. These guidelines are connected to each other and must be followed by nurses.
Upon observing Katie’s case, it can be seen that her patients appear as if they have not been cared for. Katie does not change the wet bedsheets, empty the urine bottles and spends most of her time at the nurses’ station instead of tending to her patients, who are neglected. Given Katie’s actions, it can be stated that she is not adhering to the NMBA standards of practice. The quality of patient care provided by Katie to her patients does not meet the necessary requirements. As mentioned before, the NMBA standards state that as a registered nurse one must engage in a professional as well as a therapeutic relationship with one’s patients. This includes effective communication and respecting the dignity, values and right of the patients, provide support and resources that help optimize health-related decisions, supervise, coordinate and consult with other healthcare professionals so that the patient care quality is not compromised with as well as create a safe environment for the ones placed under their care. Katie’s conduct has been nowhere close to the standards of practice. Patients have the right to access quality health care, safety, respect and communication. Katie’s actions are a violation of their healthcare rights as, they are neglected, disrespected by being kept in an undignified and unhygienic manner, not being communicated with and receiving poor quality care. It can be stated that Katie has been unsuccessful in forming a therapeutic and person-centred relationship with her clients.
A therapeutic relationship between a nurse and patient is built on the foundation of mutual respect and trust. It requires the nurturing of belief, hope, being sensitive to the needs of others and assisting the patient with physical, emotional and spiritual needs through one’s knowledge and skills. Both the patient and the nurse have expectations from this relationship and for both parties to benefit from this relationship, they must be on the same page and work as one unit towards positive and healthy outcomes. Nurses have to align their approach with that of the patient’s expectations (Wiechula et al., 2016). Some of the ways to develop this relationship are – by developing effective verbal and nonverbal communication methods, providing privacy and a safe environment to the patient and maintaining boundaries especially concerning one’s preferences or cultural beliefs.
Effective communication as well as active listening are the keys to a stable therapeutic relationship. It is essential to build a rapport with one’s patients to make them feel more comfortable and earn their trust (Price, 2017). Another thing to be acknowledged is that the patient knows what they are experiencing better than anyone else so it is of extreme importance to listen to them patiently and take their feedback seriously as it may help assist them better. Being emphatic towards one’s patients (Moreno-Poyato & Rodriguez-Nogueira, 2020) and collaboratively working with them are all the factors which help facilitate a good working relationship. Failing to do so would make the patients feel neglected and uncared for. For starters, Katie should keep the beds and surroundings of her patients’ rooms clean. The neglect of hygienic practices is a violation of the patients’ rights and will have an adverse effect on the relationship with them. Instead of spending time at her workstation, Katie should use that time to develop a better understanding of her patients and their problems. This would help foster a sense of trust between her and the patients placed in her care, which will lead to a better understanding of their problems and the solutions to those problems. Additionally, she should maintain professionalism by acknowledging boundaries regarding the preferences and cultural beliefs of the patient (Abdolrahimi et al., 2017). For instance, if a patient does not wish to be touched then she should respect their wishes. Similarly, if a certain practise is not aligned with the patient’s cultural beliefs, it should be recognised and respected by the nurse. The benefits of fostering a therapeutic relationship are that it helps improve patient satisfaction, helps build a relationship based on trust, there is more compliance to the health practices from the patient’s end and creates an overall positive environment for the patient as well as the healthcare professional.
Katie was being an irresponsible professional. Hence, it was appropriate and responsible behaviour on the part of her colleagues to report her conduct to the manager. According to the NMBA Code of Conduct and Standard of Practice, registered practitioners should accept accountability for the actions and behaviours of themselves, as well as the actions of others working with them or under them. They are also responsible for providing, seeking and responding to review and feedback. Nurses and managers have to not only make sure that duties are delegated according to their scope of practice but they also need to provide timely direction and supervision to ensure that the delegated practice is safe and appropriate. Nursing practices have to be monitored and their success and failure have to be evaluated. Then based on these evaluations the plan is either continued or revised.
