Critical Analysis on the Role of Advanced Practical Nurse

Introduction

In the present times, the health of individuals plays a fundamental role in as far as the economic development of a nation is concerned. This is due to the fact that when most individuals are unwell, they tend to spend most of their time seeking for quality health care services or relaxing at home rather than attending to their daily economic activities. This is one of the major reasons why most governments, both the developed and the developed ones are determined in ensuring that the health sector have sufficient resources in order to not only facility various health programs, but also to ensure that majority of the health consumers can afford and access quality health care services with ease. In this connection, the health professionals plays a great role in as far as the recovery of patients is concerned. Doctors, pharmacists, public health professionals, advanced nurse practitioner, clinical nurse specialists, and community health workers works collaboratively in order to ensure that they do not only meet the health needs of these clients, but also exceed their expectations. In this connection, clinical nurse specialists are mandated to execute a number of roles within the health care facility. Among these roles is the aspect of optimizing patient care by evaluating current practices, consulting with patient care managers, reviewing alternatives and providing education to staffs and patients. this paper will pay high attention to the description of the aforementioned role, the standards of practice that are associated with the role, the impact of this role on the health care system, critical analysis of the application of this role into my workplace, and my independent interpretation, thought and appraisal of the role.

Description of the role based on clear explanation of major themes and concepts

In the present times, the health care system is continually changing especially with the introduction of technology as well as the patients` demand becoming more complex. As the clinical situations continues to be more demanding, the clinical nurse specialists keep up with the patients` needs by adopting and implementing standards of practice as well as model best practice behaviors. Precisely, clinical nurse specialists tends to be excellent partners in collaborating with the other nurse practitioners by initiating, modelling, educating and providing resources that helps in meeting the demands that are characterizing the modern health care facilities. According to Zuzelo (2010), the practice environment for critical and acute care is explained not only by the physical location, but rather by the dynamic interaction between critically and acute ill patients, the caregiver, the family members, and more importantly, the health care environment.

As a way of meeting the increasing demand in the health care settings, the clinical nurse specialists do not only ensure that new graduate nurses are hired to help the current staffs, but also goes a step further of ensuring conducting orientation and providing educational needs of newly absorbed nurses. During the orientation process, the clinical nurse specialist provides general staff training, mandatory updates as well as being the controller and monitor of the overall orientation requirements. According to Kesten (2012), the clinical nurse specialist contemplates that it is important to apply adult learning principles which enhances the use of evidence based practice and the value of lifelong learning, and this promotes relative and logical experience that is related to learner`s practice. Through the principles of adult learning, the facilitated education by the clinical nurse specialist is important to the new graduate nurses as they build on their previous experience and knowledge, and can easily and readily manage to apply and implement new knowledge into practice.

Moreover, the clinical nurse specialist is also concerned with the quality of health care services that the patients are receiving, their level of satisfaction, and ways of preventing the occurrence of communicable and non-communicable health conditions in the future. Precisely, the clinical nurse specialist establishes an interpersonal relationship with the health consumers and this helps in creating an environment where both parties can share their experiences with each. Precisely, clinical nurse specialists can be said to be the most effective in terms of the use of the Peplau`s theory of interpersonal relations. Peplau`s theory of interpersonal relations can be defined as the interpersonal and; therapeutic process that occurs when health professionals (specifically those who are adequately educated to be nurses), enter in therapeutic associations with health consumers (Hagerty, 2017). According to Peplau, an effective nurse-patient relationships must meet three core phases in order to be termed as successful, and these phases are not limited to Orientation, working, and termination. During the orientation phase, the patients who have newly admitted tends to contemplate that they really require medical help and try to adjust or adapt to their new (current) experiences. At the same time, nurses tends to encounter and gain necessary information about the newly admitted patients as individuals with unique needs and priorities. At this phase, nurses tends to assume numerous roles including that of meeting a stranger. The nurses are supposed to greet the patients with the respect and positive interest that are displayed to a stranger, and they should continue displaying this level of respect and courtesy even in the other consecutive phases.

