Assistants in Nursing working in the acute care · PDF fileAssistants in Nursing Working in...

Assistants in Nursing working in the

acute care environmentHealth Service Implementation Package

NSW DEPARTMENT OF HEALTH

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NORTH SYDNEY NSW 2060

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NSW Department of Health

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© NSW Department of Health 2009

SHPN (WDL) 100137

ISBN 978 1 74187 472 3

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August 2010

Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package NSW HEAltH PAGE 1

Contents

Section 1Introduction ................................................................................................................................................ 4

Section 2Incorporating Assistants in Nursing into the acute care clinical skill mix ............................................. 52.1 Stage1:IdentifyingopportunitiesforAINpositionsinacutecareclinicalareas.......................................................6

2.2 Stage2:SkillmixreviewandmanagementprocessforincorporatingAINs.............................................................8

2.3 Stage3:KeyquestionstoevaluatetheStage2skillmixreviewprocess................................................................ 10

Section 3 Education and Development ....................................................................................................................143.1 GeneralinformationontheHLT32507CertificateIIIinHealthServicesAssistance................................................ 15

3.2 Recommendedcompetencyunitsfortheskillset“AssistinginNursingWorkinAcuteCare”............................... 16

3.3 AssessmentsincludedinHLT32507CertificateIIIinHealthServicesAssistance

(Descriptor:AssistinginNursingWorkinAcuteCare)........................................................................................... 19

3.4 UpskillingexistingworkerstotheHLT32507CertificateIIIinHealthServicesAssistance

(Descriptor:AssistinginNursingWorkinAcuteCare)........................................................................................... 19

3.5 Clinicalplacementguidelinesforclinicalareas...................................................................................................... 20

3.6 Careerpathwaysinnursing.................................................................................................................................. 21

Section 4Scope of practice of acute care Assistants in Nursing..........................................................................234.1 PositionDescription–AssistantinNursing–AcuteCare....................................................................................... 23

4.2 AcuteCareAssistantinNursing–CareActivitiesList............................................................................................ 26

Section 5Delegation and supervision .....................................................................................................................30

Section 6Definitions ..................................................................................................................................................32

Section 7References ................................................................................................................................................37

PAGE 2 NSW HEAltH Assistants in Nursing Working in the Acute Care Environment Health Service Implementation Package

ListofTablesandFigures

List of TablesTable1: KeyquestionstoevaluatetheStage2skillmixreviewprocess....................................................................... 11

Table2: NSWHealthPreferredCoreUnitsandElectivesforHLT32507CertificateIIIinHealthServicesAssistance

(Descriptor:AssistinginNursingWorkinAcuteCare).................................................................................... 15

Table3: SummaryofcontentcoveredintherequiredelectivesforHLT32507CertificateIII

inHealthServicesAssistance(Descriptor:AssistinginNursingWorkinAcuteCare)....................................... 16

Table4: AcuteCareAINCareActivitiesList................................................................................................................ 27

List of FiguresFigure1: StepstoidentifyopportunitiesforutilisingAssistantsinNursing................................................................... 7

Figure2: TheskillmixreviewandmanagementprocessforincorporatingAINs........................................................... 9

Figure3: CommonunitsofcompetencyacrosstheHLT32507CertificateIIIinHealthServicesAssistance

(Descriptor:AssistinginNursingWorkinAcuteCare)andnursingqualifications........................................... 22


Abbreviations

ADL ActivitiesofDailyLiving

AHS AreaHealthService

AIN AssistantinNursing

ANMC AustralianNursingandMidwiferyCouncil

CIAP ClinicalInformationAccessProgram

CS&HISC CommunityServicesand

HealthIndustrySkillsCouncil

CVAD CentralVenousAccessDevice

DMF NationalFrameworkforDecisionMaking

byNursesandMidwives(ANMC,2007)

VAD VascularAccessDevice

EEN EndorsedEnrolledNurse

EEO EqualEmploymentOpportunity

EN EnrolledNurse

IIMS NSWHealthIncidentInformation

ManagementSystem

N/A Notapplicable

NUM NursingUnitManager

O2 Oxygen

OHS&R OccupationalHealthandSafety

andRehabilitation

PEG Percutaneousendoscopicgastrostomy

PICC PeripherallyInsertedCentralCatheter

RN RegisteredNurse

RPL RecognitionofPriorLearning

RTO RegisteredTrainingOrganisation

TPR Temperature,pulse,respirations


Theavailabilityandskillofhumanresourcesinhealthisthe

foundationofasustainablepubliclyfundedhealthsystem.

AustralianHealthMinistershaveundertakeninitiatives

aimedatadoptingastrategicapproachtoworkforce

planninginthehealthsector.Demographicand

epidemiologicalfactorscontinuetoshapethechanging

contextforthehealthworkforce,demandingmore

co-ordinatedandintegratedservices.Thishasmanifestedin

redesigningpatientcareprocessesaroundpatientneeds

ratherthanhavingservicesplannedaroundthehealthcare

professionalbasedonhistoricalpracticearrangements.This

environmenthasprovidedthestimulusfortheHealthcare

AssistantInitiative,aprojectimplementedbyNSWHealth.

AsapartofthisInitiativeaprocessofconsultationhas

occurredtoestablishaconsistentapproachtothe

education,roleandemploymentofassistantswithin

nursingservicesintheNSWpublichealthsystem.This

resourcedocumenthasbeeninformedbythatconsultation

anddevelopedtoassistwithestablishingconsistent

practicesattheHealthServicelevel.Itisenvisagedthat

practicesofemploymentandclinicalallocationofAssistants

inNursingaswellaspromotionoftheroleasavaluable

teammemberwithinacutecarenursingserviceswillbe

supportedbytheuseofthisresource.

Thetitle“AssistantinNursing”(AIN)isusedthroughout

thisdocumenttodescribeahealthcareproviderwho

assistshealthcareprofessionalsintheprovisionofnursing

caretopatientsinacutecaresettings.

ThisresourcedocumentsupportstheHealthcareAssistant

Initiative,theaimsofwhichinclude:

n improveutilisationofAINsinnursingteamsinaward

orunitsettingtosupportmodelsofcareandbetter

integrateassistantsinnursingintoteamworkpractices;n furtherdevelopassistantrolesinsupportinghealth

professionals,andbetterutiliseskillswithinthe

professionalworkforce;n facilitateappropriatetrainingprogramsfornursing

assistantroles,inconsultationwithhealthprofessionals;

andn standardisetitlesandpositiondescriptionsforAINs

acrosstheNSWpublichealthsystem.

Thedocumentiscomprisedoffoursectionscovering;

1. Processestoassessandevaluatetheincorporationof

AINsintoclinicalenvironments,

2. AnoverviewoftheeducationanddevelopmentofAINs,

3. Thecomponentsestablishingthescopeofpracticeof

anAIN;and

4. Delegationandsupervisionguidelines.

Theguidelineswithinthisdocumentwillbesupportedby

furtherinformationandresourcestoidentifyspecific

practiceswithregardtotheemploymentofallAINsinNSW

Health.Furtherdevelopmentandsharingoftoolsor

guidelinestoassistinsupportingtheintegrationand

effectivenessofAINsasteammembersisencouraged

withinandacrossHealthServices.

SECTION1

Introduction


Thissectionincludesanumberoftoolstoassistmanagers

tomakedecisionsabouthowtoincorporateAINswhen

reviewingtheskillmixintheirclinicalareas.Determining

themostappropriateskillmixisacomplexprocess.These

toolsarethereforeprovidedasaguidetoassistnurse

managersnavigatethroughthestepsandtakeintoaccount

arangeofconsiderations.

Thefollowingthreestagesarerecommendedtoidentify

suitableareasforAINsandeachstageisexploredinmore

detailinthisSection:

Stage1–IdentifyappropriateopportunitiesforAINs

inacutecareclinicalareas

Stage2–Reviewthenursingskillmixandmanage

theprocessforincorporatingAINs

Stage3–AskkeyquestionstoevaluatetheStage2

reviewprocess

SECTION2

IncorporatingAssistantsinNursingintotheacutecareclinicalskillmix

Implementation recommendations:

n Reviewallresourcedocumentsandmodifytolocalrequirementsn ReviewandmodifyAHS/facilityorganisationalstructuretoincorporateAINsn Developtherequiredpolicies,protocolsandguidelinesrelevanttoincorporatingAINsintoclinicalenvironmentsn EstablishtheclinicalareasthatareappropriateforAINpositionsn EstablishtargetpositionsforAINsn Developachangemanagementplann DevelopanAINemploymentplan


2.1 Stage 1: Identifying opportunities for AIN positions in acute care clinical areas

Stage1identifiesbroadstepstoassesstheclinical

environmentanddevelopsupportforspecificclinicalarea

reviewswithaviewtoincorporatingAINsintheclinical

skillmix1.

