Internal and External Evaluation of the NHS and Nursing Job Role

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Sectors

Statutory sector

The statutory sector provides most formal care services, which are delivered by organisation including the National Health Service (NHS) and social care and early years’ services mainly through local authorities. Furthermore, they are funded governmentally through differing funds to ensure they allocate services. The best-known face of healthcare provision in England is the NHS. Which is funded by the government, this massive organisation has been through a seemingly endless series of reorganisations over recent years. It is grouped into the following areas:

  • Primary care: This is the care given to people when they first become aware of a health problem. Furthermore, primary care providers offer health education on subjects such as smoking, run clinics, give vaccinations, and carry out small surgical operations. Some mental health care provision is also carried out by primary care providers.
  • Secondary care and emergency care: This is the care that is provided to people in an emergency or following a referral from a primary care organisation. Therefore, conditions treated at this stage tend to be acute or specialist in nature. Primary care trusts plan for secondary and commission the providers of secondary services to deliver these plans.
  • Tertiary care:  Tertiary care requires highly specialised equipment and expertise. This refers to specialist care such as renal transplant or cardiac surgery.

The NHS isn’t the only public-sector employer of nurses. The armed forces also employ nurses from all branches of nursing. Employers include the Royal Air Force, the British Army, and the Royal Navy. Job opportunities are available in the UK and at overseas bases. https://patient.info/doctor/monitoring-the-nhs

Private sector

Independent health care organisations

This sector provides most of long-term care available in the UK. The sector also provides acute care services but has fewer acute hospitals than the NHS, but these have a critical role to play in providing a service for private patients and in helping the Department of Health (DH) to reduce waiting lists for acute care mainly through the provision of routine surgery. Moreover, the private sector will play a significant role in enabling the health service in England to introduce patient choice. In addition to this, independent employers can be divided into 3 main groups such as:

  • For profit: This term refers to single owners and large corporates who own single and groups of acute hospitals or nursing homes. Single owners are in the minority, particularly in the care-home sector following a spate of mergers and takeovers in the recent years.
  • Not for profit/registered charities: These can be national organisations, single owners, or smaller set ups. Most of these offer care home facilities for older people, those with learning disabilities or those with mental health conditions. It is also worth noting that some acute providers have charitable status since they plough any profits they make back into the organisation. Examples including BUPA and Nuffield Healthcare.
  • Voluntary: Some organisations in the voluntary sector provides care homes. For example, MENCAP. The voluntary sector is the duty of social activity undertaken by organisations that are non-governmental, moreover, it is provided by people who do not get paid for their service and do not expect payment. An example of this would be involved in work roles involving short-term contracts and time-limited project-based funding which can lead to a less secure placement.  A mental health charity organisation such as MIND relies on donations through fundraising, for example if they spend their money through every £1 they raise they put 70p in their charitable work.

Funding

Statutory sector

According to A2 Textbook Chapter 1 the funding for the statutory sector comes directly from the local government which comes in various forms of taxation which include income tax, council tax which is paid by business rates and the National Insurance. The NHS is funded mainly through general taxation and NHS contributions. In 2001, an increase of the National Insurance rates intended to boost NHS funding, increased the portion paid for the National Insurance, although general taxation still accounts for 80% of its funding in the NHS. User charges generate some funding. Charges for prescription, dental treatment and spectacles were first introduced during the 1950’s.  Therefore, these charges account for only small proportion of NHS income- for example, the income for patient fees and charges for prescription and dental care was 1.3 billion in 2015/16, which was 1.1% of the Department of Health budget. Furthermore, the level of NHS funding in each year is set by central government through the Spending Review process. This process estimates how much income the NHS will receive from sources such as user charges, national insurance, and general taxations. However, if National Insurance or patient charges raise less funding for the NHS than originally estimated, funds from general taxation are used to ensure the NHS receives the level of funding it was originally allocated. See appendix 1

Private sector

The private sector care provision includes self-employed practitioners and small businesses providing specialist forms of care for which people are willing to a pay a fee or charge. This sector includes organisations that were previously run by the NHS and local authorities but were privatised following the NHS and Community Care Act according to A2 Textbook Chapter 1. Furthermore, it provides a vast range of products to the NHS including medicines, CT scanners, radiotherapy machines etc. Therefore, some private provisions services run as businesses as the private sector maximises shareholders’ wealth. The private sector plays a significant role enabling the health service in England to introduce to the patients’ choice. The private sector is funded by the clients who use the service, the patient’s money is used to buy supplies and pay wages. See Appendix 2

Employer

The largest employer in the UK healthcare sector is the NHS as it employs more than 1.5 million people- placing it in the top 5 largest workforces in the world. Furthermore, there are more than 350 different roles available within the NHS. A significant proportion of the sector’s workforce is in independent healthcare. In addition to their private sector functions, these providers are increasingly contracted to provide services on behalf the NHS.