During the working phase, nurses make assessments about the patients which they (nurses) use when contributing to the interdisciplinary plan of care. Additionally, nurses become more familiar with patients and therapeutic form of communication as well as non-judgmental feedback to patients is extensively embraced by nurses. The terminal phase encompasses aspect of planning for the discharge of patients. Considering this theory focuses on the association between nurses and patients, the theory stands the most appropriate to the low safe staffing ratio of nurses.

Standards of practice associated with the role nationally and internationally

There are numerous standards that have been implemented by the Australian health docket which relates to the aforementioned role. One of the standards stipulates that each health service organization must establish an incident monitoring system that facilitates reporting of incidents of patient ‘near misses’ and harm, and that which should be used by health service leaders to enhance care. Reporting of incidents to the clinical nurse specialist greatly helps in reducing serious harm among patients. When incidences are reported, the clinical nurse specialist will manage to embrace and implement measures which would help in curbing the trend or minimizing the occurrence of similar incidences in future. Another standard entails safe and appropriate prescription of antimicrobials (Australian Commission on Safety and Quality in Health Care, 2016). Nurses in the Australian health care system adhere to this standard by optimizing the use of antimicrobials through activities such as providing feedback to subscribers, prescribing audits, as well as prescribing restrictions. Another standard entails the aspect of nurses conducting regular screening of patients who are immobile or have extended bed rest. This is due to the fact that these patients tend to be at a high risk of developing pressure injuries. Another standard entails the aspect of nurses (off course being spearheaded by the clinical nurse specialist) to recognize and respond to clinical deterioration in acute health care in order to save life. This standard is mostly applicable to patients who have been admitted, including those who are at a risk of suffering from cardiac arrest.

Impact of the role in the health care system

The aspect of clinical nurse specialists optimizing patient care by evaluating current practices, consulting with patient care managers, reviewing alternatives and providing education to staffs and patients has a number of positive impacts in the health care system. For example, the aspect of establishing an interpersonal relationship with patients encourages the latter to be open with the former, and this creates a culture where patients can freely inquiry anything from the nurses. In most cases, nurses tends to have a poor relationship with the patients. For example, when a patient happens to ask a question concerning his or her health, most nurses tends to scorn them or respond in a rude manner, and this creates fear among the patients to such an extent that they may never inquire again. Precisely, in such a situation, the patients live with the fear that asking a question is bad within the health care setting. However, with the presence of a clinical nurse specialist, an open relationship is established, to such an extent that patients can ask anything including aspects which do not relate with health (Gurzick & Kesten, 2010). In the long run, the reputation and loyalty of the clinical nurse specialist and that of the entire health facility is enhanced.

Moreover, the aspect of orienting and educating new graduate nurses before they are allowed to work independently has also ensured that the quality of health care services that health consumers receive is up to standard. Precisely, by so doing, the new graduate nurses manage to not only meet the expectations of the patients, but also exceed them. Poor quality health care services has been among the major aspects that most of the patients complain about, since they are not only treated in a manner that they would not have wanted, but also being treated as lesser beings by nurses. When patients leave the health facility complaining of being mistreated by the health care professionals, they are less likely to come back in future when they happen to fall sick again, or even recommend other family members or friends to come in such a health facility. In addition, the clinical nurse specialist ensures that nurses are not overloaded in terms of having so many clients to attend to, as this may contribute to the occurrence of medical errors. The occurrence of medical errors do not only jeopardize the health of the patients by inflicting chronic or acute health conditions or injuries, but also contributes to the loss of trust between the health professionals and the health consumers (Cloete, 2015).

Moreover, clinical nurse specialists impacts the health care system by facilitating teamwork among nurses. It is worth noting that some of the factors which contributes to the occurrence of medical errors in the health care setting includes the aspect of health professionals working individually. However, when the clinical nurse specialist is present, he or she ensures that nurses work hand in hand as a team in the execution of various clinical roles that they have been assigned (Ortiz, 2016). For example, the new graduate nurses are encouraged to work closely with the other experienced nurses in order to not only manage to learn new insights concerning the job, but also to adapt to the culture of working as a team.