Figure1representsaprocesstoidentifythese

opportunities.Itisimportantfornursemanagerstouse

aprocesstoclearlydistinguishbetweeneachofthesteps

intheflowchart,whichinclude:

n Legislativeorregulatoryrequirementsthatcould

prohibittheallocationofanAINinanyparticularclinical

area,forexample,dothePoisonsandTherapeutic

GoodsAct1966,thePoisonsandTherapeuticGoods

Regulation2008,ortheNursesandMidwivesAct1991

prohibittheallocationofAINsinanyclinicalareas?n Practicestandardsorevidencethatindicatesaspecific

nurseskillmixinaclinicalarea.n Thepatientcasemixdependencylevelsofaclinicalarea

andhowthisalignswiththecareactivitiesandscope

ofpracticeoftheAIN.ThisImplementationPackage

containsanagreedscopeofpracticeandAINpatient

careactivitiestoassistwiththisstep.Thisstepinvolves

askingquestionssuchas:

-Whatarethepredominantpatientcareactivities

withintheclinicalenvironment?

-Whichofthosepatientcareactivitiesalign

withthescopeofpracticeofanAIN?

-Whatistheratio/averagenumberofpatients

whohavepredictableoutcomestopatientcare

activitieswithinthescopeofpracticeofanAIN?

-Whatistheratio/averagenumberofunstable

patientsthatrequireconstantapplicationof

technicalskillsbeyondthescopeofpractice

ofanAIN?

1 “Skill mix” refers to all staff that deliver nursing care

n TheskillmixcapacityforsupervisionofAINsinaclinical

area.Thisstephelpstoidentifythelevelofdecision

making,supervisionandsupportregisterednursescan

affordwhenconsideringskillmixandtheabovepatient

dependencycharacteristics.

Duringeachofthesteps,evidenceisreviewedtoidentify

orcreateopportunitiestointroduceAINsinappropriate

clinicalareas.Insomecases,theevidencemaynotsupport

theuseofAINsintheskillmixofparticularclinicalareas

anditisimportanttoidentifythesesituations.


Figure1:StepstoidentifyopportunitiesforutilisingAssistantsinNursing

Reviewbackgroundandscopeofpractisedocuments

Arethereanylegislativeor

regulatoryrequirementsforan

RN&/orE/ENonlyskillmix?

Aretherepredictablepatient

outcomesregardingADLs&

routinemonitoring?

YES

Go to STAGE 2

YES

Reviewmodelofcare.

Implementappropriatemodel

ofcaretoaccommodateall

members.

NO

YES

Istherecapacity

forsupervisionofAINs?

YES

Endreviewprocess

Identifyandreview

requirements

NO

Endreviewprocess

AlignAINpositiondescription

andScopeofPractice

documentswithward/unit

patientclinicalmix/dependency

NO

Endreviewprocess

Reviewskillmix:nNo.ofNursesinTransitionnNo.ofRNsnNo.ofENsnUseofcasuals

Isthemodelofnursing

careappropriate?


2.2 Stage 2: Skill mix review and management process for incorporating AINs

Stage2providesspecificelementstobeconsideredwhen

undertakingaprocessofskillmixreviewandmanagement

toincorporateAINs.

ThestepsinStage2reflectareviewandmanagement

processthatstartsattheconclusionofStage1.Stage2

consistsofthefollowingfoursteps:

n Step A: Assessment,recommendstheanalysis

andalignmentofpatientneeds,staffnumbers,staff

characteristicsandtheclinicalenvironmentusing

establishedandlocallydevelopedtools.n Step B: Plan,recommendsstrategiestopreparethe

environmenttosupporttheintroductionofAINs,

includingidentificationofrolechangesandstaff

developmentneeds.n Step C: Implement,recommendsstrategiestomove

forwardwithskillmixchanges.n Step D: Evaluate,identifiespatient,nurseand

environmentaloutcomesthatcouldbereviewedto

determinetheeffectivenessoftheskillmixchanges,

usingestablishedandlocallydevelopedtools.

PleaserefertoFigure2whichpresentsaflowchart

representingtheabovefourstepsintheskillmixreview

andmanagementprocessforincorporatingAINS.


Figure2:TheskillmixreviewandmanagementprocessforincorporatingAINs

A. ASSESS Patient needsn numbern clinicalmixn complexityn dependency

Staffn numbersn availabilityn scopeofpracticen experiencen support

Environmentn physicaln supportservicesn culturen ModelofCaren NUMs’spanofcontrol

-clinicalleadership

-policyinfluence

MA

TCH

D. EVALUATEPatient outcomesn clinicalindicatorsn changesinnursesensitive

patientoutcome

-(IIMSdata)

-anecdotalevidence

Nurse outcomesn changesinrosterflexibilityn perceivedworkloadn perceivedresponsibilityn sickleaven communicationn rolefocus/utilisation

Environment outcomesn staffattritionratesn budgetaryn roleoverlapn collaborativeculturen policy/protocoladherence

B. PLANn Rostering–identify

appropriateAINnumbersand

shiftsn Staffdevelopment/educationn Developmonitoringand

feedbackmechanismsn ModelofCarechangesn Supervisionguidelinesn Roleredesignn Reviewlocalworkflow

practicesn Localprotocol/policy

developmentn Preimplementationdata

collectionn Reviewemploymentprocessesn Supportnetwork

C. IMPLEMENTn Provideorganisational

supportn Promulgaterelevantpolicies

andprotocolsn Maintainappropriatestaffing

consistencyn Delivereducationandtrainingn Establishtools/resources/

documentsn Commencemonitoringand

feedbackmechanisms


2.3 Stage 3: Key questions to evaluate the Stage 2 skill mix review process

Stage3iscomprisedofanumberofkeyquestions

toaskwhenevaluatingtheStage2skillmixreview

andmanagementprocessforincorporatingAINs

inclinicalareas.

Alistofpossiblequestionsthatcouldbeaskedis

representedinTable1.Thequestionsaredesignedtohelp

reviewandevaluateconsiderationsobservedduringthe

fourstepsinStage2.

The‘Yes’,‘NotApplicable’(N/A)and‘Tobeaddressed’

columnsinTable1canbeusedtoidentifyassessments,

relevantstrategies,outcomes,elementsforfurtheraction

andnewstrategydevelopmentsovertime,astheprocess

isfollowed.

Questionscanbemodified,addedand/orremoved

accordingtotherequirementsoftheHealthService,facility,

orward/unitwheretheskillmixreviewprocessisunderway.


Table1:KeyquestionstoevaluatetheStage2skillmixreviewprocess

A. Assessment Yes N/A To be addressed

1 Arethepatientneedscentraltoallskillmixdecisions?

2 Aretheremechanismsinplaceformatchingtheskillmixwithpatientneeds/dependency?

3 Arepatientnumbers(census)maintainedconsistently?

4 Arethereprotocolsformanagingtimeswhenclinicalareasareoverpatientcensus?

5 Isthepatientclinicalmixconsistent?

6 Aretherelowtonolevelsofoutlierfluctuations?

7 Istherelittleornochangeinpatientcomplexitypatternsacrosstheunit/ward?

8 Arethereprotocolsforskillmix/numberresponsestochangesinpatientcaredemands?

9 Arethereprotocolsforredeploymentofstaffinresponsetostaffdeficitse.g.unplannedleave?

10 Arenursingskillmixdecisionsconsistentwithregulatory/mandated/recommendedrequirements?

11 Arenursingstaffdecisionsmadebyanurseleader?

12 Aretherepolicies/guidelinesforongoingevaluationofnursingstaffskillmixdecisions?

13 Aretherolesandresponsibilitiesofnursingcareprovidersarticulatedinpoliciesandpositiondescriptions?

14 Aretheresufficientresourcestosupporttheimplementationoftheidentifiedskillmix?

15 Isstaffsafetyconsideredinskillmix?

16 Isthephysicalenvironmentconsideredinskillmixdecisions?

17 Doskillmixdecisionssupportthebestuseofallnursingresources?

18 Doskillmixdecisionsconsiderpatientoutcomesrelativetothemodelofnursingcaredelivery?

19 Areskillmixdecisionsmadeandevaluationsconductedinconsultationwithothermembersofthenursingteam?

20 Doestheprocesstomakeskillmixdecisionsmeasurepatientacuity,complexity,variabilityandnumber?

e.g3

21 Doskillmixdecisionsallowflexibilityinresponsetochangesinpatientacuity,complexity,variabilityandnumber?

22 Doesevidencesupportskillmixdecisionsregardingworkload,productivity,availability,numberandemploymentstatus(i.e.fulltime,parttime,casual,agency)?

23 Doskillmixdecisionsrecognisethecompetenciesandexperienceofthestaffprovidingnursingcare?

24 Dostaffhaveopportunityforinputintoskillmixdecisions?

25 Aretheresultsfrommonitoringandevaluationusedtoimproveskillmixdecisions?

Elements to be addressed

Number Issue Action

e.g.20 Nocurrentmechanismformeasuring.Daytodaydecisionsbasedontheprofessionaljudgementapproach,andlongertermdecisionsutiliseGeneralWorkloadCalculationTool.