Independent healthcare organisations include:

  • Bupa
  • BMI Healthcare
  • Care UK
  • Ramsay Health Care UK

Voluntary and non-profit organisations in the healthcare sector includes:

  • British Red Cross
  • Nuffield Health
  • Save the Children
  • Sue Ryder

Access

Statutory sector

Private sector

The independent sector is those that are private, these are privately owned services not for property owned charities. Therefore, an example of an independent service is the priory group, if a patient with Generalised Anxiety Disorder wants to access the private sector, they would usually need a GP referral to commence their treatment and will usually be assessed by a psychiatrist to determine the best treatment plan that would be suitable for the patient. They provide all the necessary treatments that are used to treat the mental health condition. People may choose to use the priory group may be because their local NHS providers may not offer the specific treatments that the patient requires or there are long waiting lines. However, private healthcare can be very expensive as the cost would usually depend on: what the therapist charges, how many sessions you go for, and how often you go. Some private therapists offer a sliding scale payment depending on the patient’s circumstances, as there are 2 main payment options which are:

  • Paying the health care provider directly. A healthcare provider will explain any treatment or appointments cost clearly beforehand, as some providers may have payment plans that allows you to pay in instalments.
  • Taking out private healthcare insurance. Insurance can cover part or all the cost of the patient treatment, depending on their policy. This is because not all policies cover psychiatric treatment or pre-existing conditions. Furthermore, buying insurance means that a patient needs to pay a sum of money to the insurance provider, who in return will provide a financial pay-out if something bad happens or the thing you have insured. Therefore, many people find that buying insurance provides financial security and peace of mind. For example, they could get insurance to cover medical costs in case the person becomes unwell.

In addition, an advantage of accessing the private sector is that they are flexible with making appointments at times that are most suited to the patient with giving the patient guarantee that they will be delivered the right care with the best possible results.Therefore, with getting help from the priory group there should be a GP referral before treatment can begin.

Job role

Adult nurses care for patients who are suffering from a variety of health conditions, ranging from minor injuries, to acute and long term-illness and diseases. Furthermore, they support patients by using care plans and carrying out care procedures and assessments and evaluating on the needs of the patient rather than the illness or condition. Nurses usually work within a multidisciplinary team but are the main point of contact for patients, often providing the most continuity of care. They will have to meet the patient’s families, particularly in cases of chronic illness where the patient may be returning regularly for treatment. As an adult nurse, they would need to:

  • Gain the trust and confidence of each patient
  • Check and administer drugs and injections
  • Respond quickly to emergencies

Moreover, they provide hands on care by administering patient’s medication, communicating with doctors. They are relied upon to give direction and supervision for junior nurses. Also, they provide emotional support for family, friends and are responsible to care and comfort patients. In addition to this, adult nurses are on call and must be ready to work in short notice.

Main duties/ activities of job skills 

Nursing is a difficult, rewarding profession that will require a variety of hard skills. Therefore, nurses need to have medical knowledge, to perform certain procedures such as giving out vaccinations, measuring blood pressure and drawing up blood. Also, nurses need to have technical knowledge because in the hospital, nurses must be able to update patients record through a hospitals online database. The key skills for an adult nurse would be having the ability to deal with emotionally charged and pressured situations, excellent teamwork, and people skills, ability to use initiative, good health, fitness, and being able to develop interpersonal relationships with patient’s family or carer.

