Three graduates talking about scope of practice, skill mix and delegation.

Assessment 1. Transcript. NSB305 Semester 2 2018.

Three graduates talking about scope of practice, skill mix and delegation.

Helen: Hi Shirly, Hi Darren, Hi Daria. How have you been? How’s your first year as a registered nurse going?

Shirly: Hi Helen. Well I have been in the graduate program for about 6 months now. I am just starting to

feel as though I am finding my feet. But sometimes I still feel a bit lost and at times, I do wonder if I am not

working outside of my scope of practice. This happens mostly on evening and night shifts when there aren’t

a lot of people around to ask for help or advice. I remember we were told at uni about it being our own

responsibility to provide safe care and to not work outside of our scope of practice; no matter what. But

sometimes it’s really difficult. Like last week, I was on a night shift and a patient’s naso gastric tube had

come out. I knew that it had to be reinserted but, apart from in the clinical practice sessions and watching a

couple on the ward, I hadn’t done one before. And there was no one to help me, so I just did it. I think the

patient was OK, but I know that that is not good practice but what else do I do? I am worried about being

accountable for doing the wrong thing.

Darren: Yes Shirly, I am finding similar things. Finding the support you need on evenings and night shifts can

be difficult and I have found that at times the skill mix is just wrong. One day during report, I counted 5

senior RN’s on the morning shift but apart from the team leader (who was a 2nd year RN) and I, we were the

only other RN’s on the PM shift. It was pretty scary stuff and because the team leader was so busy, I was

constantly double checking myself, so I got behind in my work. It didn’t help that we had patients coming

back from theatre and the team leader said that I had to get them all as she didn’t want to leave me alone

on the floor in case the EEN’s needed close supervision with delegated tasks that I was not able to do. This

didn’t make me feel any better. It jest kept ringing in my head. Whatever happens here, you are not just

responsible you are accountable as well. I must say that I felt a bit overwhelmed.

Daria: Oh delegation! It’s my greatest headache. I know that delegating tasks to others can really help me as

a graduate to learn and focus on registered nurse work, but I really struggle with deciding what tasks to

delegate and who to delegate them to. I worry that the EEN’s think that I am just lazy and trying to get rid of

the jobs that I don’t wat to do. This I see the other RN’s delegating, but I don’t think that they are really

making sure that the person they delegate to understands the task nor do they appear to be supervising or

supporting them. Last week, a patient feel in the shower. The assistant in nursing doing the shower hadn’t

realised that the patient always needed someone with them and went back into the ward area to make the

bed. So while I am also constantly aware that I have a responsibility to delegate, and I know that it will help

me keep up with my work, the concern that I am accountable if anything goes wrong, really worries. Me.

Helen: Thanks everyone. I know that it is tough when what happens in the clinical are does not always meet

your expectations, but it is great that you are aware of the difficulties so that you can work towards finding

ways to improve the working environment. Just be sure that you work within your codes of practice and

standard guidelines. This will give you direction and reassure you that you are meeting best practice

principles. This is an exciting time for you and its really helpful to hear your experiences as a graduate nurse.