Supportthedevelopmentofprocessesthatarealsosensitivetopatientdependencychangesandsafecarestandards.AllocatespecificresponsibilitytoaNurseManager.


B. Plan Yes N/A To be addressed

1 Haveidentifiedelementsofassessmentrequiringactionbeenaddressed?

2 Istherosterreflectiveofappropriatecapacityforsupervisionrequirements?

3 Havestaffattendededucationandtrainingregardingpositionroles,responsibilities,accountabilitiesandsupportmechanisms?

4 Havemonitoringandfeedbackmechanismsbeendeveloped?

5 Hasthemodelofcarebeenevaluatedandappropriatechangesmade?

6 Arestaffresourcesandguidelinesavailable?

7 Havestaffparticipatedinprocessestoreflectonandidentifyproductiveandprogressiveworkpractices?

8 HasaformalanddocumentedprocessbeendevelopedtoensureAINactivitiesareappropriateandmonitored?


Number Issue Action

C. Implement Yes – evidence To be addressed

1 Hastherebeenanorientation/resourcebook/packagedevelopedforAINs?

2 ArethereestablishedmechanismstosupportstaffandAINteambuilding/development?

3 Arestaffawareofmechanismstomanageskillmixconcerns/disputes?

4 HavehealthcarecolleaguesreceivedcommunicationregardingnursingteamchangesandAINrole?

5 HavenursingsupportstaffreceivedcommunicationregardingnursingteamchangesandAINrole?

6 Aretherestrategiestosupportconsistentmessagesregardingnursingteamrolestopatients/consumers/significantothers?

7 Aretools/resources/documentsreadilyavailabletoallstaff?

8 Havemonitoringandfeedbackmechanismsbeencommunicatedtostaffandputinplace?

9 AreallnursingstaffawareofprocessestoreviewAINactivities?

10 AreallnursingstaffawareoftheprocesstomonitorandmaintainappropriateAINactivities?


Number Issue Action


D. Evaluation/Outcome Yes – evidence To be addressed

1 Havetherebeenpositive,negativeornochangesidentifiedandreportedinclinicalindicatorsrelatedtoskillmixdecisions?

e.g¸3

2 Isthereotherevidenceofappropriateskillmixdecisions?

3 Hastherebeenstabilityorimprovementtorosterflexibility?

4 Arestaffexpectationsofteammemberrolesreasonable?

5 Arestaffexpectationsofteammemberresponsibilitiesreasonable?

6 Havetherebeenanytrendsidentifiedinsickleaverelatedtoskillmixdecisions?

7 Dostaffexpresssatisfactionwiththeircommunication?

8 Dostaffrecogniseroleboundariesandminimisepracticeoverlaps?

9 DoRegisteredNursesreportconfidenceintheirsupervisorycapabilities?

10 Havetherebeenanytrendsreportedinattritionratesattributedtoskillmixdecisions?

11 Isthecostofskillmixdecisionssustainable?

12 Arethereovertandcovertsignsindicatingpositiveprogresstowardscollaborativepracticewithintheallocatedskillmix?

13 Aretherepositivesigns/reportsindicatingadherencetopolicyandguideline?

14 Doskillmixdecisionsmakethebestuseofresources?

15 Aretherecostsavingsrelatedtoturnover,reducedabsenteeism,andreducedovertime/agencystaffthatcanbelinkedtoskillmixdecisions?

16 Aretherecostsavingsrelatedtoimprovednursesensitivepatientoutcomesthatcanbelinkedtoskillmixdecisions?


Number Issue Action

e.g1 Increaseinmedicationerrorsintwoareasthathaveexperiencedrecentskillmixchanges.Anecdotalevidencesuggestsperceivedambiguityinrolesandresponsibilitieswithinteam.

nReviewincidentinvestigationsnReviewandensureeducationandtraininghasbeenprovidedandattended

nReviewcommunicationandfeedbackmechanismsandconsultstaff


EducationandDevelopment

SECTION3

Thequalification,HLT32507CertificateIIIinHealthServices

Assistance(Descriptor:AssistinginNursingWorkinAcute

Care),isthenationallyrecognisedqualificationtotrainas

anAssistantinNursingintheacutecareenvironment.

Thissectionprovidesinformationonthequalificationas

wellasotherinformationrelatedtotheeducationand

developmentofAINs,including:

n TheunitsofcompetencyNSWHealthhave

recommendedstudentscompletetoobtainthe

qualificationandsupporttheiremploymentasacute

careAINsintheNSWpublichealthsystem.Anumber

ofunitsinvolveaclinicalplacementcomponentinthe

acutecareenvironment.n Thecontentelements,essentialskillsandassessments

ofthesixrecommendedelectivesincludedinthe

qualification.

n Informationaboutupskillingexistingworkerstothe

HLT32507CertificateIIIinHealthServicesAssistance

qualificationwiththeskillset,AssistinginNursingWork

inAcuteCare.Theinformationcanbeusedtoidentify

andsupportexistingworkerstoconvertorupgrade

theircurrentqualificationsthroughaRecognitionof

PriorLearning(RPL)process.n Supervisionguidelinesforstafftoassistandsupport

studentsontheirclinicalplacementandtoencourage

developmentofpositiverelationshipsbasedonan

understandingoftheresponsibilitiesofallinvolved.n Theunitsofcompetencythatarecommonacrossthe

HLT32507CertificateIIIHealthServicesAssistance

(Descriptor:AssistinginNursingWorkinAcuteCare)

andhigherlevelqualifications,whichshowshowthe

CertificateIIIqualificationcontributestothepathway

intocareersinnursing.

Implementation recommendations:n Developrelationshipswithtrainingproviders(RegisteredTrainingOrganisations)tomaintainprogrammetopractice

relevancebymonitoringandfeedbackmechanismsn Disseminateinformationacrossnursingservicesn ReviewclinicalplacementprocessesforAINstudentsandmaximisepositivestudentandclinicalplacementareaexperiencen Identifyandsupportexistingworkersinnursingcareorhealthcareroleswhowouldbenefitfromconvertingtheir

qualificationsorgainingaqualificationn DeveloporincorporateAINsinestablishedmentoringsystemstoprogresstheircareerinnursingwheredesired


3.1 General information on the HLT32507 Certificate III in Health Services Assistance


qualificationincludestheoptionofanumberofskillsets

andcoversworkersinarangeofworkroles.Health

ServicesAssistanceinvolvestheworkerindirectclient

contactundersupervision.Thisqualificationhasbeen

structuredtoprovideeither:

n agenericqualificationthatcoversarangeofwork

functions,orn askill setwhichistargetedtospecificworkroles,

oneofwhichistheAssistinginNursingWorkinAcute

CarewhichtranslatestotheroleofAINintheacute

caresetting.

OutlinedinTable2belowistherecommendedskill

pathwayproposedbyNSWHealthfortheelectiveskillset

inAssistinginNursingWorkinAcuteCare.Itconsistsof

sixcompulsorycoreunitsandafurthernineelectives,sixof

whicharerequiredbytheHealthTrainingPackagetoobtain

thetargetedAssistinginNursingWorkinAcuteCare

qualification.

Thequalificationisdeliveredover360nominalhours,

withtheminimumrecommendedhoursfortheorybeing

310hoursandanadditionalminimum50hoursofclinical

placement.NSWHealthhasrequestedthatpreferred

trainingprovidersensureatleast50oftheclinical

placementhoursareconductedinanacutecaresetting.

Table2:NSWHealthPreferredCoreUnitsandElectivesforHLT32507CertificateIIIinHealthServicesAssistance(Descriptor:

AssistinginNursingWorkinAcuteCare)

CORE UNITS – 6 Units

Competency Code Competency Title

BSBFLM303B C ContributetoEffectiveWorkplaceRelationships

BSBMED201A C UseBasicMedicalTerminology

HLTAP301A C RecogniseHealthyBodySystemsinaHealthCareContext

HLTHIR301A C CommunicateandWorkEffectivelyinHealth

HLTIN301A C ComplyWithInfectionControlPoliciesandProceduresinHealthWork

HLTOHS200A C ParticipateinOHSProcesses

ELECTIVES – 9 Units

Competency Code Competency Title

HLTFA301B E ApplyFirstAid.

HLTCSD305B RE Assistwithclientmovement.

HLTCSD208B RE Transportclients.

HLTCSD306B RE Respondeffectivelytodifficultorchallengingbehaviour.

HLTCSD201B RE Maintainhighstandardofclientservice.

HLTAIN301A RE AssistNursingTeaminanacutecareenvironment.

HLTAIN302A RE Providesupportinanacutecareenvironment

HLTHIR403B E Workeffectivelywithculturallydiverseclientsandco-workers.

HLTHIR404B E WorkEffectivelywithAboriginalandTorresStraitIslanders.Or

Legend

C Compulsoryforissueofthisqualification

RE RequiredElectiveforAssistinginnursingworkinacutecare–aslistedintheTrainingPackagerules

E PreferredelectiveproposedbyNSWHealth.Whiletherearearangeofelectivestoselectfromtoallowforflexibilityrelatedtospecificworkplaceneeds,NSWHealthhasspecificallyrequestedpreferredtrainingproviderstoincludetheseelectivesinthequalification.