Examples of skills that a nurse should have:

  • Critical thinking is a key skill that an adult nurse must have because as nurses gain clinical knowledge and good experience, they are able to recognise the problem of a patient on their own. Therefore, nurses must be competent to acquire self-sufficiency through critical thinking which helps them to adapt according to the changes. Critical-thinking skills come into play when nurses assess changes in the health status of a patient and must make decisions such as when to take proactive action or make a referral.
  • Nurses must have communication skills because so much of what they do involves around transmitting information and educating patients to doctors and other nurses on changes in a patient’s status. Furthermore, matters are complicated by the fact that many patients know little about medicine, so health information must be translated into less technical terms so there will be no barrier to effective communication which leads to miscommunication and devising the wrong treatment plan that would be suitable for the patient. Communicating compassion, respect, and confidence to patients and family who may be frightened or angry is critical.
  • Compassion is very important in nursing because it makes patients feel calmer and gives them the assurance that everything is being done to make them well as soon as possible.
  • Nurses must have the skills to analyse, review and judge different situations in the hospital. They must take accurate and suitable actions considering the incident. They can’t get annoyed or lose temper because it can result into fatal situations.

Teamwork, working with others in different job roles 

Teamwork is essential for an adult nurse because it allows their work colleagues to become more familiar with one another’s professional strengths and weaknesses.  Maintaining a strong teamwork environment in the health sector can enhance colleague’s knowledge because of working together adult nurses can pass along new strategies and techniques, which increases overall team knowledge, since some nurses may come from varying skill, training, and experience backgrounds. For nurses to deliver high standard of practice and care to the patients’, NMC (2008) specifies that nurses should ask for support, when needed and should not feel embarrassed to admit that they need more guidance and help. For example, considering the concerns of their patients’ views within the ward during ward rounds, or (CPA) meetings; patients could be facing barriers in expressing concerns, when faced with several health practitioners because they may feel intimidated thus results them from withdrawing any information,

Furthermore, adult nurses are a key part of the multidisciplinary teams that look after patients. As they will be at the centre of the teams that can include: physiotherapist, radiographers, or healthcare assistant. However, adult nurses also must work closely alongside with patient’s family or carers. Patient assessment is a multidisciplinary team process, therefore, consultation with other team members and colleagues is important for assessments to be conducted. During patient assessments, it may be that some members of the team are more practiced in carrying out skills that are required for the assessment of the patient’s condition. In this case, the nurse should be willing to share information and skills that they have with other members of the team so that the process of the assessment is conducted. Providing feedback to colleagues about a patient’s condition and their individual needs is also an essential part of the assessment phase, which could be done through hand over notes and care plans. Sharing of information ensures that all the team become accountable for the care provided to the patient and enable individuals to have a chance to suggest alternative methods of patient management, which have not previously been considered.

Status

According to A2 Textbook Chapter 1 – Working in Health & Social Care. Some job roles seem to be more highly valued by the public than others. This is influenced to some extent by perceptions of how useful certain jobs are. Health workers such as an adult nurse have a relatively high level of public approval as they are perceived to influence the quality and length of people’s lives.

Qualifications 

Before someone can work as an adult nurse they must first have the required qualifications of a GSCE and an A level requirement that they need before they go and get a degree. Typically, an adult nurse would need to have a minimum of five GCSE grade at grade C or above possibly in English language or literature and one science subject. Furthermore, 2 A levels will be asked for, however, some universities want different grades. For example, London Southbank University expects students to achieve BBC whilst Middlesex grade requirement is BBB. Moreover, before going into university people need to undertake a numeracy and literacy sample test before they get accepted for an interview.

To work as an adult nurse in the UK, the qualifications needed is to have a degree, such as having a degree in a health-related subject or other practice-based learning and must be registered with the nursing and midwifery council (NMC). The Nursing and Midwifery council is a professional body that regulates the professional standards of nurses and midwives. Furthermore, they needed to have completed an accepted pre-registration nursing programme to be eligible to register. However, all adult nurses are required to undergo a Disclosure and Barring Service (DBS) check. This is important because it protects the patients by preventing unsuitable people from working in sensitive posts, against discrimination and to also see if they had any convictions.

In addition, half of the programme is based on clinical practice, giving them direct experience of working with patients and families. They could be based within a variety of settings including hospitals, the community, patients’ home, and independent organisations. Whilst the other half is time spent on their academic learning. They may be able to get accreditation of prior learning (APL) if they have a degree in another health-related subject or other practiced-based learning. Evidence of this learning would be counted towards the programme requirements of some of the approved degrees and postgraduate diplomas, allowing for the course to be accelerated.

