Critically analyse the nurses' roles and responsibilities within care provision

Nurses have a range of roles and responsibilities in order to provide society with the highest quality of care (Peate, 2016). The Royal College of Nursing (RCN, 2014:3) define nursing as the ability to ‘improve, maintain, or recover health, to cope with health problems, and to achieve the best quality of life’ for patients until their death. This essay will critically analyse the nurses’ role and responsibilities within care provision, discussing their role as a primary caregiver, a leader, advocate, educator, collaborator, practitioner, in addition to their responsibilities in line with professional codes of practice (Nursing and Midwifery Council, 2015).

The nurse has a role as a primary caregiver, adhering to succinct evidence-based practice in order to meet the holistic needs of every patient and their families through the use of clinical judgement and expertise (RCN, 2017). They show compassion and knowledge in order to provide direct care to patients within each setting or different environments (Masters, 2015). Illness prevention and the promotion of public health initiatives are also vital roles in nursing care (Joel, 2017). However, political and societal issues place strain on the nursing workforce, hindering their ability to adhere to their roles which can negatively impact on the provision of high quality care (Ryan, 2018). For instance, with the introduction of an English test by the Nursing and Midwifery Council following Brexit, the number of EU nurses has reduced by 89% (Tapper, 2017). Furthermore, the government has removed the nursing bursary, which in turn has led to a reduction in the number of nursing students, thus leading to nurse shortages (Adams, 2017). Many nurses have stressed that they find it difficult to carry out their roles and responsibilities as a healthcare professional (Tapper, 2017).

Nurses must act as leaders, coordinating care as members of multidisciplinary care teams, contributing to a collaboration of care (Crowell, 2015). This involves physical and psychosocial assessment, provision of education, support and diagnostic testing to navigate patients through appropriate care pathways (Crowell, 2015). The nurse coordinator is a key resource for patients and families who are an integral point of contact during their care (Weberg et al, 2018). Nurse leaders need to continually contribute to the development of other healthcare professionals, ensuring that they are educated and equipped with evidence-based knowledge in order to provide high quality care (Weberg et al, 2018). Different leadership styles can be utilised to carry out this role, primarily the use of a transformational style. A transformational style encourages and motivates other staff members to improve the provision of care, without dictating information (Marshall, 2016). However, a more transactional leadership style is necessary in time-sensitive, critical situations (Stanley, 2016). These aspects are considered within the role of nurse leaders.

Nurses also act as advocates and educators, ensuring appropriate information is relayed to patients, enabling informed decisions which are fundamental to maintain patients’ autonomy (Scott, 2017). This includes developing therapeutic relationships to support and empower patients (Stein-Parbury, 2017). The nurse must provide holistic care in order to meet unmet needs through professional intervention (Weberg et al, 2018). This is especially important if a patient lacks the capacity to make informed decisions and so the nurse is responsible for adhering to health legislation (McEwen and Wills, 2017). The Mental Capacity Act 2005 provides the framework in order to protect a patient who cannot make an informed decision. Nurses should carry out an assessment in order to evaluate levels of capacity, in an appropriate manner in which the patient can understand. If the patient is found to lack capacity, the least restrictive option should be chosen in order to provide care in their best interests (McEwen and Wills, 2017). Nurses must also be aware that capacity can change at any moment and so succinct clinical judgement is key in order to provide high quality and ethical care (Stanley, 2016).

Another important role of the nurse is as an educator, to patients, families, society, other healthcare professionals and students (Bastable, 2017). Within a hospital environment, they provide knowledge about illness and teach patients how to self-manage their conditions (Bastable, 2017). Emphasis and facilitation of self-care are vital components of nursing, especially as approximately 15 million individuals within England have one or more long-term condition (RCN, 2018). Furthermore, with the increasing concern of antimicrobial resistance, education and self-care are important, to ensure that antibiotics are taken correctly to uphold the health of society (RCN, 2018). Health education is a necessity and a key responsibility of nurses throughout the world (Bastable, 2017).

Nurses must ensure they collaborate with other professionals within multidisciplinary teams, remaining accountable with sound clinical judgement and excellent communication skills (Joel, 2017). They must appreciate the expertise of other professionals and learn from their experience in order to care holistically for patients (Bogaert and Clarke, 2018). This must include adherence to patient and family- centred care, with enthusiasm to work towards the best patient outcome (Finkelman, 2017). This role is grounded within professional and personal values, expertise, theories and practice that encompass innovative and evidence-based care, whilst complementing other healthcare providers (Joel, 2017). Patient-centred care is beneficial in that is ensures patients are treated with compassion and respect (Finkelman, 2017). Improvements are also witnessed in regards to staff performance and morale when patient-centred care is provided (Stein-Parbury, 2017).