3.2 Recommended competency units for the skill set “Assisting in Nursing Work in Acute Care”

Thissectionprovidesanoverviewofthecontentcovered

withineachofthesixrequiredelectives,whichmustbe

studiedtobeawardedthequalification,HLT32507

CertificateIIIinHealthServicesAssistancewiththeskill

set,“AssistinginNursingWorkinAcuteCare”.

Anoverviewoftheessentialskillsresultingfromthe

studyofeachunitofcompetencyisalsoincludedaswell

asinformationonhowthestudentisassessed.Further

informationonassessmentisprovidedinSection3.3.

TheinformationinTable3hasbeensummarisedfrom

theHealthTrainingPackage(HLT07)Version1Formore

detailedinformationpleasegotowww.cshisc.com.au

andlookundertrainingpackages–health.

Table3:SummaryofcontentcoveredintherequiredelectivesforHLT32507CertificateIIIinHealthServicesAssistance


Competency Title Content Element Essential skills † Assessment

HLTCSD305BAssistwithclientmovement

Preparetoassistwithclientmovement

Operateliftingandtransferringequipment

Observationofperformanceinanactualorsimulatedworkplacesetting.

Assistwithclientmovement Assistaprofessionalwithclientmovement

Completeassistancewithclientmovement

Dealwithconflict

Assistclientswithmeals

HLTCSD208BTransportclients

Prepareclientfortransport Applysafeworkingpractices,includingmanualhandling

Thestudentmustprovideevidenceofspecifiedessentialknowledgeandskills.Assessmentoccursintheworkplaceorinsimulatedworkplaceconditions.

Interpretandfollowtheinstructionsandguidanceofhealthprofessionals

Transportclient Solveproblemsincludingtheabilitytouseavailableresourcesandprioritiseworkload

Workwithothersanddisplayempathywithclientsandrelatives

Deliverclient Usereadingandwritingskills

Useoralcommunicationskills

Usenumeracyskills

† Essential skills that are common across competency units are not repeated in list


Competency Title Content Element Essential skills Assessment

HLTCSD306BRespondeffectivelytodifficultandchallengingbehaviour

Planresponse Identifywhenassistanceisrequired

Mostappropriatelyassessedintheworkplace(simulatingdifficultorchallengingbehaviour)orinasimulatedworkplaceandunderthenormalrangeofworkconditions.

Applyresponse Maintainpersonalsafetyandthesafetyofothers

Foreseeandrespondquicklyandeffectivelytocontingencies

Maintaindutyofcare

Reportandreviewincidents Effectivelyusetechniquesformonitoringownserviceareaincludingclientsatisfaction

Speakinafirm,diplomaticandculturallyappropriatemanner

Remaincalmandpositiveinadversity

Thinkandrespondquicklyandstrategically

Remainalerttopotentialincidentsofdifficultorchallengingbehaviour

Monitorand/ormaintainsecurityequipment

HLTCSD201BMaintainahighstandardofclientservice

Communicateappropriatelywithclients

Workwithinroleandresponsibility

Mostappropriatelyassessedintheworkplaceorinasimulatedworkplaceandunderthenormalrangeofworkconditions.Establishandmaintainan

appropriaterelationshipwithclients

Complywithrelevantpolicies,protocols,guidelinesandprocedures

Actinarespectfulmanneratalltimes

Establishandmaintainrelationships

Interpretandfollowinstructions

Evaluateownworkandmaintainahighstandardofclientservice

Handlecomplaintsandconflictorreferasappropriate

Workeffectivelyaspartoftheteam

Useliteracyskillsinreading,writingandoralcommunication

Useproblemsolvingskillsto:

nEffectivelyutiliseavailableresources

nPrioritiseworkload

Demonstraterespectforclients

Communicateinanon-discriminatory,supportiveandinclusivemanner

Listenandrespondtocommunicationinitiativesofclients


Competency Title Content Element Essential skills Assessment

HLTAIN301AAssistnursingteaminacutecareenvironment

Assistwiththedeliveryofnursingcaretoclientsinanacutecareenvironment

Communicateeffectivelywithclientswhencollectinginformationanddataandassistingwithpersonalcareneeds

Observationofworkplaceperformanceisessentialforassessmentofthisunit.

Supporttheclienttomeetpersonalcareneedsinanacutecareenvironment

Useequipmentandfollowproceduresforcollectingclientclinicaldata

Workinateamenvironment Operateequipmentandaidsutilisedinthedeliveryofpersonalcare

Workeffectivelyundersupervision

Workunderdirectionandsupervision

Workeffectivelywithclients,colleaguesandsupervisors

Dealwithconflict

Workinamannerthatrespectsthedignityofclients

Displayempathytoclientsandrelatives

HLTAIN302AProvidesupportinanacutecareenvironment

Maintainaccuraterecords Maintainclienthealthrecordsinasecureandconfidentialmanner

Observationofworkplaceperformanceisessentialforassessmentofthisunit.

Complywithadministrationprotocolsofanacutecareenvironment

Completeformsanddocumentsinaclear,conciseandfactualmanner

Collectandprocessworkplaceinformation

Collateanddispatchinformationaccordingtospecifictimeframesandorganisationalrequirements

Organiseandsupplyequipmentrequiredinanacutecareenvironment


3.3 Assessments included in HLT32507 Certificate III in Health Services Assistance (Descriptor: Assisting in Nursing Work in Acute Care)

Assessmentsundertakenaspartofthequalificationmust

meetthecriteriasetoutforRegisteredTraining

Organisations(RTOs)bytheCommunityServicesandHealth

IndustrySkillsCouncil(CS&HISC).

Eachofthecompetencyunitsareassessedinformal

classroomsettings,workplacesettingsand/orbysimulated

laboratory/clinicalassessments.

Theminimumspecificclinicalskillsassessmentsthat

astudentmustsuccessfullycompletetobeawardedthe


(Descriptor:AssistinginNursingWorkinAcuteCare)are:

n TPRmeasurementn Bloodpressuremeasurementn Bloodglucose/sugarlevelmeasurementn Simplewoundcleansinganddressingn Collectingandtestingurinespecimen(Urinalysis)n Handwashingn Cardiopulmonaryresuscitationn Manualhandlingn Patientphysicalmovement

3.4 Up skilling existing workers to the HLT32507 Certificate III in Health Services Assistance (Descriptor: Assisting in Nursing Work in Acute Care)

CurrentlythereareAINswithoneormoreofavarietyof

qualifications/experiencelevelsworkingintheNSWpublic

healthsystemwhohavenotattainedtheHLT32507

CertificateIIIinHealthServicesAssistancequalification

withtheskillsetAssistinginNursingWorkinAcuteCare.

Theseinclude:

n Undergraduatestudentsofnursingstudies;n ThosewhoholdtheCertificateIIIinAgedCare;n ThosewhoholdtheCertificateIIIinHealthServices

Assistance(GenericQualification);andn Thosewhohaveon-the-jobexperiencewithno

qualification.

Giventherangeofwaysinwhichpeoplecanbeemployed

asAssistantsinNursing,NSWHealthisdeveloping

resourcessuchasaPolicyDirectivetoclarifytheacute

careAINrole.Providingadditionalinformationthrough

resourcessuchasthesewillfacilitateHealthServicesto

employuniformpracticesindevelopingtheroleofall

AINs.Thefollowingprovidesinformationontheprocess

forupskillingexistingworkersforworkinacutecare

andrecognisingtheskillsandexperienceofexistingstaff

whomaynotholdtheacutecarequalification.

AttainmentoftheunitsofcompetencyintheHLT32507

CertificateIIIinHealthServicesAssistance(Descriptor:

AssistinginNursingWorkinAcuteCare)qualification

canoccurinanumberofwaysincludingthrough:

n Formalorinformaleducationandtrainingn Experiencesintheworkplacen Generallifeexperiences,and/orn Anycombinationoftheabove

Inawardingthequalificationtheprimaryconsideration

iswhetherthecandidateiscompetent,nothowthe

competencyisacquired.

SkillsRecognition(includingRecognitionofPriorLearning

–RPL)istheprocessthroughwhichaperson’sskills,

knowledgeandexperienceareassessedbyaqualifiedand

experiencedtrainer/assessorinordertoascertaintheperson’s

levelofcompetencyagainstarangeofvocationalskills.

Recognitionprocessescanonlybedeliveredby

appropriatelyqualifiedandexperiencedtrainers/assessors

onbehalfofaregisteredtrainingorganisation(RTO).

Recognitionprocessesaregenerallyprovidedaspartof

theenrolmentcostofacourse.However,iffullrecognition

servicesarerequestedbeforeenrolment,anRTOmay

chargeacommercialfeeforthisservice.