Relevant subjects may include:

  • Biomedical science
  • Human biology
  • Psychology
  • Physiology

Opportunities for career progression 

Nursing begins with a period of preceptorship, which is a transition phase designed to help newly registered nurses to further develop their practice. As it covers fundamental competencies in patient care as well as broad skills in leadership, management, teaching, and communication. After successfully completing this, they would then begin to progress through various roles, including:

  • Senior staff nurse
  • Junior sister
  • Nurse practitioner
  • Nurse consultant

Moreover, progression to roles such as ward sister, ward manager and team leader depends on the development of management skills and level of specialist knowledge. Therefore, they may then progress either within a clinical specialism up to posts such as nurse consultant, or through further managerial responsibility as a matron and then up the executive ladder to a director of nursing post. For adult nurses, there are opportunities for promotion. But, Adult Nurses do not get promoted in terms of job title. The title will still be the same, what will change is their band. Adult nurses start off as a band 1 and can progress to the highest band, which is band 9.

Local and political factors

Due to living in a highly populated area I.e. London borough there are more job opportunities for people who want to qualify for the profession of an adult nurse.

Although there are advantages of living in a local community due to a variety of job opportunities in the health sectors. There are also disadvantages.

A relative who works in Queen’s hospital stated that there are “shortages of staff in the wards”, this creates a bad representation of the Queen’s hospital as it can lead to a variety of complaints and may stop people from going to that specific hospital, because of the shortages of staffs the work efficiency will be bad.  A review from the Care Quality Commission on the Queens hospital stated that ’We found nursing staff did not comply with the trust policy for intravenous administration where there should have been two registered nurses involved in the checking process. Nursing staff told us that staff shortages made this difficult to comply with’.  Therefore, this implies that shortages of staff can put patients at risk as they may not be able to meet patients’ needs and requirements such as managing their pain or not having enough time to manage their records or give them comfort. Which can be viewed in appendix 3 as it also talks about how shortages of staffs can lead to traumatising experiences, for example witnessing a death of a patient if there are shortages of staffs

(http://news.sky.com/story/patients-dying-alone-due-to-lack-of-nhs-staff-report-finds-11058481 )

To improve the public health care, the labour party suggested on having a renewed commitment to keeping people ‘fit and well’ as their focus would be on the efforts in children’s health. Furthermore, the labour party is willing to fight health inequalities to break the link between child-ill health and poverty. Furthermore, the labour party will increase the social care budgets by £8 billion pounds and include an additional of £1 billion for the first year.

The Conservative party are currently in power. Whereas, the conservative party manifesto pledge will increase the NHS spending by the minimum of £8 billion in real terms over the next 5 years. Additionally, the conservative party will ensure that the NHS has the midwives, nurses, and doctors that it needs. As they will make it as a priority that the 140,000 staff in the EU countries can make vital attributions within their role in the health and care system.

For example, the Conservatives promised that if the nation was to leave the EU it would result in their being £350 millions of disposable income for the government, which they would use to re-invest into the NHS. But, this statement was later denied and said they would not go through after Brexit when the media confronted the conservative party on if £350 million was still going to be invested into the NHS (https://www.theguardian.com/politics/2017/may/21/boris-johnson-wrongly-claims-350m-nhs-promise-is-in-manifesto)

Now hopes and expectations of funding for the NHS has gone down as not only did they lie about investing that much into the NHS, but also that now Theresa May claims that there is no extra money for the NHS. Without the extra money, it will be difficult to look for funds to improve on services on services so that it can become more convenient and faster. Meaning that patients will not be able to get quicker bookings for appointments with doctors. In addition, the mirror tells us that 40,000 NHS vacancies must be filled in this past year, and with these cuts, people will not be motivated to apply because they know that their job is at risk of redundancy. Less staff will mean fewer patients will get the necessary attention needed, leading in a slower and more delayed service, resulting in patients live seeing put at risk. Furthermore, according to the (http://www.mirror.co.uk/news/uk-news/worst-nurse-shortage-ever-nhs-11118667)  it talks about how “experienced nursing staff are leaving in droves, not because they don’t like the job, but because they can’t afford to stay” this is  due to the decrease of nursing pay to fall by 14% and also 68% of nurses were underpaid from their salary which creates more problems in the health sector.

