Registered Nurses (RNs) provide many different services to health care consumers in a variety of settings. Some things nurses do on a daily basis offer a unique contribution to health care, whereas others can be done by other health team members. Professional nursing offers a specialized service to society. Professional nurses use a broad approach when considering holistic health need of the people they serve. Because of the broad nature of the discipline, nurses assume multiple roles while meeting health care needs of clients.
For this reason, this paper would be discussing the role of the registered nurse in health care delivery. We would also discuss the professional standard and expectations for registered nurse. The quality assurance and confidentiality issues would then be discussed. In addition, this paper would explore the responsibility of the employers in hiring new health care staff. This would then include the employers' expectation regarding competencies. Finally, a conclusion would be provided in order to highlight important details discussed in the paper.
Different Roles of the Registered Nurse
As a caregiver, the nurse practices nursing as a science. The nurse provides intervention to meet physical, psychosocial, spiritual, and environmental needs of patients and families using the nursing process and critical thinking skills. The nurse as a caregiver is skilled and empathetic, knowledgeable and caring. RNs provide direct, hands on care to patients in all health care agencies and settings. They also take an active role in illness prevention and health promotion and maintenance (Chitty, 2005; Australian Nursing and Midwifery Council, 2006; Masters, 2009).
The Nurse Coordinator role is unique. It is a vital part of the multidisciplinary care team for patients and contributes to improved patient outcomes. The core functions of the Nurse Coordinator role centre around the patients' physical and psychosocial assessment, care coordination, education and support, from coordinating the patients diagnostic work-up tests to assisting them to navigate the hospital system, and referring them to allied health professionals. The Coordinator is an important resource for the patient and family and acts as a focal point of contact throughout their time in the hospital (ANMC, 2006; Hood & Leddy, 2006).
Incorporated in this advanced practice role, the Nurse Coordinator is responsible for maintaining clinical competencies and participating in those activities that contribute to the ongoing development of self and other health care professionals. The Nurse Coordinator contributes to the educational needs of clinical nurses and participates in both informal and formal education programs at a national and international level (ANMC, 2006; Hood & Leddy, 2006).
The purpose of this role is to respect patient decisions and boost patient autonomy. Patient advocacy includes a therapeutic nurse-patient relationship to secure self-determination, protections of patients' right and acting as an intermediary between patients and their significant others and healthcare providers (Blais et al., cited in Masters, 2009). A patient advocate is mainly concerned with empowering the patient through the nurse-patient relationship. The nurse represents the interests of the patient who has needs that are unmet and are likely to remain unmet without the nurse's special intervention. The professional nurse speaks for the patients interest as if the patient's interests were the nurses own (Chitty, 2005; ANMC, 2006; MacDonald, 2006: Masters, 2009).
Nurse educators teach patients and families, the community, other health care team members, students and businesses. In hospital settings as patient and family educators, nurses provide information about illnesses and teach about medications, treatments and rehabilitation needs. They also help patients understand how to deal with the life changes necessitated by chronic illnesses and teach how to adapt care to the home setting when that is required (Chitty, 2005; ANMC, 2006).
Nurse as Collaborator
Collaboration is important in professional nursing practice as a way to improve patient outcomes. Multidisciplinary teams require collaborative practice, and nurses play a key role as both team members and team leaders. To fulfill a collaborative role, nurses need to assume accountability and increased authority in practice areas. Collaboration requires that nurses understand and appreciate what other health professionals have to offer. They must also be able to interpret to others the nursing needs of patients. Collaboration with patients and families is also essential. Involving patients and their families in the plan of care from the beginning is the best way to ensure their cooperation, enthusiasm and willingness to work toward the best patient outcome (Chitty, 2005; ANMC, 2006).
A nurse practitioner is a registered nurse educated and authorized to function autonomously and collaboratively in an advanced and extended clinical role. The nurse practitioner role includes assessment and management of clients using nursing knowledge and skills and may include but is not limited to, the direct referral of patients to other health care professionals, prescribing medications and ordering diagnostic investigations. The nurse practitioner role is grounded in the nursing profession's values, knowledge, theories and practice and provides innovative and flexible health care delivery that complements other health care providers. The scope of practice of the nurse practitioner is determined by the context in which the nurse practitioner is authorized to practice. (ANMC, 2006; Carryer, Gardner, G., Dunn, & Gardner, A., 2007).
Professional Standards and Expectations for Registered Nurses
Standards within a professional practice are known as statements of an authoritative nature through which the profession to which they relate to provide a unique description of the responsibilities of all practitioners within that profession (Campbell & Mackay, 2001). Further, the standards and expectations are in place to ensure that all practitioners are also accountable for the work and duties they perform. When it comes to nursing, this is done in order to create boundaries and to provide a level of care that is equitable for all patients. Further, the priorities and values of nurses must be common to each nurse within the profession, and the standards and expectations outlines this as such (Campbell & Mackay, 2001; Pearson, Fitzgerald, Wash, & Borbasi, 2002; American Association of Critical-Care Nurses, 2003; ANMC, 2006, 2008; Schiemann, 2007; Furaker, 2008).
While standards will vary in specifics across nursing specializations, and across countries, there is a general mindset as to what is expected of nurses in terms of expectations and standards. They are intended to provide daily guidance to nurses as they practice. Accountability, ethics, competence, knowledge, and the practical application of knowledge are key elements that are common to all nursing standards and expectations (Campbell & Mackay, 2001; Pearson, et al., 2002; AACN, 2003; ANMC, 2006, 2008; Schiemann, 2007; Furaker, 2008 ).