Typically,aperson’spreviousworkexperienceandcurrent

qualificationsareassessedandcomparedwiththeunits

ofcompetencycontainedinthequalificationinwhichthey

hopetoenrol.Dependingontheoutcome,someunits

ofcompetencyinthetargetqualificationmaybegranted

viarecognition(alsoknownasAdvancedStanding).Upto

anentirequalificationmaybegrantedviarecognition.

Thepersonseekingrecognitionisrequiredtoprovide

evidenceoftheirskillsknowledgeandexperience.The


typesofevidencerequiredwillvaryfromassessorto

assessorandRTOtoRTO.Evidencemayrangefroman

interview,paper-basedqualificationsorreferences,and

examplesofwork.RTOsmayalsouseothermeans,e.g.

‘challengetests’(quizzesorpracticalactivitiesaimedat

gaugingcompetencies)toassesscompetency.

Whereapersonisdeemedbythequalifiedassessortobe

almostcompetentagainstunitsinaqualification,a‘gap

training’programisdesignedtotraininonlythoseskills

whicharecurrentlylacking.

Asaresultofrecognitionprocesses,apersonmaybeable

tocompleteaqualificationmorequicklyandcheaplythan

wouldbethecaseiftheentirequalificationhadtobe

completed.Thisalsoworksfortheemployerwhoisfunding

trainingasitmeansthatstaffwillgainqualificationsovera

shortertimeframe,potentiallyatalowercostandwithless

timeawayfromduties.

3.5 Clinical placement guidelines for clinical areas

ThissectionprovidesinformationonsupervisingAIN

studentswhoareundertakingtheHLT32507CertificateIII

inHealthServicesAssistancequalificationwiththeskillset,

AssistinginNursingWorkinAcuteCare,whilsttheyareon

theirclinicalplacementwiththeHealthService.The

informationisprovidedtoassiststafftosupportthe

studentsandencouragedevelopmentofpositive

relationshipsbasedonanunderstandingofthe

responsibilitiesofallinvolved.

Objectives:n Patientsafetyn Studentorientationn Studentlearning

Facilitation model:n RegisteredTrainingOrganisationswillprovidestudent

facilitatorswhilestudentsareonclinicalplacement.

Supervision:n Frontlinenursingunitmanagers(NUMs)areresponsible

forensuringthatthereisanappropriatelevelof

supervisionforstudentsintheclinicalareaorotherwise

seekingalternativearrangements.n Thesupervisionofastudentbyaregisteredorenrolled

nursemaybedirectorindirectaccordingtothepatient

careandstudentcompetencycontext.n Allsupervisingnursesareresponsibleforcommunicating

anyconcernswithstudentperformancetothefrontline

manager(NUM).

Direct supervision can be:n Continuous–requiredwhenthestudentisnewtothe

areaofpracticeandisoperatingatanovicelevel.n Frequent–requiredwhenthestudentisjudgedbythe

supervisingregisterednursestobenotyetproficientor

isexperiencingacrisisofconfidence.n Occasional – requiredwhenthestudenthasbeen

judgedbysupervisingregisterednursestobesafeand

proficientyetneedstobuildupconfidenceinthe

provisionofcare

(DepartmentofNursingandMidwifery,

SterlingUniversity,UK)2.

Accountabilities:n Aregisterednurseisaccountablefortheallocation

ofpatientcareactivitiestostudents,ensuringthe

studentcansafelyandcompetentlyperformthe

allocatedactivities.n Aregisterednurseatthepointofcareisrequired

todecide,accordingtothespecificpracticesetting,

theindividualstudent’scurrentcompetenciesand

thepatientneedsandstatusastothecareactivities

allocated.n Aregisterednurseorenrollednursesupervisinga

studentisrequiredtohavethelevelofcompetence

tobeabletoguideandassistthestudentinachieving

theclinicalplacementlearningobjectives.

Assessment:n Assessorsofstudentcompetenciesareprovidedby

theRegisteredTrainingOrganisation.Theassessments

willoccurduringclinicalplacementandlaboratory

simulation.

2 Department of Nursing and Midwifery, University of Sterling. Information for mentors. accessed from http//:www.nm.stir.ac.uk/mentors on 10.11.09


Performance Management:n TheRegisteredTrainingOrganisationisresponsibleto

addressandmanageperformanceissuesthestudent

mayhaveduringclinicalplacement.n Studentsmusthavetheappropriatetheoryand/or

simulatedpracticefromtheeducationprogrammeprior

toperformingdirectpatientcareactivities.

3.6 Career pathways in nursing

TheHLT32507CertificateIIIinHealthServicesAssistance


qualificationwillsupportstudentstoworkasanassistant

innursinginacutecareenvironments.Completingthis

qualificationandgoingontoworkasanAINinacutecare

providesthepersonwiththeopportunitytogainvaluable

clinicalexperienceandalsohelpstofinanciallysupport

furtherstudiesinnursingateithertheCertificateIVor

Diplomalevelsinenrollednursingorabachelorofnursing

level.

Thisqualificationalsosupportsthedevelopmentofstudent

confidencebyprovidinganentryleveltowardsanursing

careerpathwaythatisflexibleandlessarduous,helpingto

meetvariedlifestyleresponsibilities.

CommoncompetencyunitsarefoundacrosstheCertificate

III,CertificateIVandDiplomaprogrammes,providinga

pathwayfromHLT32507CertificateIIIinHealthServices

Assistancetobecominganenrolled/division2nurse,by

completingHLT43407CertificateIVinNursing,HLT51607

DiplomaofNursingorHLT61107AdvancedDiplomaof

Nursing.

Onsuccessfulcompletionofaqualification,astudentis

abletoapplyforrecognitionandcredittransferifapplicable

tootherqualifications.

Figure3showsthecompetencyunitsoftrainingincluding

thosethatarecommonacrosstheHLT32507CertificateIII

HealthServicesAssistance(Descriptor:AssistinginNursing

WorkinAcuteCare)andhigherlevelqualifications.


Figure3:CommonunitsofcompetencyacrosstheHLT32507CertificateIIIinHealthServicesAssistance(Descriptor:Assisting

inNursingWorkinAcuteCare)andhighernursingqualifications

AIN EN EN EN RN

CertificateIII CertificateIVinNursing

DiplomaofNursing

AdvancedDiploma

BachelorofNursing

HLT32507 HLT43407 HLT51607 HLT61107

(AssistinginnursingworkinAcuteCare)

(Enrolled/Division2Nursing)



15Compulsory(9Electives)




BSBFLM303BnNoformallinkstoTertiaryQualifications

nIndividualinstitutionsmaydecidetoofferlimitedcreditpointstowardsaBachelorDegree

BSBMED201A

HLTAP301A

HLTHIR301A

HLTOHS200A

HLTCSD305B

HLTCSD208B

HLTCSD306B HLTIN301A

HLTCSD201B HLTFA301B

HLTAIN301A HLTHIR403B

HLTAIN302A HLTHIR404B HLTIN301A

HLTIN301A HLTOHS300A HLTFA301B‡HLTFA301B HLTAP401A HLTHIR403B‡HLTHIR403B HLTEN401A HLTHIR404B‡HLTHIR404B HLTAP501A HLTOHS300A

HLTEN507A HLTEN401A

HLTAP501A

HLTEN507A

Key

representcompetencyunitsthatmakeupthemandatorynumber

indicaterecommendedelectivecompetencyunitsforanAINqualification

identifycommoncompetencyunitsbetweenidentifiedCertificateIII,CertificateIVandDiplomaqualifications

identifycommoncompetencyunitsbetweenCertificateIVandDiplomaqualifications

‡ NSW Health recommended Electives in Certificate III


Thissectionprovidesthetwoprimarydocumentsoutlining

theroles,responsibilitiesandscopeofpracticeoftheAIN

workinginacutecareinNSWHealth.Thedocumentsaim

todevelopworkplaceunderstandingandconfidenceinthe

scopeofpracticeoftheAINworkinginacutecare.The

documentsinclude:

n AcuteCareAINpositiondescriptionn AcuteCareAINcareactivitieslist

BoththeAcuteCareAINpositiondescriptionandtheAcute

CareAINcareactivitieslisthavebeendevelopedthrough

wideconsultationwithkeystakeholdersincludingHealth

Servicenursingandworkforcestaff,DepartmentofHealth

staffandtheNSWNurses’Association.

4.1 Position Description – Assistant in Nursing – Acute Care

ThepositiondescriptiondescribestheacutecareAIN

positiondetails,qualifications,keyfunctions,scopeof

practiceandresponsibilities.Thestandardstatementsof

employeeobligationsareincludedasaminimumfor

individualHealthServicestoexpandonaccordingtotheir

establishedformats.