  • Increased pay by 1%

(https://www.theguardian.com/politics/2016/oct/14/no-extra-money-for-nhs-theresa-may-tells-health-chief )

A political factor would be due to the conservatives cutting the bursaries for nursing in universities there has been fewer students applying to universities due to cuts in bursary. Due to the government’s decision to remove the bursary, the number of nursing applications dropped from 65,620 to 53,010. Which can be viewed in Appendix 4. Therefore, this affects the job profession as it piles up more problems for the NHS about having shortages of staff within the health sector which leads to staffs having to work overtime and adding more hours than what they need to, which leads them to be stressed in their job role.

Whereas, the conservative party will increase the NHS spending by the minimum of £8 billion in real terms over the next 5 years. Additionally, the conservative party will ensure that the NHS has the midwives, nurses, and doctors that it needs. As they will make it as a priority that the 140,000 staff in the EU countries can make vital attributions within their role in the health and care system.

Labour governments and labour-controlled councils have a history of providing more funding for health and social services, compared to conservatives due to having a history of spending less on public services to reduce national and local taxation. Furthermore, the reduction in spending less on public service may lead to fewer employment opportunities in health and social care as well as to more difficult working conditions.

Local factors

  • Opportunities for working in the area = London teaching which is an advantage for havering
  • London weighting – explain what it is (London weighting is an allowance paid to certain civil servants, PhD students, and security officers
  • Population in havering – densely populated area, if there’s lots of people they would need more medical care- disadvantage = link to shortages of staff
  • Ask parent – if they’re taking in new staff, are they becoming redundant

Conditions of employment 

Annual pay increments

Each agenda for change pay band has many points. If the nurse has not reached the maximum point in their pay band, they will progress to the next point each year if their performance is satisfactory and demonstrate the expected knowledge and skills required. The employer must have a fair appraisal system in place to assess their performance. The competencies for each band are determined by the Agenda for Change Knowledge and Skills Framework (KSF), which sets out the knowledge and skills required for each job role.

High cost area supplements

If an adult nurse work in Greater London or the counties immediately surrounding London (the fringe zone), they will receive extra pay on top of their basic salary as follows: +20% if you work in inner London which you will be subjected to a minimum payment of £4,076 and a maximum payment of £6,279.  If they work in outer London they will receive 15% which is subject to a minimum payment of £3,448 and a maximum payment of £4,395. Also, if the nurse works in the fringe zone they will get a total of 5% which they will be subject to a minimum payment of £942 and a maximum payment of £1,632.

An adult nurse is required to do full-time work with a minimum of 40 hours a week, overtime is included, and adult nurses are paid for the overtime that they do. This is only if they are in band 1-7, if their band is 8 or 9 then they will not get paid for the overtime that they do. Adult nurses will get paid 1.5x more than their standard salary for every hour of overtime according to https://www.rcn.org.uk/employment-and-pay/nhs-conditions-of-employment. Fully qualified nurses start on salaries of £22,128 rising to £28,746 on band 5 of the NHS Agenda for Change Pay Rates. Salaries in London attract a high-cost area supplement. Therefore, with experience in positions such as nurse team leader on Band 6, salaries will progress to £26,565 to £35,577. However, at more senior levels such as nurse advanced, modern matron and nurse consultant who would be in Band 7 to 8c salaries would range from £31,696 to £69,168.

However, if they are working overtime on a bank holiday the overtime pay will be 2x more than their standard salary. The salary of an adult nurse can vary depending on their band. In terms of holiday requirements, Adult Nurses do get 35 days off for the first 5 years in the job role. After 5 years’ service, it increases and becomes 37 days per year, and after 10 years of service, it will become 41 days of holiday entitlement per year.  For example, an adult nurse starting from band 5 would earn a minimum of £21,692 but when their career progresses and promotion is included an adult who is in band 8C would earn an amount of £55,548. See Appendix 5 for more information about the nursing work band.

