Role and Career Opportunities for a Nurse

Terms of Reference

Accountability: Means that healthcare professionals are accountable to their selves and to others on the care received by the patients.

Adverse event: Refers to an incident that occurred in the hospital or any other clinical setting that resulted to harm or could have resulted to the patient’s harm.

Colleagues: Other healthcare professionals, co-workers, midwifery and nursing students.

Patient-centred care: A consideration of patient preferences, engagement and needs when making healthcare decisions.

Patient satisfaction: The perceived level of satisfaction on the quality of care they receive from their nurses.

Introduction

This report aims to discuss the role and career opportunities for a nurse. This report will include the qualification, skills and experience that are required to be a nurse in Ireland. A discussion on the daily work of a nurse with reference to health and safety issues will also be presented. Possible job opportunities for nurses in the Irish healthcare system will also be discussed. A conclusion will summarise the key points raised in this report.

Qualification, Skills and Experience Required to be a Nurse

The Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (Nursing and Midwifery Board of Ireland, 2014) lays out the skills and professional requirements necessary for registered nurses in Ireland. These skills include the ability to provide safe and quality care for different groups of patients, respecting the dignity of each patient, professional accountability and responsibility, quality care, collaboration and trust and confidentiality. Since nurses continue to professionally develop from newly registered to specialist nurses, it is expected that professional characteristics and skills would be honed as nurses begin their practice. One of the important skills required for quality patient-centred care is the ability to communicate effectively with patients and colleagues. Communication is defined as a two-directional process that could involve transmission and receiving of verbal and non-verbal messages (Kourkouta and Papathanasiou, 2014). Nurses have a crucial role in promoting the health and welfare of patients. Establishing a relationship of trust in the beginning of care is crucial in promoting effective communication (Houghton and Allen, 2005). The first meeting between a nurse and a patient is important since this could either reassure patients or convey fear and indifference (O’Daniel and Rosenstein, 2008). However, communicating with patients who suffer from cognitive impairment or are unable to communicate because of confusion and hypoxia is often difficult and challenging (O’Daniel and Rosenstein, 2008). In patients unable to verbally express themselves, nurses have to recognise non-verbal messages in order to determine the healthcare needs of the patients (Watson, 2008). For instance, facial expressions, body gestures and posture (Houghton and Allen, 2005) could help identity the patient’s feelings and needs. Effective communication is important in patient care since this will help facilitate timely and early intervention for the needs of the patients (Watson, 2008). Kourkouta and Papthanasiou (2014) argue that physical space, social and cultural values and psychological conditions have an impact on the communication between the nurse and patient and vice versa. Hence, it is crucial for nurses to identify the factors that promote effective communication and those that deter patients from communicating their needs with the nurses. For instance, a language barrier might lead to miscommunication or misinformation, which in turn, affects the quality of communication of the nurses and patients.

Apart from communication skills, healthcare professionals are also bound to provide safe and effective care as stressed in the Code of Conduct for nurses in Ireland (Nursing and Midwifery Board of Ireland, 2014). Avoidance of medication errors does not only promote safe and effective care but also prevents adverse events and death of the patients. Acquiring numeracy skills is a prerequisite in the preparation and safe administration of medications. However, Eastwood et al. (2011) suggest that a number of nursing students have poor numeracy skills. While applicability of the findings of these studies to a larger and more heterogeneous population is limited due to the small sample sizes, findings could show a trend on the numeracy skills of nursing students. These suggest the need to enhance nursing curriculum to ensure that students have sufficient numeracy skills to prepare and administer medications before they become registered nurses. It is noteworthy that these findings are not only seen in nursing students but also in registered nurses (Warburton, 2010). This indicates that there is a continuing need to train nurses on how to safely administer or prepare medications in order to prevent medication errors.

Another nursing quality that is associated with quality care is the ability to show empathy to patients. Empathy is described as the ability to share and understand the feelings of other people (Kinnell and Hughes, 2010). Developing this characteristic could calm down patients and let them feel that nurses are willing to listen to their concerns and are available to help them with their needs. Rana and Upton (2009) suggest that patients are satisfied with the care they receive if they perceive nurses to be empathic to their needs, feelings and concerns. Increasing levels of patient satisfaction is important since high levels are associated with better quality care (Rana and Upton, 2009).

The Code of Professional Conduct and Ethics (Nursing and Midwifery Board of Ireland, 2014) should also develop skills on how to collaborate effectively with others. This means that individuals also have to learn effective leadership skills in order to lead health care teams, introduce innovations and work in partnership with other agencies in order to improve care. It has been shown that the transformational leadership style is consistent with effective leadership (Bach and Ellis, 2011). This type of leadership requires leaders to develop empathy with their colleagues and patients. These leaders also tend to have high emotional intelligence (Bach and Ellis, 2011). Hence, developing the skills needed to become a transformational leader would be essential as a nurse. Further, collaborating with others requires skills on how to resolve conflicts.