Nurses have the responsibility to remain up-to-date with relevant evidence-based research in addition to adhering to professional standards of practice (Ellis, 2016). These standards are in place to create boundaries and a level of accountability (NMC, 2015). This will incorporate various aspects such as ethics, competence, knowledge, confidentiality, accountability and how evidence can be applied in a practical environment (Avery, 2016). Nurses are held accountable for every aspect of care, with continual documentation under the direction of management (Standing, 2017). Ethical principles are also adhered to, such as a patient’s right to autonomy, non-beneficence, maleficence and justice (Beauchamp and Childress, 2013). However, the individual self-perception of one’s role can differ, influenced by individual background, societal attitude, government policies and trends (Joel, 2017). Within contemporary nursing, role theory can be used to theoretically explain the role of the profession, with Brookes et al. (2007) noting three main perspectives that emerge from evidence-based research. They include; social structuralism, symbolic interactionism and a dramaturgical perspective. Social structuralism argues that a nurses’ role will differ in regards to different structures within society throughout time, whereas symbolic interactionism is in relation to a nurses’ environment. Dramaturgical theory notes a connection between time, place and audience (Brookes et al, 2007). However, quality assurance is expected of all nurses, within standards, legislation and society (Sherwood and Barnsteiner, 2017). These standards ensure that all professionals are providing care with utmost competence and the ability to apply evidence-based research within practice. The nurse has a responsibility to remain up-to-date and educated, as quality assurance standards across many different environments, countries and time are in a continual state of evolution (Brown, 2017).

Upholding confidentiality is an additional responsibility of a nurse, that is mandatory in order to provide high quality patient care (Tingle and Cribb, 2013). Privacy is a key aspect of legislation within the UK and throughout the world, as nurses are expected to maintain confidentiality, in terms of medical records and verbal conversations (Drury, 2017). It is discussed in detail within the Nursing and Midwifery Council Code of Conduct, to uphold dignity and to provide high quality care (NMC, 2015). However, from a critical perspective there are times in which this idealism may be breached, to uphold the health of the patient or society (Blightman and Griffiths, 2013). The legitimate exceptions to confidentiality rights are in relation to disclosures with consent, disclosures required by legislation and those made in society’s best interests (Blightman and Griffiths, 2013). The NHS has historically struggled to uphold patient confidentiality, which led to the Caldicott Report, outlining a succinct process in order to protect and maintain privacy (Peate, 2012). This includes the need to justify disclosure, utilise the minimum amount of information necessary, maintain anonymity when possible, access on a ‘need-to-know’ basis and strict adherence with the law (Herring, 2015). This extends to social media platforms in which patient information should never be disclosed (Blightman and Griffiths, 2013). Confidentiality and disclosure is also influenced by capacity and so nurses have a legal and professional duty of care to consider capacity when consent is expressed (Joel, 2017). This can be challenging if a patient is in severe pain which can impact upon conscious levels and so clinical judgement is a necessity (Griffith and Tengnah, 2017).

Nurses should also appraise their abilities, in relation to strengths, weaknesses and their preferences during the provision of care (Stanley, 2016). This should involve the process of self-analysis, to recognise one’s abilities in line with the care standard necessary, with realistic expectations to maintain high quality, safe care (Stanley, 2016). Nurses need to be able to recognise early signs and symptoms of illness, to take quick and appropriate action in addition to noting potential problems that could arise (Gulanick and Myers, 2016). This involves a succinct understanding and initiation of assessment, analysis, diagnosis, planning, an intervention and evaluation of the provision of care (Gulanick and Myers, 2016). Furthermore, these stages should be documented in a clear and concise manner, without the use of jargon or abbreviated terms in order to enhance patient-centred care and understanding (Monsen, 2017). During the provision of patient care, nurses are also required to remain self-aware, in order to evaluate personal strengths and an awareness of when to ask for help in line with personal limitations (Monsen, 2017). This upholds patient safety and the provision of high quality care (Stein-Parbury, 2017). Lastly, a nurse must be organised, with the ability to prioritise workloads in order to uphold their role (Monsen, 2017).

To conclude, the roles and responsibilities of a nurse have advanced within different spheres of practice, which will continue to adapt as healthcare within the UK evolves. As discussed, a nurse’s role is influenced by social structuralism, symbolic interactionism and a dramaturgical perspective (Brookes et al, 2007). The role and responsibility of the profession will change in regards to self-perception, influence of society, environment, time place and audience. Legislation also affects the role of a nurse, with ever changing political and legislative focus. However, there are aspects of the role which continue to prevail. For instance, the need to uphold confidentiality, dignity, competency and adhere to professional standards. Ultimately, the main role of a nurse is to provide high quality, safe care to all patients within society, with compassion, humanity, effective leadership and collaboration within multi-disciplinary teams to uphold good standards. This is in line with the Nursing and Midwifery Code of Conduct, which outlines the professional practice necessary to provide high quality care. Self-awareness is also paramount, to note personal strengths and limitations in order to uphold a sense of accountability, safe practice and protection against litigation. If nurses do not uphold the perceived roles and responsibilities of a nurse, they may be subjected to the legal implications which may impact on their ability to practice as a nurse.

