Exploring Enrolled Nurse Scope Of Practice: A Critical Analysis

HLTEN508B: Apply Reflective Practice

Factors impacting changes to Enrolled Nurse practice

The nurse, in this given case study, failed to apply critical thinking and analysis, while providing medication to the patient. As the patient was not ready to wait for the treatment, she could have thought critically and asked any physician about the patient’s situation (Butts and Rich 2012). This would have helped the patent properly, as she could have a well documented prescription, depending on which her medication could have been resumed. Further this action would not violate the Australian nursing guideline and could comply with the standard 3 of the nursing ethical practices according to which, professional communication should be done for patients betterment and professional development (Chadwick and Gallagher 2016). This is the identified situation, where the nurse could have applied her critical thinking.

In the given case study, the nurse did not worked according to the Australian Nursing and Midwifery Federation Standards (ANMFS) (Australian Nursing and Midwifery Federation Standards 2018). According to these guidelines, nurses are a part of safe, efficient and high quality primary care and therefore it is there duty to contribute in strengthening primary care. This guideline provides the Australian nurses with the scope of performing functions, roles, and activities that other individuals of similar authority can perform within the organization, without harming the patient’s rights and nursing ethical code of conduct (Australian Nursing & Midwifery Federation 2018). The most important fact of code of practice according to NMBA foundation is that the nurses should not indulge in actions that can harm the image of the healthcare organization and their own Nobel profession (Nursing and Midwifery Board of Australia 2017).

However, in the given case study, the enrolled nurse, while working in the emergency department intentionally breached the code of practice and provided medicines without any proper prescription and authorization from medical officer. Further, she made wrong entry in the medical record of the patient (Nursing and Midwifery Board of Australia 2017). These activities not only questioned her ethical morality but also risked the patient’s health by providing complex medication without taking consent from physicians. Therefore, the nurse did not acted according to their code of practice.

While working in a healthcare service, the nurses should follow the 22 standards of the nursing practices that reflect the broadening of the service. These standards are basic for any registered or enrolled nurses so that they can serve in healthcare services within the boundary of ethical standards. There are 5 standards of nursing practices that provides a wide array to the code of conduct (Australian Nursing and Midwifery Federation Standards 2018). In the given study, the nurse, however failed to comply with the ethical practices.

1. She did not followed the standard 2 according to which, the nurse should provide the current and consistent practice to the patient with compliance to legislation, guidelines, regulations and standards. Her action of providing medication without the consent of physicians and medical officer and making false entry in the medical register, violated the second standard of ethical practice.
2. She further violated the standard 1 according to which, she should understand the primary care service and healthcare principles prior to making any decision. She should inform her seniors about the condition of patient and seek help prior to providing medication without any prescription.

Considerations in viewing scope of practice for nurses

According to the Code of Professional Conduct for nurses and Midwives, in this given case study, the nurse breached the three of these conduct statements

1. The nurse breached the ethical code of conduct by not informing the seniors about the condition of patient and providing her with medication without any prescription.
2. The nurse breached the national practice standards due to the above-mentioned action.
3. The nurse breached the ethical code of conduct and professional ethics of conduct by entering wrong information in the register (NMBA 2018).

The Australian Health Practitioner’s Regulatory Authority has a number of acts that the nurses should adhere to while serving in any healthcare agency. There are ethical code of conduct that every employee of any organization should maintain to effectively work in organization. However, violation of these codes can provide the organization to take necessary action against such employee. In case of nursing profession, the AHPRA regulates these situations. As per the given case study, the nurses should be adhere to the Health Practitioner Regulation National Law Act 2010 (AHPRA 2018).

In this given case study, one such event that contravened the legal or professional standards of nurses was entering false data in the medical register. For any organization, register is the way to keep track of their progress, potholes and aspects that possess chances to improve. However, the nurse, while making ethically wrong decision, breached the professional code of conduct and entered wrong details about the patient in the registered. Hence, due to the wrong entry, the hospital authority would not be able to track the patient and stop her taking those medicines that can hamper her health. Hence, this situation can be denoted as professional and legal violation.

As the nurse has already made the mistake, the professional development plan made for her should provide her knowledge of the nursing ethical code, the professional code of conduct while serving in an organization and finally the roles, responsibilities and boundaries of that nurse as an enrolled nursing professional (NMBA 2018).

1. Training: The nurse will be provided with training about ethical codes, and nursing standards so that she can easily understand her abilities and disabilities as an enrolled nurse of the organization.
2. Narrative- She should be narrated about the nursing principles and standards so that she can comply herself every time she faces any problematic situation.
3. Expertise assistance- She will be assigned to assist an experienced registered nurse so that she can be monitored through experience vigilance every moment.

As per the case study, the two main issues that reflects the seriousness of the situation was the communication gap that the nurse created by not discussing her dilemma with seniors and provided the patient with crucial antibiotics. On the other hand, the nurse entered fake data in the medical book and this was another serious breaching of the professional code of conduct. These both issues were serious enough that can affect the image of the organization. As well as the patients’ health was risked in the situation, that breached the nursing standards. These two situations were identified as serious for both patient, and the organization.

The three benefits of the reflective practice-

1. It provides an opportunity to assess the situation and note every situation that happened in the setting. Further, it helps to evaluate the risks of those actions and determine the processes authenticity (Thompson and Pascal 2012).
2.  It helps to understand the mistakes or loopholes in the process and finds a way out to not repeat those mistakes again.
3. It helps the nursing professions to make a plan and implements it so that the mistakes and problems they faced while performing the task, cannot occur again (Thompson and Pascal 2012)

References

AHPRA 2018. Australian Health Practitioner Regulation Agency – Legislation. [online] Ahpra.gov.au. Available at: https://www.ahpra.gov.au/about-ahpra/what-we-do/legislation.aspx

Australian Nursing & Midwifery Federation 2018. Australian Nursing & Midwifery Federation. [online] Anmf.org.au. Available at: https://anmf.org.au/pages/professional-standards

Australian Nursing and Midwifery Federation Standards 2018. Australian Nursing and Midwifery Federation Standards. [online] Anmf.org.au. Available at: https://www.anmf.org.au/documents/National_Practice_Standards_for_Nurses_in_General_Practice.pdf

Butts, J.B. and Rich, K.L., 2012. Nursing ethics. Jones & Bartlett Publishers. https://books.google.co.in/books?hl=en&lr=&id=9R_ET0JLvEwC&oi=fnd&pg=PR5&dq=nursing+ethical+principles&ots=faDbJPdxZE&sig=saPjKWa6IT-9EwJRuIYKNmTczSs#v=onepage&q=nursing%20ethical%20principles&f=false

Chadwick, R. and Gallagher, A., 2016. Ethics and nursing practice. Palgrave Macmillan. https://books.google.co.in/books?hl=en&lr=&id=vG6CDAAAQBAJ&oi=fnd&pg=PP1&dq=nursing+ethical+principles+australia&ots=_Ja7rVITdi&sig=JekliFG_VyuwBhVP_Kn_jv250-4#v=onepage&q=nursing%20ethical%20principles%20australia&f=false

NMBA 2018. Nursing and Midwifery Board of Australia – Guidelines. [online] Nursingmidwiferyboard.gov.au. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx

Nursing and Midwifery Board of Australia 2017. Nursing and Midwifery Board of Australia – Professional standards. [online] Nursingmidwiferyboard.gov.au. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Thompson, N. and Pascal, J., 2012. Developing critically reflective practice. Reflective practice, 13(2), pp.311-325.