Critical analysis of the application of the role into my workplace

This role of clinical nurse specialist can be perfectly applied in my workplace in numerous ways. For example, just the same way clinical nurse specialists optimize patients` care by working hand in hand with the other nurses, I can as well ensure that the best results are achieved in the health care facility that I work for, by fostering teamwork and effective management of the workforce. One thing that is worth noting is that a team is always a pool of ideas, and even the challenging tasks can be accomplished when nurses or employees in general agree to work as a team. In the health care facility that I work in, there had been numerous cases of patients complaining of poor services as well as the manner in which they are perceived by the health care professionals. Sometimes I tend to bear with the situation since the number of nurses is small compared to the number of patients that each nurse is supposed to attend to in a day (the nurse-patient ratio is low). For this reason, most of the patients who visits the health care facility for the first time end up not turning u any other time in future due to the poor experience that they learnt during their first visit. Apparently, by putting all things constant, patients are supposed to be treated and discharged when they have become fully satisfied with the services that they receive. There is need for the adoption of measures that would optimize patients` care.

In addition, clinical nurse specialists optimize the patients` care by coming in to reduce the workload when need arises. Precisely, clinical nurse specialists are leaders by nature, especially due to the fact that they do not only intervene in helping the nurses to reduce the workload, but tends to be in the forefront in as far as orienting new nurse graduates on how to execute clinical tasks within the set duration and in accordance to the set quality standards (Garcia et al., 2017). In the health facility that I work in, new nurses are oriented by the existing nurses, in terms of being asked to examine how the nurses are performing their duties. However, due to the high workloads that characterize the facility, it sometimes becomes challenging for the existing nurses to orient new graduate nurses in an effective way. However, I will implement this role or culture in the workplace, by proposing the aspect of having a formal way of orienting new graduate nurses. When new employees are oriented on what the employer expects from them, they perceive themselves as valued assets of the organization, and this does not only enable them to deliver quality work, but also enhances their motivation to work extra harder as well as their loyalty to the employer.

My independent thought, interpretation and appraisal of the role

I strongly believe that the aspect of clinical nurse specialist to embrace and implement orientation of new graduate nurses as well as offering regular training programs to the nurses in order to help them in improving in their level of quality health care services is encouraging. By so doing, the clinical nurse specialist ensures that the nurses make health decisions based on the evidence that they have concerning the situation of patients. Making health decisions should be based on evidence based interventions in order to prevent the occurrence of medical errors. It is worth noting that health professionals are dealing with human life, which is precious and should be protected from being harmed or lost, and considering that medical errors jeopardizes the health and life of a patient, it is important for care to be taken by the nurses and the other health care professionals. I greatly appreciate the role of clinical nurse specialists in ensuring that the welfare of patients is taken care of by the nurses. In addition, the aspect of advocating and fostering teamwork among the health professionals is an important milestone in not only preventing the occurrence of medical errors, but also ensuring that challenging situations within the health care setting are solved as soon as possible. I also appreciate the role of clinical nurse specialists of focusing on how to optimize patients` care by evaluating alternatives rather than sticking to one model of care.

References

Australian Commission on Safety and Quality in Health Care, (2016). Vital Signs 2016. Retrieved from, https://www.safetyandquality.gov.au/wp-content/uploads/2016/11/Vital-Signs-2016-PDF.pdf

Cloete, L. (2015). Reducing medication errors in nursing practice. Nursing Standard, 29(20).

Garcia, M. G., Watt, J. L., Falder-Saeed, K., Lewis, B., & Patton, L. (2017). Orienting and Onboarding Clinical Nurse Specialists: A Process Improvement Project. Clinical Nurse Specialist, 31(3), 163-168.

Gurzick, M., & Kesten, K. (2010). The impact of clinical nurse specialists on clinical pathways in the application of evidence-based practice. Journal of Professional Nursing, 26(1), 42-48.

Hagerty T., Samuels W., Norcini-Pala A., and Gigliotti E., (2017). Peplau’s Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data? Nurs Sci Q. 2017 Apr; 30(2): 160–167. doi:  [10.1177/0894318417693286]

Ortiz, J. (2016). New graduate nurses’ experiences about lack of professional confidence. Nurse education in practice, 19, 19-24.

Zuzelo, P. (Ed.). (2010). The clincial nurse specialist handbook (Second ed.). Philadelphia, Pennsylvania: Jones and Bartlett.