Bibliography

• Adams, R. (2017) ‘Nursing Degree Applications Slump after NHS Bursaries Abolished,’ The Guardian, 2nd Feb 2017. Available at: https://www.theguardian.com/education/2017/feb/02/nursing-degree-applications-slump-after-nhs-bursaries-abolished Accessed: 24.02.18
• Avery, G. (2016) Law and Ethics in Nursing and Healthcare: An Introduction, London: Sage.
• Bastable, S. (2017) Nurse as Educator: Principles of Teaching and Learning for Nursing Practice, London: Jones and Bartlett Learning.
• Beauchamp, T, Childress, J. (2013) Principles of Biomedical Ethics, Oxford: Oxford University Press.
• Blightman, K, Griffiths, S. (2013) ‘Patient Confidentiality: When can a Breach be Justified?’ BJA, 2 (1) pp.52-56.
• Bogaert, P. Clarke, S. (2018) The Organisational Context of Nursing Practice: Concepts, Evidence and Interventions for Improvement, London: Springer.
• Brookes, K, Davidson, P, Daly, J, Halcomb, E. (2007) ‘Role Theory: A Framework to Investigate the Community Nurse Role in Contemporary Health Care Systems,’ Contemp Nursing, 25 (1-2) pp.146-155.
• Brown, J. (2017) Evidence-Based Practice for Nurses, Burlington: Jones and Bartlett Learning.
• Crowell, D. (2015) Complexity Leadership: Nursing’s Role in Health-Care Delivery, Philadelphia: Davis Company.
• Drury, P. (2017) Core EU Legislation 2017-2018, London: Palgrave MacMillan.
• Ellis, P. (2016) Evidence-based Practice in Nursing, London: Sage.
• Finkelman, A. (2017) Professional Nursing Concepts: Competencies for Quality Leadership, London: Jones and Bartlett Learning.
• Griffith, R, Tengnah, C. (2017) Law and Professional Issues in Nursing, London: Sage.
• Gulanick, M, Myers, J. (2016) Nursing Care Plans: Diagnoses, Interventions and Outcomes, London: Elsevier.
• Herring, J. (2015) Medical Law, London: Routledge.
• Joel, L. (2017) Advanced Practice Nursing: Essentials for Role Development, Philadelphia: Davis Company.
• Marshall, E. (2016) Transformational Leadership in Nursing, London: Springer.
• Masters, K. (2015) Role Development in Professional Nursing Practice, Burlington: Jones and Bartlett Publishing.
• McEwen, M, Wills, E. (2017) Theoretical Basis for Nursing, London: Lippincott Williams and Wilkins.
• Monsen, K. (2017) Intervention Effectiveness Research: Quality Improvement and Program Evaluation, London: Springer.
• NMC. (2015) The Code, London: NMC.
• Peate, I. (2016) The Essential Guide to Becoming a Staff Nurse, London: Wiley Blackwell.
• Peate, I. (2012) The Student’s Guide to Becoming a Nurse, London: Wiley Blackwell.
• RCN. (2018) Self Care, London: RCN.
• RCN. (2017) Principles of Nursing Practice, London: RCN.
• Royal College of Nursing. (2014) Defining Nursing, London: RCN.
• Ryan, F. (2018) ‘Waiting for an Ambulance, Unable to Breathe, Brings Austerity Home,’ The Guardian, 8th February 2018. Available at: https://www.theguardian.com/commentisfree/2018/feb/08/ambulance-austerity-cuts Accessed: 24.02.18
• Scott, A. (2017) Key Concepts and Issues in Nursing Ethics, London: Springer.
• Sherwood, G, Barsteiner, J. (2017) Quality and Safety in Nursing: A Competency Approach to Improving Outcomes, London: Wiley Blackwell.
• Standing, M. (2017) Clinical Judgement and Decision Making in Nursing, London: Sage.
• Stanley, D. (2016) Clinical Leadership in Nursing and Healthcare: Values into Action, London: Wiley Blackwell.
• Stein-Parbury, J. (2017) Patient and Person: Interpersonal Skills in Nursing, London: Elsevier.
• Tapper, J. (2017) ‘Difficulty of NHS Language Test ‘Worsens Nurse Crisis’, Says Recruiters,’ The Guardian, 24th June 2017. Available at: https://www.theguardian.com/society/2017/jun/24/english-speaking-ovserseas-nurses-fail-nhs-too-tough-language-test Accessed: 24.02.18
• Tingle, J, Cribb, A. (2013) Nursing Law and Ethics, London: Wiley Blackwell.
• Weberg, D, Porter-O’Grady, T, Mangold, K. (2018) Leadership in Nursing Practice, London: Jones and Bartlett Publishing.