AnAINwillbeallocatednursingactivitiesthatarewithin

theparametersdocumentedintheNSWHealthposition

description.Anyadditionalcontextspecificnursing

activitiesallocatedmustfollowaformallydocumented

processthatreflectstheANMCDecisionMaking

Frameworkandhealthservicesguidelines

ScopeofpracticeofacutecareAINs

SECTION4

Implementation recommendations:n UtilisetheAINpositiondescriptiontoinformstaffoftherolesandresponsibilitiesoftheAINacutecareposition

anditscontributiontotheAINscopeofpracticen FormulatelocalprotocolandguidelinestosupportpracticesappropriatetoAINscopeofpracticen DeveloporutilisecurrentprocessesthatformallymonitorandauthoriseappropriateAINcareactivitiesn MaintainstandardisedAINrolesandresponsibilitieswithinHealthServices


PositionDescription–AssistantinNursingAcuteCare,May2010

Position Requirements

1. Qualifications



orequivalent

2. Key functions

Provisionofsupporttothenursingteaminthedelivery

ofnursingcareinanacutecareenvironmentasdirected

bytheRegisteredNurse

Providedirectcareactivitiestopatientsinaccordance

withthenursingcareplanandunderthesupervision

ofaRegisteredNurse

AssistRegisteredandEnrolledNurseswithpatient

careinterventionsasdirected

Contributetocollectingaccuratehealthcareinformation

andmaintainingaccuratehealthcaredocumentationas

required

Communicateeffectivelywithpatientsandotherhealth

careteammembersinaccordancewithappropriate

protocol

3. Scope of Practice

Assistantsinnursingworkwithinaplanofcareunder

thesupervisionanddirectionoftheRegisteredNurseand

withinthelimitsoftheAssistantinNursingposition

description

AssistantsinNursingretainresponsibilityfortheirown

actionsandremainaccountabletotheRegisteredNurse

forallallocatedfunctions

AssistantsinNursingpracticeinaccordancewithNSW

Healthguidelines,thepositiondescriptionandlocalpolicy

andprotocol

Position Description

Position Details

PositionNo:

PositionTitle: AssistantinNursing(AIN)–AcuteCare

Responsibleto: DirectorofNursingServices

Reportsto: NursingUnitManager

Division: Nursing

Award: PublicHealthSystemNursesandMidwives(State)Award

Location: NSWHealth–HealthServices

HoursofWork: Sevendayshiftworker

PerformanceManagement: Appraisalafterinitial3monthsthenannually


4. Responsibilities

Assistinthedeliveryofthefollowingdirectcareactivities

asallocatedbyaRegisteredNurse;

n showering,bathing,spongingn repositioning,pressureareaandskincaren hairwashing,shavingn mouthanddenturecaren eyeandearcaren assistancewithtoiletingn provision,removalandcleaningofbedpansandurinalsn generalwardambulationandsupportmobilisation

asperplanofcaren reinforceinstructionsonuseofaidsformobility

orcareasdetailedinplanofcare,whereappropriaten assistwithpositioning,posturemaintenanceand

comfortn observeandreportpatientcompletionofand

performanceoftasksinlinewithcareplann setupandassistancewithpatientmealsandfluids

forassessedlowriskpatientsn applicationofantithromboemboleticstockingsn simplewounddressingsn lastoffices/careofthedeceased

Assistinthecollectionofclinicaldataasallocated

byaRegisteredNurse;

n patientweighingandspecificmeasurementsn specificpatientobservationsn nursingadmission(notnursinghistoryorassessment)

Observepatientsphysicalandpsychologicalstatusand

responsesduringthecourseofinteractionswithinscope

ofknowledge,andreportchangestotheRegisteredNurse

Reportallpatientobservationstotheappropriate

RegisteredNurse

Documentallpatientresponsestodirectcare/assistance

given,includeinprogressnotesandclinicalrecordsin

accordancewiththeplanofcareandorganisational

protocols

Maintaintheappearanceandfunctionofequipmentsuch

asliftingandmobilisingaids,pressurereducingmattresses

andotherclinicaldevicesusedinnursinginterventions

Changeandmakeupoccupiedandunoccupiedbeds

Promoteandmaintainaclean,comfortableandsafe

environmentforpatients,staffandvisitors

5. Standard Statement of Obligations

(TobecompletedbyHealthService/nursingunit)

5.1Professionalpractice

5.2Educationandprofessionaldevelopment

5.3Infectioncontrol

5.4CodeofConduct

5.5OHSandR

5.6EEO


4.2 Acute Care Assistant in Nursing – Care Activities List

TheAcuteCareAINCareActivitiesListprovidesboundaries

ontherangeofactivitiesthatanewlyqualifiedAINcanbe

reasonablyexpectedtoundertake.

AsindividualAINsgainexperienceandconfidenceintheir

role,nursingcolleagues’confidenceinthemwillalsogrow.

ToavoidunderutilisationorinappropriateextensionofAIN

activitiesduringintroductoryperiodsandwhileconfidence

increases,HealthServiceswillberequiredtodevelop,ifnot

alreadyavailable,aprocessformonitoringthepracticeof

anAINastheydevelopskillsandknowledgewithinthe

describedscopeofpractice.

WhereAINSareemployedaspartofthenursingteam,

responsibilitiesforpatientcare,supervisionandpractice

shouldbeviewedasfollows:

n Theprovisionofsafepatientcareisashared

responsibilityofallthoseinvolvedinthedelivery

ofnursingcare.n AINsaretoworkatalltimesunderthesupervision

ofaregisterednurse.n Registerednursesallocatepatientcareactivitieswith

predictablepatientoutcomestoAINs.n AINsretainresponsibilityfortheirownpractice,

reportingpatientcareoutcomestoregisterednurses

andworkingwithintheirscopeofpracticeandlevel

ofexperience.n AINsareresponsibleforusingtheirinitiativerelative

totheirscopeofpracticeandroleasasupportive

teammember.

TheAcuteCareAINCareActivitiesListispresented

inTable4.

Notes on Table:

1.Adefiningfactorofappropriateallocationtothe

activitiesidentifiedbelowisthecontextinwhichthe

decisionisbeingmade–pleaserefertotheAustralian

NursingandMidwiferyCouncilDecisionMaking

Framework3forpracticeguidelines.

2.Activitiesreferstothoseactivitiesthatarewithin

thescopeofpracticeofanAINwhohascompleted

thequalificationHLT32507CertificateIIIHealthServices

Assistance(Descriptor:AssistinginNursingWorkin

AcuteCare)i.e.expectedentrylevelskills.

3.Explanatorycommentsaremadewhereapplicable

andincludeexamplesofwhatcouldbeexpectedto

bereportedtoregisterednurses.

3 Australian Nursing and Midwifery Council. (2007)


Table4:AcuteCareAINCareActivitiesList

Activities Comments and general examples of what to observe and report

Direct Patient Care

Activities of Daily Living

Showering Mobility,skinintegrity

Sponging Skinintegrity,comfort,mentalorientation

Washes–FaceandhandsPerinealtoiletsPostopTepid

Skinintegrity,comfort,mentalorientation

GroomingShaveHygienePresentation

Skinintegrity,comfort,mentalorientation

SimpleeyecareOralhygiene

Discharge,comfort,inflammationofbrokenmucusmembrane

DietaryassistanceSetupmealsOralintake

LowriskfeedingasperriskassessmentIntakecapacity/appetiteAbilitytomanagediet

MobilisationAssistambulationPosturemaintenanceandcomfortReinforceinstructionsonuseofaids

AbilitytomaintainpostureComfortAbilitytomanageaidsRespiratoryrateonexertion

SkincarePressurerelieve/PressureAreaCareMoisturiseMaintainingadryenvironment

ConditionofskinIdentificationofpresenceofdressings

Patient Communication

Consultpatientregardingactivitiesofdailyliving(ADLs) Patientconcerns/issues

Reflectcommitmenttopatientrightsandresponsibilities Patientconcerns/issues

Reinforcepatientorientationtowardenvironment Patientdisorientation

Clinical data collection

TemperaturePulseRespirations Individualchanges

Bloodpressure(manualandelectronic) Individualchanges

Weight Individualchanges

Girth/thighmeasurements Individualchanges

FluidBalanceChart(basic) Individualchanges

Foodchart Patientconcerns/issuesIndividualchanges

Stool/emesischart Patientconcerns/issuesIndividualchanges

Urinalysis Individualchanges

BloodGlucoselevels Patientconcerns/issuesIndividualchanges

Neurologicalobservation BasicconsciousnessIndividualchanges

Wound care

Simpledressing DescriptionofwoundPatientexperience



Specimen collection

Sputumviasterilecontainer Specimenobtained

Urineviacontainer/pan Specimenobtained

Stool Specimenobtained

Venous access observation

PeripheralCannulaobservationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge

CentralVenousCatheter(CVAD)observationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge

VascularAccessDevice(VAD)observationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge

PeripherallyInsertedCentralCatheter(PICC)observationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge

Vas-cathobservationandreporting Stateofsurroundingtissue,dislodgement,entrysitedischarge

Care of drains

ObservationofdrainRecorddrainageSimpledressingofdrain

Stateofsurroundingtissue,movement/dislodgement,output,entrysitedischargeReporttheneedforachangeofdressing