Moreover, all staff in pay bands 1 to 7 will be eligible for other payments. There is a single harmonised rate of time-and-a-half for all overtime, apart from work on public holidays, which will be paid at double time. Over time payments will be based on the hourly rate provided by basic pay plus any long-term recruitment and retention premia. The single overtime rate will apply whenever excess hours are worked over full-time hours, unless time off in lieu is taken, or has been provided by the employee’s line manager or team leader has agreed with the employee to this work being performed outside the standard hours. In addition to this, staff may request to take time off in lieu as an alternative to overtime payments. However, staff who, for operational reasons, are unable to take time off in lieu within 3 months must be paid at the overtime rate.

Furthermore, part-time employees will receive payments for the additional hours at plain time rates until their hours exceed standard hours of 37.5 hours a week. They would earn around £18,000 a year.

https://www.nursingtimesjobs.com/article/nursing-differences-in-roles-and-salaries/

Pension rights

When a nurse starts working for the NHS they will automatically be included in the NHS pension scheme. The scheme is voluntary, so therefore they have a choice to opt out. The amount of money that is put in the pension is dependent on how much they earn, and the current contribution rates are between 5% and 14.5% as the rate will be determined on the nurses’ full-time equivalent pensionable pay. However, the contributions will be deducted from the nurses’ gross pay which implies that less of their income is taxable.  This in effect means that their actual contribution considering tax relief is between 4% and 8.7%. whilst the employer on the other hand (from 1 April 2015) contributes 14.3%.

In 1 April 2015 a new pension scheme was introduced and came into effect. The new pension scheme reflects the changes that were negotiated and fought over between the government and the NHS trade unions back in 2011. Union members took strike action over the initial government proposals for changes to public sector pensions. Following negotiations, the government made significant changes to the proposals and the Proposed Final Agreement (PFA) for the NHS pension scheme was produced. Some of the main features of the scheme are:

  • Each year’s pension earned will increase every year in value by the Consumer Price Index (CPI) plus 1.5 % per year.
  • It is a type of defined benefit scheme which provides pension benefits based on a fixed formula.
  • It is a Career Average Revalued Earnings (CARE) scheme, rather than a final salary scheme where benefits are built up on the value of your pensionable earnings each year during your NHS career.

The NHS offers a pension scheme, sickness, and maternity benefits. However, nurses employed outside the NHS may not have the same terms in relation to pension provision or benefits but may be offered other incentives such as private insurance or, occasionally, a company care for senior roles.

Job security

NHS ‘could go under’ if EU staff are not assured job security post-Brexit according to the independent. Figures from the nursing and midwifery council in July showed that the number of EU workers (who make up 5% of the register) leaving the profession had increased from 1,173 in 2012/2013 to 3,081 in 2016/2017. “the risk is that people will start to leave, and we are now starting to see that happen”. “we simply can’t afford to lose any more nurses; we don’t have enough as it is. Furthermore, according to the article, it said how the NHS ability to recruit and retain EU staff as if the budget does not show the governments clear intent to remove the pay cap then industrial action by nurses is on the table. The fall in the value of sterling had also affected the NHS ability to recruit and retain EU staff, she said, and pointed to the Brexit’s votes impact on morale.

Evidence of anti-discriminatory practice

Discrimination is when people have their rights to the things that provide an equality of life and opportunity marginalised, excluded, or inadequately provided for. There are several factors that fall into this category and examples are based on ethnicity, gender, disabilities, and religious beliefs. The equality act 2010 protects employers from discrimination, harassment, and victimisation because of age, which may include because they are ‘younger’ or ‘older’ than a relevant and comparable employee. For example, if an organisation has a training policy excluding employees aged 60 or more from applying for courses then this is likely to be discriminatory. Direct discrimination because of age is the only one of the three different types of direct discrimination.

Relevant legislation/ policies

Legislations are a legal document that provide protection and affect people’s rights. Within the social care setting social care workers need to be aware of the legislations so they can provide a service where the legislations are promoted. Therefore, legislations are very important throughout any work environment because without them people are not protected from hazards and promoting safety in the workplaces. There are 4 legislations that are important in nursing, which are:

Human Rights Act (1998)

This legislation ensures that the power of the state is balanced against from the power of the individual. Therefore, nurses and doctors cannot over use the power of the laws to infringe people’s rights to continue the daily business of their life or to take away their liberty.

