Fundamentals of Nursing and Midwifery 2e

Chapter 18 Implementing person-centred care

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BOX 18- 2 Nursing and midwifery delegation and supervision guidelines

• The registered nurse or midwife must determine the level of skill and knowledge required to ensure the safety, comfort and security of the person prior to delegating care. This determination must be based on an accurate health assessment of the person, including consideration of the complexity of the care required rather than the tasks to be performed. • The delegation of nursing and midwifery care occurs between registered nurses and registered midwives, and registered nurses and midwives to enrolled nurses. The registered nurse and/or midwife may also delegate aspects of care, within a healthcare setting, to other healthcare workers. • The employer must ensure that there are clear role descriptions for other healthcare workers, supervision/delegation policies and communication systems to support the registered nurse and midwife in this role. • It is the registered nurse and midwife’s responsibility to provide direct or indirect supervision according to the nature of the delegated tasks. The registered nurse or midwife should understand the role and function of the enrolled nurse as well as the role and function of other healthcare workers to ensure that they are not required to function beyond the limits of their education, competence, experience and lawful authority. • Registered and enrolled nurses and midwives and other healthcare workers should only undertake activities for which they have legal authority and the competence to perform. The registered nurse and midwife retains accountability for evaluating whether the person carrying out the delegated activities maintains the relevant standards and outcomes. The person performing the delegated activity is accountable for their own actions and to the registered nurse or midwife. • Registered and enrolled nurses and midwives should maintain current knowledge and awareness of the appropriate legislation and bylaws relating to delegation and supervision in their state/territory of practice. Nursing and midwifery regulatory authorities’ policies and position statements reflecting the relevant legislative requirements may be an additional resource for nurses and midwives delegating care. • The registered nurse or midwife is responsible for assessing each delegated activity. • The registered nurse or midwife should be fully supported to enable supervision to occur. • An appropriately educated and experienced registered nurse or midwife may supervise across more than one setting. This is provided that the processes for supervision, and the context, are appropriate.

Source: Adapted from ANF, 2011.

for students and novice nurses and midwives to acquire. Organising responsibilities in this formal way can assist in developing time management skills. Caring for oneself It is difficult for nurses and midwives to be attentive to the needs of others if their own needs are not being met. Because no one is perfectly healthy or ‘whole’ all the time, it is important that students preparing for professional prac- tice spend time becoming self-aware. Activities that promote psychological health when practised on a regular basis include self-awareness, effective communication skills, time management, preparation for crisis and loss, developing and maintaining support systems, and concur- rent practice of self-care in all areas. The characteristics of emotional health include self-esteem, self-knowledge, satisfying interpersonal relationships, environmental mastery, stress management, a positive body image, a sense of humour and the ability to experience pleasure. Students who want to be competent practitioners learn early to care for themselves and others before attempting to care for people. Good personal health enables them not only to practise more efficiently but also to be a health role model for people and their families.

Whenever you are asked by a registered nurse or midwife to perform an intervention for which you lack training or that is outside the scope of practice determined by your curricu- lum, you should consult with your facilitator to see if you can safely perform it with supervision. Under no circum- stances should you attempt to perform interventions beyond your capacity without supervision, even if instructed to do so by a registered nurse or midwife. Students who work as assistants in nursing or enrolled nurses should not confuse this role with their current student role and not be tempted to perform these tasks, since they are more likely to be asked to perform interventions beyond their mastery.

GUIDE FOR STUDENTS ORGANISING CARE

Student nurses and midwives trying in advance to organise their care for a particular clinical day can use the guidelines for student clinical responsibilities outlined in Box 18-3 to help identify the care for which they will be responsible. After these have been identified, working out a time sched- ule may provide clear direction for the clinical day to ensure that the patient’s needs are met. Time management can be one of the most difficult skills of implementing care