Katie’s incompetency was not only a reflection of her but also of the entire staff. Reporting her was a practical decision as it is the only way to rectify her behaviour and provide the necessary guidance and awareness required for her job role. The NMBA Code of Conduct states that nurses are committed to teaching, assessing as well as supervising other nursing staff and nursing students for the overall development of their workforce. It is the combined responsibility of all the nurses to create opportunities for the staff under supervision and students to learn and provide them with feedback in order to improve. While assuming the roles of teachers and supervisors, nurses must undergo training themselves to develop skills, attitudes and practices of an effective mentor (Ryan & McAllister, 2017) and avoid conflicts of interest which may hamper the objectivity or interfere with the learning outcomes of the person being supervised. They require to keep all their biases aside and focus solely on the welfare of the person they are mentoring and the patients they will eventually be providing care to. Nurses assuming the role of educators feel connected and valued while teaching the next generation (Ebert et al., 2020). The nurses who become teachers and supervisors have to assess their colleagues as well as students to make sure that they are adhering to the highest standard of practice. While assessing performance and level of competence, the nurses must maintain honesty, objectivity, provide constructive criticism and not provide feedback which is inaccurate or which would negatively impact the learner, thus harming his learning outcomes. They should provide information which is accurate and justifiable in a prompt manner. The information in the reports about their colleagues and students should be relevant and have adequate references.
Katie’s colleagues and supervisor should be accountable for her actions as they do not meet the standards of practice they are collectively hoping to achieve. As a result, the entire workforce is getting a bad reputation. The way to rectify this would be to put Katie under supervision and assign a mentor to shadow her. This mentor will be responsible to monitor Katie’s daily activities, make a schedule of her everyday routine, including her breaks, which she must stick to, evaluate her daily and have weekly discussions with her about her conduct, providing her with constructive feedback and imparting knowledge to her about things which she may not be aware of or has forgotten. Care should be taken that the person selected to be Katie’s mentor does not have any biases towards her, cares about her performance and has her best interests in mind. The person should be competent enough to monitor her, correct her as well as teach her whenever necessary.
To summarise this case study, we can say that Katie is currently showing incompetent behaviour towards the patients delegated to her. She is not performing her basic, everyday duties, such as changing her patients’ sheets and emptying their urine bottles. As a result, her patients seem neglected. Due to her misconduct, her colleagues have reported about her to their manager. According to the code of conduct for nurses, they have to assume teaching and supervising roles so that the high standards and quality of their care is maintained. In order to improve, Katie must be supervised and shadowed by an experienced nurse, who can help her improve her performance, provide valuable and relevant feedback, and develop a fulfilling and therapeutic connection with her patients that will help her do better at her job. Through the collective effort of her colleagues and mentor, Katie will likely show signs of improvement and end up becoming a competent nurse and a valuable member of the workforce.
Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic Physician, 9(8), 4968–4977. https://doi.org/10.19082/4968
Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., Kerdo, E., Kelly, J., Thoms, D., & Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255–266. https://doi.org/10.1016/j.colegn.2016.03.002
Ebert, L., Mollart, L., Nolan, S. J., & Jefford, E. (2020). Nurses and midwives teaching in the academic environment: An appreciative inquiry. Nurse Education Today, 84, 104263. https://doi.org/10.1016/j.nedt.2019.104263
Moreno‐Poyato, A. R., & Rodríguez‐Nogueira, Ó. (2020). The association between empathy and the nurse–patient therapeutic relationship in mental health units: a cross‐sectional study. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/jpm.12675
Nursing and Midwifery Board of Australia - Professional Codes & Guidelines. (2018). Nursing and Midwifery Board. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements.aspx
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Price, B. (2017). Developing patient rapport, trust and therapeutic relationships. Nursing Standard, 31(50), 52–63. https://doi.org/10.7748/ns.2017.e10909
Ryan, C., & McAllister, M. (2017). Enrolled Nurses’ experiences learning the nurse preceptor role: A qualitative evaluation. Collegian, 24(3), 267–273. https://doi.org/10.1016/j.colegn.2016.04.001
Wiechula, R., Conroy, T., Kitson, A. L., Marshall, R. J., Whitaker, N., & Rasmussen, P. (2016). Umbrella review of the evidence: what factors influence the caring relationship between a nurse and patient? Journal of Advanced Nursing, 72(4), 723–734. https://doi.org/10.1111/jan.12862
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