The Health and Safety Act (1974)

This Health and Safety Act enforces the act with other acts alongside it to ensure that the working environment is safe to work in without causing any hazards that may cause an affect to a person’s health. The Health and Safety Act which is referred to as HASAWA, is the main piece of legislation covering occupational health in the UK. Furthermore, the key requirements for this act is that employers are responsible for the health and safety of employees, workers from other organisations, and visitors whilst they are on the premises, as employers must:

  • Provide safety equipment, written health and safety information and training
  • Ensuring that the workplace is fully insured, as employers’ compulsory liability insurance must be taken out and public liability is strongly recommended, in case an incident occurs
  • Ensuring that there is a health and safety policy written for the setting and appoint someone to be responsible for health and safety.

Data Protection Act (1998)- DPA

The Data Protection Act relates to personal information held in paper and electronic format. As the information held should be relevant and not excessive because it should have been obtained for lawful reasons and should be accurate and current. However, information should not be held for longer than necessary, but information should be protected against unauthorised access and accidental destruction. The Data Protection Act 1998 came into force in March 2000 to protect the movement and the processing of information towards the individual. However, the DPA replaced the previous Data Protection Act 1984 that was devised in response to the large amount of data collected about individuals via electronically.  Therefore, the main difference with the DPA 1998 is that it applies to data held electronically and manually implying that the act will cover all written information and records held about patients.

To be lawful, nurses must ensure that the way they process information about their patients must comply with the legislation. The way that information is processed m

Care Minimum Standards

The Care Minimum Standards was published in 2003, following the Care Standards Act 2000. They form the basis for the inspection of care settings, which is done by the Care Quality Commission. Furthermore, they include information about the standard of care that should be given, and part of this will relate to health and safety. Different versions of the National Minimum Standards exist for each category of care settings:

  • Nurse agencies
  • Adult placement schemes

Safe guarding

Safeguarding means protecting patient’s health, well-being, and human rights, and enabling them to live free from harm, and neglect.  Therefore, having a safeguarding policy in place helps to protect and promote the welfare of the vulnerable and gives assurance to staff as well as parents and carers. The NHS safeguarding policy sets out the statutory requirements for NHS to discharge its appropriate accountability for Safeguarding children, young people, and adults at risk of harm and abuse. Furthermore, the safeguarding policy sets out the collective and individual expectation for the NHS staff to comply with legislations, codes of conduct, and behaviours that is required from an employee of the NHS.  But before a care setting can open, an inspector from the Care Quality Commission will visit to ensure that the building i.e. the hospital is safe and suitable for the people who will access the setting. Also, location may cause hazards, if it’s on a busy road or very isolated. In which access to the premises is very important because visitors will be arriving and leaving frequently, so the entrance must be positioned to allow drivers to see it easily. There must be adequate parking space, so the road wouldn’t be obstructed with cars being parked outside. For example, the Queens hospital has easy access because there are public transport links provided by buses which stop within the hospital grounds. Also, the bus stops provide shelter and seating for waiting passengers within 200 metres of the main hospital entrance.

Moreover, another way patients can be safeguarded is by having DBS checks on nurses before they start their profession as an adult nurse. DBS checks are usually carried out on anyone who volunteers or work with vulnerable children and adults. Employers will carry out DBS checks before allowing employees to work in a Regulated Activity with children or vulnerable adults to ensure they haven’t been barred from doing so. It was introduced to ensure that recruiters made safe decisions on who they employ in the work place. For the work place to be safeguarded, there is a complaint procedure that nurses can go to which are line managers have a responsibility to understand the safeguarding policy and the commitment of the NHS to ensure all staff are supported to maintain training and awareness. When an adult nurse feels that patients are not being safeguarded with the standard of the hospitals ethic values or nurses witness bad practice within their ward, they can bring the attention and complain to the line manager. For example, Margaret Haywood was a panorama’s secret filming nurse, she worked undercover for panorama to take the 2005 film ‘Undercover Nurse’ that went on to expose instances of neglect of elderly patients on a ward in Royal Sussex County Hospital in Brighton. http://news.bbc.co.uk/1/hi/england/sussex/8002559.stm