Patient Escort

AsassessedbySeniorRN Delays,individualpatientchanges,transportequipmentissues

Cardiac/vascular

BasicLifeSupport Asaccredited

Assistinrespondingtoemergencies,includingchestpain,asdirectedbytheRegisteredNurse

Fittingandapplicationofthromboemboleticstockings Changesinskincondition

Respiratory

AssistpatientpositioningforoptimalO2exchange Patientcomplaintsofshortnessofbreath/puffing/snoring,inabilitytopositionpatientappropriately

Repositioningofnon-invasiveestablishedO2supportdevices Contaminated/soileddevice,inflamed/brokenskinfromdevice,O2flowrateoff,patientunabletomanage/tolerate,patientremovingO2supportdevice

Endocrine/digestive

Recordfaecalelimination/bowelregularity Individualpatientchangesinfrequency,comfort,characterofbowelmotions

Observationofestablishednasogastrictube Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundanchor/insertionsite

Observationofestablishedenteralfeeds Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundanchor/insertionsite.Completionoffeeds,volumetricpumpalarm

ObservationofPEGTube Changesinpositionoftubing,kinking,displacement

SimplePEGsitedressing Position,stateofsurroundingtissue,entrysitedischarge

Positionandpreparepatientformeals Patientrefusaltoeat/dislikeofmeal,inabilitytopositionappropriately,changeinlevelofconsciousness,wrongmeal/diet

Feedingofpatientsaccordingtoriskassessmentandcareplan Difficultyswallowing,coughingduringmeal,loosedentures

Renal/urinary

Indwellingurinarycathetercare,observationandoutputrecording Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundinsertionsite.DislodgementofanchorIndividualpatientchangesinamountand/orcharacterofurine

Supra-pubiccathetercare,observationandoutputrecording Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundinsertionsite.DislodgementofanchorIndividualpatientchangesinamountand/orcharacterofurine

Nephrostomycathetercare,observationandoutputrecording Changesinpositionoftubing,kinking,displacement,discharge.Inflammationoftissuearoundinsertionsite.DislodgementofanchorIndividualpatientchangesinamountand/orcharacterofurine

SimpledressingofSupra-pubicandNephrostomycatheters Stateofsurroundingtissue,entrysitedischarge,movementofcatheter



Rehabilitation Nursing

Careandobservationoflegstumpsasperdirection/careplan Discomfort,patientinabilitytomaintainprescribedpositioning

Reinforceappropriateuseofprosthesisasperdirection/careplan Reportpatientdifficulties/management

Miscellaneous

Careofthedeceasedperson ObservefacilityandCoronialrequirementsReportbreachesofabove

Activities Comments and general examples of what to report

Indirect Patient Care

Documentation

Contributetocareplandevelopment Contributeownobservations

Documentationofindividualactionsincontemporaneousnotes(reports,includingadverseincident)

Ownactionsandobservations

Observationcharts Resultsofownobservations

Information systems

Intranetresourceretrieval:ClinicalPractice/PolicyManualContinuingEducationopportunitiesHumanResourceformsStaffdirectoryCIAPBulletin/communicationboards

Reportaccessdifficulties

IIMSreporting

Team communication

Workloadconcerns ReporttoappropriateRN

Patientissues ReporttoappropriateRN

Contributetoclinicaldecisions Communicateobservationsandpatientconcerns

Practicelimitations InformRNimmediatelyofownpracticelimitationsregardingdelegated/allocatedactivities

Patientcareomissions ReportpatientcareomissionsimmediatelytoRNwhenidentified

Equipmentissues Reportbroken/dysfunctionalequipmentthroughestablishedprocesses

Interpersonalissues Addressissues/conflictsassertively,obtainsupportfromcolleagues/RNin-charge

Positivecontributiontowardculture IdentifyandcontributestrategiestoapositiveworkenvironmentMaintainestablished/desiredstandards

OHS

Useofslidesheetsandpatientmanualhandlingequipment Issueswithequipment/environmentAnyinjurytoself

Useandmaintenanceofpatientlifters Maintenanceandoperationissues

Useofchemicalspillkit AnyspillsanduseofspillkitUnavailabilityofspillkit

Responsetobodycontamination(staff) AnycontaminationLackofPersonalProtectiveEquipment(PPE)


Supervisionanddelegationresponsibilitiestolicensed

andunlicensedhealthcareprovidersarebeingincreasingly

recognisedasacriticalelementofaregisterednurse’s

practiceinpublichealthcaresettings.Allmembersof

thepatientcareteamshouldbeconfidentintheir

responsibilitiesandaccountabilitieswithregardto

supervision,assignment/allocationanddelegationoftasks.

TheAustralianNursingandMidwiferyCouncilhas

developedtwodocumentsthatcanbeusedtosupport

confidenceinresponsibilitiesandaccountabilitiesofnursing

teammembers.ItisrecommendedthateachNursingUnit

accessthesedocumentsanddiscussthemwithalllevelsof

staffinthenursingteam.

National Framework for Decision Making by Nurses and Midwives

TheNationalFrameworkforDecisionMakingbyNurses

andMidwives4(NationalDMF)isdesignedtoassistdecision

makingaboutnursingandmidwiferypractice.TheDMF

providesanationallyacceptedstandardforinformed

decisionmakingregardingprovisionofnursingand

midwiferycare.

‘TheANMCholdstheviewthatdecision-makingtoolsfor

nursesandmidwiveswillassistindevelopingahealth

workforcethatiseducatedandpreparedtomeethealth

consumerneedsintothefuture.Nursesandmidwivesusing

thesetoolswillcontributetoriskmanagementandto

ensuringaflexibleworkforce’(ANMC,2007).

WhilsttheDMFdoesnotdefinespecificpracticeactivities

orprocedures,useofthetoolswillassistnursesnavigate

thecomplexpracticeenvironmentswhenincorporatingthe

roleoftheAIN.

4 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice.

ANMC Guidelines for Delegation and Supervision for Nurses and Midwives

TheANMCGuidelinesforDelegationandSupervision

forNursesandMidwives5areapartoftheprofessional

practiceframeworkdesignedtosupportnursesand

midwivesinrelationtotheirpracticeobligations.The

nationalstandardsaredevelopedinrelationtothecurrent

regulatoryandlegislativeenvironmentsthatgovern

Australianhealthcare.

Theseguidelinesaredesignedtoassistnursesandmidwives

tomakesounddelegationandsupervisiondecisionsand

understandtheiraccountabilityandresponsibilitiesin

relationtodelegationandsupervision.Accordingly,the

ANMCguidelineswillsupportthedevelopmentofnurse’s

decisionmakingskillsandconfidenceinregardstotheir

ownandAINnursingcarepractices.

FortheNational Framework for Decision Making by Nurses

and MidwivesandtheANMC Guidelines for Delegation and

Supervision for Nurses and Midwives,pleaserefertothe

AustralianNursingandMidwiferyCouncilwebsiteatwww.

anmc.org.au

5 Australian Nursing and Midwifery Council. (2007). Guidelines for Delegation and Supervision for Nurses and Midwives

Delegationandsupervision

SECTION5


Recommended actions:n Establishresourcesinclinicalareastoprovideinformationregardingscopesofpractice,supervisionanddelegation

e.g.meetings,education,inservice,resourcefoldersn EstablishtheNationalDMFandlocalpracticalscenariosineducationandtrainingsessionsn Developmonitoringandfeedbackmechanismsforpracticereviewn Developtherequiredpolicies,protocolsandguidelinesrelevanttoincorporatingAINsintoclinicalpracticen EstablishsupportnetworksfornursesandAINstohelpresolveconflictandprovideprogressiveguidelines


Thefollowingdefinitionsareincludedtointroducecommon

conceptswithinanursingcaredeliverycontext.Thelistis

notexhaustive,norinclusiveofallinterpretations,thoughis

offeredtofacilitateconsistentunderstandingin

organisationalandcollegialconversation,particularlywith

regardtomodelsofcareandAINsupervision.

Accountability

n Theobligationtoanswerfortheprofessional,ethical

andlegalresponsibilitiesofone’sactivitiesanddutiesn Cannotbedelegated

(AustralianNursingandMidwiferyCouncil2007)6

Activity/activities

n Aserviceprovidedtoaconsumeraspartofanursing

planofcaren Maybeaclearlydefinedindividualtaskormore

comprehensivecaren Thetermcanalsorefertointerventionsdesignedto

producebeneficialoutcomestohealthcareconsumers


Activities of daily living

n Proceduresareconsideredtoberoutineactivities

oflivingwhen:

-theneedfortheprocedure;

-theresponsetotheprocedure;and

-theoutcomesofperformingtheprocedure

havebeenestablishedovertimeand,asaresult,

arequitepredictable.Thesameproceduremay

bearoutineactivityoflivinginonesetof

circumstancesandpartofatherapeuticplanof

careinanother.