Nurses are required to be held accountable for every action that they take on a daily basis. This requires constant documentation of every element of their daily job, and following a chain of command within their select position. They are also required to maintain ethical standards within their practice, and to follow all ethical guidelines as set forth by their governing body of nursing. Furthermore, nurses are expected to have a set amount of knowledge before they enter the field of practitioner work, and with that knowledge set come an expectation of competence and practical application. Nurses are expected to be competent in their knowledge base such that they know and understand what they are supposed to in the medical field, and also, are supposed to know how to apply that knowledge in a practical manner (Campbell & Mackay, 2001; Pearson, et al., 2002; AACN, 2003; ANMC, 2006, 2008).
Quality Assurance is another issue that is common across all standards and expectations for nurses. Through this, quality assurance standards ensure that nurses are practicing with quality efforts which in itself promote their competence and practical applications. This will require continuous education on the part of the individual nurse, as quality assurance standards across many medical centers, cities, and countries are in a constant state of evolution. It is the responsibility of the nurse practitioner to understand their quality assurance expectations at all times (Ellis & Hartley, 2004; Hood & Leddy, 2006).
Confidentiality is another element of most standards and expectations for nurses. This is a requirement that nurses do not have an option to practice or not. Legislation and privacy concerns are in effect all across the globe, and nurses have the expectation that they will maintain confidential and private information for their patients within the patient doctor realm. Patients use medical services under the understanding that their information and medical records are not being seen by the wrong person, or found in the wrong hands, and because nurses have the most contact between patient and doctor, these are standards of paramount significance to the nursing profession (Deshefy-Longhi, Dixon, Olsen, & Grey, 2004, Ellis & Hartley, 2004; Chitty, 2005; ANMC, 2006, 2008; Masters, 2009).
Employers' Responsibility in Hiring New Health Care Staff
The employer of an organization has an inherent duty to employ competent staff. This is not only cost-effective on the part of the employer but also guarantee in some ways that the products and services provided by the organization are competently given to the end-users. In the context of health care employees, such as the RNs there is an accreditation scheme to ensure the capacity of the RNs to carry out his/her job. In this manner, the employer's responsibility to screen the professional capacity of the RN is significantly simplified. Seeking only the certification of the newly hired RN will guarantee that he/she has satisfied the minimum requirements of training, licensure, and communication proficiency to carry out his/her role as health professional. Having the employer check the credentials of the newly hired RN as well as his/her certification with authorities will allow the employer to measure the RN capability to perform his/her jobs in the organization (Ellis & Hartley, 2004; Hart, Olson Fredrickson, & McGovern, 2006). Â
Employers' Expectations Regarding Competencies
Registered nurses should appraise their strengths, weaknesses and preferences. The RNs must ensure that there is a good match between their abilities and employers' expectations. Ellis and Hartley (as cited in Chitty, 2005) suggest that RNs examine themselves in seven areas in which employers have expectations.
Theoretical knowledge should be adequate to provide basic patient care and to make clinical judgments. Employers expect RN to be able to recognize the early signs and symptoms of patient problems, such as an allergic reaction to a blood transfusion, and take the appropriate nursing action, that is, discontinue the transfusion. They are expected to know potential problems related to various patients conditions. (p. 212)
The ability to use the nursing process systematically as a means of planning care is important. Employers evaluate nurses' understanding of the phases of the process: assessment, analysis, nursing diagnosis/outcome identification, planning, intervention and evaluation. They expect nurses to ensure that all elements of a nursing care plan are used in delivering nursing care and that there is documentation in the patient's record to that effect. (p. 213)
Self-awareness is critically important. Employers ask prospective employees to identify their own strengths and weaknesses. They need to know that new nurses are willing to ask for help and recognize their limitations. New graduates who are unable or unwilling to request for help pose a risk to patients-a risk that employers are unwilling to accept. (p. 213)
Documentation ability is an increasingly important skill that employers value. Employers expect RN to recognize what patient data should be charted and to know that all nursing care should be entered in patient records. (p. 213)
Work ethic is another area in which employers are vitally interested. Work ethic means that prospective RN employees understand what is expected of them and are committed to providing it. Employers expect new graduates to recognize that the most desirable positions and work hours do not usually go to entry-level workers in any field. In the nursing profession, a nurse cannot leave work until patient care responsibilities have been turned over to a qualified replacement; therefore, being late to work or "calling in sick " when not genuinely incapacitated are luxuries professional nurses cannot afford. (p. 213)
Skill proficiency of new graduates varies widely, and employers are aware of this. Most large facilities now provide fairly lengthy orientation periods, during which each nurse's skills are appraised and opportunities are provided to practice new procedures. In general, smaller and rural facilities have less formalized orientation programs, and earlier independent functioning is expected. (p. 213)
Speed of functioning is another area in which new nurses vary widely. By the end of a well-planned orientation period, the new graduate should be able to manage the average patient load without too much difficulty. Time management is a skill that is closely related to speed of functioning. The ability to organize and prioritize nursing care for a group of patients is the key to good time management. (p. 214)
Through time nurses have advanced their roles into various spheres of practice, and this progression seems set to continue as healthcare continues to evolve. Whatever the reason, central to role extension should be the delivery of safe care to all patients, with the support of the multi- disciplinary team to ensure good standards of patient care. Nurses should ensure that each activity performed when advancing a role should complement the current job, one which they are competent in. Nurses should guard themselves against litigation and carefully consider what they really want to do, as each practitioner is accountable for their actions and should be aware of the legal implications of practice within the process of advancing professional practice.