Client outcomes

Stressors

Adult nurses are likely to get stressed out in the workplace due to the high amount of pressure caused by the lack of staff in the department which can increase in the amount of overtime done by nurses on their contracted lunch hours. Lack of break and increase in overtime is likely to make them fatigue and underwork, leading to an increase in stress levels for nurses. According to (https://www.ausmed.com/articles/stress-in-nursing/ )

Job satisfaction

Job satisfaction

Marcia Faller, PhD, RN, chief clinical officer for AMN Healthcare, reported that of the 3,400 nurses surveyed, 9 out of 10 are satisfied with their career choice, but 1 out of every 3 are unhappy with their current job. The 2013 survey found that only 73% of nurses were satisfied with their current jobs, while 35% said they often feel like resigning and 33% indicated that if they had their way, they would not be working in their current nursing job a year from now. Both percentages are up from responses in 2012. Older nurses were more likely to think about resigning or changing jobs.

Male nurses were more likely than females to plan on leaving their jobs in the year ahead.

Twenty-three percent of nurses 55 or older said they plan to change their work life in the near future: 13% plan to retire, 3% plan to take a non-nursing job and 7% plan to work part-time. In addition, 72% of those surveyed would recommend a nursing career to others. Variation occurred generationally, with 80% of nurses aged 19-39 encouraging others to become a nurse, while 7% of nurses aged 40-54 and 70% of nurses aged 55 and older replied affirmatively.

Although nurses of all ages were pleased with their career choices, differences surfaced in how nurses in various age groups view the overall state of nursing today.

Sixty-six percent of nurses 55 and older reported that nursing care has generally declined, while only 37% of nurses aged 19-39 felt that way.

The electronic medical record was another area showing differences among the generations. Younger nurses were more positive about the technology and indicated it improved productivity, time management and the quality of patient care, while Marcia Faller, PhD, RN, chief clinical officer for AMN Healthcare, reported that of the 3,400 nurses surveyed, 9 out of 10 are satisfied with their career choice, but 1 out of every 3 are unhappy with their current job. The 2013 survey found that only 73% of nurses were satisfied with their current jobs, while 35% said they often want to resign and 33% indicated that if they had their way, they would not be working in their current nursing job a year from now. Both percentages are up from responses in 2012. Older nurses were more likely to think about resigning or changing jobs. Male nurses were more likely than females to plan to leave their jobs in the year ahead. Twenty-three percent of nurses 55 or older said they plan to change their work life in the near future: 13% plan to retire, 3% plan to take a non-nursing job and 7% plan to work part-time. In addition, 72% of those surveyed would recommend a nursing career to others. Variation occurred generationally, with 80% of nurses aged 19-39 encouraging others to become a nurse, while 7% of nurses aged 40-54 and 70% of nurses aged 55 and older replied affirmatively. Although nurses of all ages were pleased with their career choices, differences surfaced in how nurses in various age groups view the overall state of nursing today. Sixty-six percent of nurses 55 and older reported that nursing care has generally declined, while only 37% of nurses aged 19-39 felt that way. The electronic medical record was another area showing differences among the generations. Younger nurses were more positive about the technology and indicated it improved productivity, time management and the quality of patient care, while older nurses thought it was slowing them down and was not improving their patient care.https://www.rn.com/nursing-news/nursing-career-satisfaction-vs-job-satisfaction/

Level of responsibility

Quality Assurance Regulator

Quality assurance in nursing refers to the practice of protecting the health and safety of the public by regulating competencies and the quality of licensed nursing staff members.  Quality assurance nurses are tasked with monitoring and enforcing licenses for nurses. Furthermore, in nursing, quality assurance applies to maintaining consistent standards of practices among nursing staffs and providing opportunities for professional development. Organizations and individuals tasked with quality assurance in nursing are responsible for developing procedures and rules that promote quality health care for patients while ensuring standards of practice are followed through in medical facilities.

Moreover, competency standards are also a primary task of quality assurance departments, and evaluations of state wide and federal practices are taken into consideration. Quality assurance nurses are often responsible for investigating complaints against nurses, serving as members on review boards that determine the outcome of disciplinary cases and, if necessary, suspend or restrict nursing licenses or a nurse’s ability to practice. They will work closely with nurses in medical facilities to determine best practices for patient care, evaluate policies and procedures that improve patient care, and analyse consistency within nursing practices as they compare to other facilities and licensing standards.

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