Health and Safety Issues

Nurses working on clinical and primary care settings have some health and safety issues to consider. For example, nurses assigned to patients who are immobile often have to handle these patients manually. Failure to properly handle patients could lead to health issues such as musculoskeletal injuries (Cornish and Jones, 2007; Powell-Cope et al., 2014). The rising incidence of musculoskeletal injuries (Powell-Cope et al., 2014) is a cause of concern since guidelines are available for nurses and students on how to properly handle patients manually. Yet, it has been shown that adherence to these guidelines is not optimal for both students and registered nurses (Powell-Cope et al., 2014). This suggests that translating evidence and uptake of guidelines in actual practice still remains to be low despite aggressive implementation of these guidelines in clinical practice. Health and safety issues are often influenced by the culture present in the clinical setting (Powell-Cope et al., 2014). For instance, student nurses who observe registered nurses not following policies or guidelines might assimilate this bad practice once they become registered nurses (Cornish and Jones, 2007).

Apart from developing musculoskeletal injuries, nurses who work long hours are also at risk of nursing burnout. It has been shown that nursing burnout is associated with lower job satisfaction (Mrayyan, 2006). This in turn affects the psychological health of the nurses, their interaction with patients and reduces the quality of care they provide to their patients (Mrayyan, 2006). Hence, it is essential to consider the number of nursing staff and whether this could support the current needs of patients in healthcare settings. Further, nursing burnout also indirectly affects nursing-patient ratio since nurses who report burnout are more likely to leave their jobs (Mrayyan, 2006; Wong et al., 2013). This could lead to a high turnover of nursing, which in turn, affects the quality of care received by the patients.

Another important health and safety issue in healthcare setting includes percutaneous and needle-stick and sharp injuries. This health issue is related to poor compliance to universal precaution (Jacob et al., 2010). This is challenging since studies (Gershon et al., 2009; Jacob et al., 2010) have shown that nurses tend to report high knowledge and awareness on universal precaution. The risk associated with failure to observe universal precaution when handling sharp objects in clinical settings include increased risk of acquiring HIV infection, Hepatitis B and C (Mark et al., 2007; Elder and Paterson, 2007). Reporting of injuries is also crucial in maintaining the safety of nurses in clinical settings. However, current data on this type of injuries might not truly reflect actual practice since underreporting is often noted in published studies (Gershon et al., 2009). For instance, Gershon et al. (2009) report that 45% of percutaneous injuries were not reported. The incidence of percutaneous injuries highlights the need for consistent training of the nurses.

Job Opportunities

Nurses in Ireland have many job opportunities as demand of healthcare increases. Incidence of long-term conditions such as obesity, diabetes and heart diseases have increased in the last few decades (DHSSPS, 2012). This requires specialist care from nurses. Further, the ageing population also means that individuals are living longer and hence, might require additional care to ensure longevity or address chronic conditions that affect older persons (DHSSPS, 2012). Newly registered nurses could acquire experience and develop to become specialists in their respective fields. For example, there is a need for specialist nurses such as diabetes nurses to manage patients suffering from type 1 and type 2 diabetes. On the other hand, mental health nurses are required in community and clinical settings to manage patients suffering from schizophrenia, depression, postpartum psychosis, depression and other mental health conditions. Learning disability nurses provide support and care management to patients and their families suffering from learning disabilities. Meanwhile, paediatric nurses provide care to pediatric patients.

Nurses could also choose to specialize to become part of surgical theatre teams. Others could also opt to become mentors, cardiology nurses or respiratory specialists. Nurses who are now specialists could also choose to further hone their skills and qualify as a nurse prescriber. These nurses could prescribe medications from their own field of specialty only (Nursing and Midwifery Board of Ireland, 2015). It has been shown that inclusion of nurse prescribers allow continuity of care and higher patient satisfaction (Nursing and Midwifery Board of Ireland, 2015). Patients report that they are also satisfied with the type of care they receive from nurse prescribers and view them as showing more empathy and sensitivity to their situations. However, it should be noted that nurses who choose to become specialists or nurse prescribers have to engage in continuing professional development, earn a Master’s degree in nursing or continue to train in their respective fields. Hence, learning is seen as continuous when an individual engages in the nursing profession. Since this is a caring profession, nurses are also expected to show empathy and compassion to their patients. These characteristics are often honed as nurses become highly specialised in their chosen fields.

