Shared governance:
Shared governance is a necessary responsibility of nurse to ensure proper team collaboration and effectiveness in work. It involves effective collaboration with multi-professional team to improve patient outcomes. Shared governance setting has improves satisfaction level of nurses and improved retentions of nurse in practice (Butao et al., 2016). I believe I have demonstrated this responsibility in my nursing practice by working together as a team and being accountable for the health of patient.
While on placement in a hospital as a student nurse, I was assigned the role of caring for a 55 years old patient with diarrhoea. I was working under the instruction of the senior nurse and the senior nurse instructed me to give certain antibiotics to patient during lunch time. However, the issue I faced at that time was that while the patient was taking his medication, he suddenly choked while swallowing water. I observed the patient panicked and he was gasping for breath. I was aware about several such incidents when choking leads unconsciousness and even death in person (Simpson 2016). Anticipating serious risk to the patient, I immediately called the doctor as I was not aware about immediate intervention to clear the airway of patient. While the doctor was observing the patient, I also informed patient’s family members about the issue after taking permission from doctor. The doctor performed an abdominal thrust to clear the blockage of air. After the patient was calm after sometime and he had to take his lunch, I consulted the dietician regarding any possible measure or diet changes that is needed for patient. This process of consulting relevant member of the health care team when required is in accordance with the national competency standard for registered nurse. It helps in demonstrating accountability within nursing practice (Nursing and Midwifery Board of Australia 2017). I also asked patient about his condition after lunch and called the speech pathologist to finally maintain optimal health of patient. In this way, proper way of collaboration with inter-professional team helped me to prevent any adverse event. Hence, it can be concluded that shared governance structure is necessary to support the nurse to take part in decision making and promote continuous improvement in professional skills.
Clinical governance:
Clinical governance is a system where health care staffs are accountable for continuously improving the quality of service and maintaining high standards of care. A nurse can facilitate clinical governance by contributing to a safe and healthy work environment (Smith, Latter and Blenkinsopp 2014). This is done by means of having right skills to accomplish the task. In case of nurse, the practice of clinical governance means practicing in a competent, legislated and authorised manner. This means having the right skills for the job and engaging in quality processes, accountability and performance management in practice (Twigg and McCullough 2014).
I have demonstrated clinical skills in my role as a student nurse while administrating medication to a 30 year old woman with acute pain. I was committed towards my work and completing the activity of medication administration in an appropriate manner. I followed all the six rights of medication administration during my duty. For instance, right medication, right route, time, client, dosage and documentation are the 6 R’s of medication administration (Latimer et al. 2017). Firstly, I reviewed the medication order. I found the writing illegible, so I confirmed about the medication again by consulting my senior nurse. Before providing the medication on the given time, I also assessed the client’s condition and have brief report to my senior nurse. As the medication needs to be given by IV route, I reviewed the Australian drug handbook to get all information about IV medication. I also informed patient regarding certain side effects of medication and being careful while getting up due to dizziness feeling after taking the medication. Finally, I completed the responsibility of documentation by vital sign assessment of patient and taking feedback regarding relief from pain (Radtke 2013). By this activity, I was successful in implementing my clinical skills in the right manner and promoting safety of patient. I fulfilled all my duty of care and clarified responsibility with other members of the team as mentioned in the competency standard for the registered nurse (Nursing and Midwifery Board of Australia 2017). Hence, such form of clinical governance is useful for fulfilling the provision of care.
Self governance:
Self-governance is the personal characteristics of professional staffs to focus on ongoing professional development in their career. Pool et al., (2016) has affirmed that nurse must critically reflect in their practice to understand the need for continuous professional development. This will help them to professionally grow in practice and fulfil self-governance role. I have demonstrated self-governance by identifying learning needs and developing my skills by taking part in continous development programme.
As a student nurse, I was only aware of the purpose of doing an ECG. However, reviewing and interpreting the ECG report was not a skill that I had mastered. I realized the need to learn about interpreting ECG report in my nursing practice when I was placed in CCUI and my senior asked me to see the report and tell what was the problem in patient. I could not answer at that time I could not interpret the waves and the graphs. This event motivated me to engage in continuous professional development for interpretation of ECG. The registered nurse standards of practice also states that participating in ongoing professional development is necessary for nurse, hence I decided to learn this skills as soon as possible (Nursing and Midwifery Board of Australia 2017). When I got time from my placement, I contacted my facilitator again and asked him regarding services that could offer me skill in the area of ECG interpretation. He directed me to the right service and I attended the course for three months and attended weekly classes. After attending the classes, I used to engage in self-learning online. Slowly, I was able to understand the concept and principle behind ECG. In the mid sessions, I was also given lesions on interpretation of ECG. This was a positive learning experience for me as I am very confident in this area now. Now I can easily figure out whether a patient is suffering from ischemic heart disease or myocardial infection or any other issues in patient.
References
Butao, R., Lamoureux, J., Cohn, T., McCue, V. and Garcia, F., 2016. The Need for Speed: Shared Governance Impacting Nursing Practice over a 3 year Magnet Journey of a newly opened hospital.
Enrolled Nurse Standards of Practice. 2017. Retrieved 14 December 2017, from https://file:///C:/Users/User00/Downloads/Nursing-and-Midwifery-Board---Fact-sheet---Enrolled-nurse-standards-for-practice---December-2016%20(1).PDF
Latimer, S., Hewitt, J., Stanbrough, R. and McAndrew, R., 2017. Reducing medication errors: Teaching strategies that increase nursing students' awareness of medication errors and their prevention.
Nursing and Midwifery Board of Australia, 2017. National competency standards for the registered nurse. Retrieved from www.nursingmidwiferyboard.gov.au.
Pool, I.A., Poell, R.F., Berings, M.G. and ten Cate, O., 2015. Strategies for continuing professional development among younger, middle-aged, and older nurses: A biographical approach. International journal of nursing studies, 52(5), pp.939-950.
Radtke, K., 2013. Improving patient satisfaction with nursing communication using bedside shift report. Clinical Nurse Specialist, 27(1), pp.19-25.
Simpson, E., 2016. How to manage a choking adult. Nursing Standard, 31(3), pp.42-46.
Smith, A., Latter, S. and Blenkinsopp, A., 2014. Safety and quality of nurse independent prescribing: a national study of experiences of education, continuing professional development clinical governance. Journal of advanced nursing, 70(11), pp.2506-2517.
Twigg, D. and McCullough, K., 2014. Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. International journal of nursing studies, 51(1), pp.85-92.