Conclusion

Nursing is a caring profession that aims to provide quality, patient-centred care to the patients. Preparing to become a registered nurse in Ireland requires earning a nursing degree. The path to becoming an effective nurse begins in the nursing student years. Developing attitudes such as empathy, compassion, responsibility and accountability and practical skills such as numeracy skills could all promote quality care. As patients perceive their nurses to reflect these attitudes and skill, they would be reassured that their nurses truly care and are willing to manage their health condition. This essay also argues the importance of developing communication skills in order to identify the needs of the patient and introduce early interventions. However, becoming a nurse is also challenging because of health and safety issues. These include the risk of musculoskeletal, percutaneous and needle-stick injuries. Some nurses, due to a low nurse-patient ratio, may also suffer from nursing burnout. Once this occurs, this might lead to poor job satisfaction and high nursing turnover. Quality of patient care is affected when there are fewer and dissatisfied nurses. Finally, this essay shows that there are many job opportunities for nurses in Ireland.

References

Bach, S. & Ellis, P. (2011) Leadership, Management and Team Working in Nursing. Exeter: Learning Matters.

Cornish, J. & Jones, A. (2007) ‘Evaluation of moving and handling training for pre-registration nurses and its application to practice’, Nurse Education in Practice, 7(3), pp. 128-134.

Department of Health, Social Services and Public Safety (2012) Living with long term conditions: A policy framework. Dublin, Ireland: Department of Health, Social Services and Public Safety.

Eastwood, KJ, Boyle, MJ, Williams, B, & Fairhall, R (2011) ‘Numeracy skills of nursing students. Nurse Education Today. 31(8) November. pp. 815-818.

Elder, A. & Paterson, C. (2006) ‘Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices’, Occupational Medicine, 56 (8), pp. 566-574.

Gershon, R., Pearson, J., Sherman, M., Samar, S., Canton, A. & Stone, P. (2009) ‘The prevalence and risk factors for percutaneous injuries in registered nurses in the home health care sector’, American Journal of Infection Control, 37(7), pp. 525-533.

Houghton, A. & Allen, J. (2005) ‘Doctor-patient communication’, British Medical Journal Career Focus, 330, pp. 36-37.

Jacob, A., Newson-Smith, M., Murphy, E., Steiner, M. & Dick, F. (2010) ‘Sharps injuries among health care workers in the United Arab Emirates’, Occupational Medicine, 6(5), pp. 395-397.

Kinnell, D. & Hughes, P. (2010) Mentoring Nursing and Healthcare Students. London: SAGE.

Kourkouta, L. & Papathanasiou, I. (2014) ‘Communication in nursing practice’, Materia Socio Medica, 26(1), pp. 65-67.

Mark, B., Hughes, L., Belyea, M., Chang, Y., Hofmann, D., Jones, C. & Bacon, C. (2007) ‘Does safety climate moderate the influence of staffing adequacy and work conditions on nurse injuries?’, Journal of Safety Research, 38(4), pp. 431-446.

Mrayyan, M. (2006) ‘Jordanian nurses’ job satisfaction, patients’ satisfaction and quality of nursing care’, International Nurse Review, 53(3), pp. 224-230.

Nursing and Midwifery Board of Ireland (2014) The Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives. Ireland: Nursing and Midwifery Board of Ireland [Online]. Available from: http://www.nursingboard.ie/en/code/new-code.aspx (Accessed: 15 June, 2015).

Nursing and Midwifery Board of Ireland (2015) What are NMBI’s professional regulations and guidance for nurse/midwife prescribing? [Online]. Available from: http://www.nursingboard.ie/en/prescriptive_authority.aspx#faq2 (Accessed: 15 June, 2015).

O’Daniel, http://www.nursingboard.ie/en/prescriptive_authority.aspx#faq2 M. & Rosenstein, A. (2008) Professional communication and team collaboration. In: Hughes, R. (ed.), Patient safety and quality: An evidence-based handbook for nurses. Rockville (MD): Agency for healthcare research and quality.

Powell-Cope, G.,Toyinbo, P., Patel, N., Rugs, D., Elnitsky, C., Hahm, B., Sutton, B., Campbell, R., Besterman-Dahan, K., Matz, M., Hodgson, M. (2014) ‘Effects of a National Safe Patient Handling Program on Nursing Injury Incidence Rates’, The Journal of Nursing Administration, 44(10), pp. 525-534.

Rana, D. & Upton, D. (2009) Psychology for nurses. London: Pearson.

Warburton, P. (2010) ‘Numeracy and patient safety: the need for regular staff assessment’, Nursing Standard (Royal College of Nursing, Great Britain), 24(27), pp. 42-46.

Watson, D. (2008) ‘Pneumonia 2: Effective nursing assessment and management’, Nursing Times, 104(5), pp. 30-31.

Wong, C., Cummings, G. & Ducharme, L. (2013) ‘The relationship between nursing leadership and patient outcomes: A systematic review update’, Journal of Nursing Management, 21(5), pp. 709-724