(CollegeofNursesofOntario2008)8

6 Australian Nursing and Midwifery Council. (2007). National framework for the development of decision-making tools for nursing and midwifery practice


8 College of Nurses of Ontario. (2008) Practice Guideline; working with unregulated care providers. Toronto.

Assignment/allocation

n Allocationofpatientcareactivitiesamongcare

providersinordertomeetpatientcareneeds.Allocation

occurswhentherequiredcarefallswithinthefacility’s

policiesandpositiondescriptionsandthecarer’sscope

ofpractice

(CollegeofRegisteredNursesBritishColumbia2002)9

Assistant in Nursing (Public Health) (AIN)

n Aworkerwhoassistsnursestoprovidefundamental

patient/consumernursingcarewhoisnotlicensed

topracticeasaregisteredorenrollednurse/midwife.n TheminimumeducationalstandardforanAINworking

inNSWHealthinanacutecareenvironmentis

aCertificateIIIoralternativelyastudentcurrently

enrolledinanursingdegreeprogrammewhohas

completedaminimumof1yearstudy.n AssistantsinNursingareindividuallyaccountablefor

theirownactionsandaccountabletotheregistered

nurseandtheiremployerfortheirdelegatedduties.


Collaborative Care

n Collaborativecareseekstheactiveparticipationofeach

disciplineandcontributorinpatientcare.n Corecomponentsofacollaborativepracticemodel

aresuggestedas:

-Acommongroupofpatients

-Commongoalsforpatientoutcomesanda

sharedcommitmenttomeetingthesegoals

-Memberfunctionstotheirindividualeducation

andexpertise

-Anunderstandingbyteammembersofeach

other’srole

9 College of Registered Nurses British Columbia, (2002). Practice Standard: Assigning and delegating to unregulated care providers. Vancouver.

10 NSW Health Circular 2001/80. Employment of undergraduate nursing students as assistants in nursing in the public sector. Sydney Australia

Definitions

SECTION6


-Amechanismforcommunication

-Amechanismformonitoringpatientoutcomesn Thereisasetofrecognisedvalues/behavioursthatisthe

foundationofacollaborativepracticemodelnotedas;

-Mutualtrustandrespectamongallteam

members

-Knowledge

-Responsibilityandaccountability(independent

andshared)

-Effectivecommunication

-Cooperationandcoordinationthatpromotesthe

useofskillsofallteammembers

(PanCanadianPlanningCommitteeonUnregulatedHealth

Workers2008)11

Competence

n Theintegrationandapplicationofknowledge,skills,

attitudesandjudgementrequiredtoperformsafely,

ethicallyandappropriatelywithinanindividualspractice

orinadesignatedroleorsettingn Encompassesconfidenceandcapability


Complexity

n Thedegreetowhichapatient’sconditionand/or

situationischaracterisedandinfluencedbyarangeof

variablese.g.multiplemedicalconditions/diagnosis,

impaireddecisionmakingability,challengingfamily

dynamics

Context

n Theenvironmentinwhichnursespractice,whichinturn

influencesthatpractice,includes

-Consumercharacteristicsandcomplexityofcare

required

-Modelofcare,typeofserviceandphysical

setting

-Amountofclinicalsupport

-Availabilityofresources,includingstaffandskill

mixandaccesstootherprofessionaland/or

supportstaff


11 Pan Canadian Planning Committee on Unregulated Health Workers, (2008). Valuing health-care team members, working with unregulated health workers. Ottawa.



Delegation

n DelegationtoanAINoccurswhentherequiredtask

isprimarily(nothistorically)performedbyregisteredor

enrollednurses.Thedelegatedtaskisalwayspatient

specific,intheinterestsofthepatientandisnot

contradictedbyfacilitypolicy.Ifthetask/functionis

classifiedasa‘shared’(common)competencyitdoes

notrequiredelegation,howeverthepatient/context

complexityinfluencestheknowledge/skilllevelrequired

andaccordinglytheallocationofthetask/functionto

AINs,e.g.assistingapatientwithshoweringisan

allocatedtaskaccordingtothepatientcomplexitynot

adelegatedonen Anactiveprocessoftransferringauthoritytoa

competentindividualtoperformaparticularactivity

inaspecificsituationn Thosedelegatingretaintheaccountabilityforthe

decisiontodelegateandmonitoringoutcomesofthe

delegatedtask.

Responsibilities when delegating

n Teachingn Competenceassessmentn Providingguidance,assistance,supportandsupervisionn Ensuringpersontowhomdelegatingacceptsand

understandstheiraccountabilityn Evaluationofoutcomesn Reflectiononpractice

Responsibilities when accepting delegation

n Negotiateteaching,competenceassessment,support,

guidanceandsupervisionasrequiredn Notify/informdelegatorofinabilitytoperformthe

activityinatimelymannern Beawareoftheextentofthedelegationandany

monitoringand/orreportingrequirementsn Performdelegatedactivitysafelyn Participateinevaluationofthedelegationn Donotdelegatetheactivitytosomeoneelseunless

authorisedn Consultwiththedelegatorifcontext/situationchanges




Learning Organisations

n Learningorganisationsareorganisationswherepeople

continuallyexpandtheircapacitytocreatetheresults

theytrulydesire,wherenewandexpansivepatternsof

thinkingarenurtured,wherecollectiveaspirationisset

free,andwherepeoplearecontinuallylearningtosee

thewholetogether

(Senge1990)15

Patient Outcomes

n Theobservableevents/resultsofnursinginterventions,

careactivitiesorthecareenvironmentonpatientsn Theresponsesthatindicatethepatient’shealthstatus

and/orlevelofknowledgeasaresultofnursing

interventionsandactivities

(CollegeandAssociationofRegisteredNurses

Alberta2003)16

Predictable patient outcomes

n Theextenttowhichonecanidentifyinadvance

apatient’sresponseonthebasisofobservation,

experience,orscientificreason.n Involvesassessmentofhoweffectivelyahealth

conditionismanaged,thechangeslikelytooccur,

andwhetherthetypeandtimingofchangecan

bepredicted

(CollegeofRegisteredNursesNovaScotia2004)17

Registered Nurse responsibilities

n Theregisterednursepracticesindependentlyand

interdependentlyassumingaccountabilityand

responsibilityfortheirownactionsanddelegation

ofcaretoenrollednursesandhealthcareworkers.

Delegationtakesintoconsiderationtheeducation

andtrainingofenrollednursesandhealthcareworkers

andthecontextofcare

(AustralianNursingandMidwiferyCouncil,National

CompetencyStandardsforRegisteredNurses)18

15 Senge, P. (1990). The fifth discipline: The art and practice of the learning organization. Doubleday, New York.

16 College and Association of Registered Nurses of Alberta, (2005). Standards for supervision of nursing students and undergraduate nursing employees providing client care. Edmonton.

17 College of Registered Nurses Nova Scotia, (2004). Delegation guidelines for registered nurses. Halifax, Nova Scotia.

18 Australian Nursing and Midwifery Council. National Competency Standards for Registered Nurses.

Risk assessment/risk management

n Ariskmanagementsystemincorporatesthe

followingstrategies:

-Identifyrisks/hazards

-Assessthelikelihoodoftherisksoccurringand

theseverityoftheconsequencesiftherisks

dooccur

-Preventtheoccurrenceoftherisks,orminimise

(mitigate)theirimpact


Role Transition

n Aperiodofadjustmenttoanewworkenvironmentthat

requireslearningnewcompetenciesandreconfiguring

one’sprofessional/occupationalidentity

(KalliathP&KalliathT2003)20

n Examplesare;newgraduateregisterednurses,

reconnectnurses,experiencednursesrelocating

toadifferentclinicalspecialtyn Transitionprogrammesaredesignedtosupportthose

inroletransitiontodevelopnewlyrequired

competenciesassoonaspossible

Scope of Practice

n Fullspectrumofroles,functions,responsibilities,

activities,decision-makingcapacityandaccountabilities

whichoneiseducated,andauthorisedtoperform

Scope of Professional Practice

n Setbylegislationandprofessionalstandardssuchas,

competencies,codeofethics,conductandpracticen Influencedbypublicneed,demandandexpectation

Scope of individual’s practice

n Influencedbypracticeenvironment/context,

consumer/patientcarecomplexityn Levelofcompetence,education,qualifications

andexperiencen Serviceprovider’s/organisation’spolicy,qualityand

riskmanagementframeworkandculture



20 Kalliath. P. & Kalliath, T. (2003) Applying action learning concepts to role transition in a dyadic group setting. Accessed from hpt//:www.education.up.ac.za/alarpm/PRP_pdf/Kalliath&Kalliath.pdf on 23.11.09



Shared (common) Competency

n Askillorservicethatmaybeperformedbyeither

registeredorunregisteredhealthworkersn Theactivitieswithinthiscategoryarewithintheskill

|setandscopeofpracticeoftheinvolvedcaregivers.

Thedeterminationofwhoshouldperformashared

competencyistheactofassignment/allocationby

aregisterednurse

Skill mix

n Thecombinationofskillsavailabletoprovidedirect

andindirectnursingcaretopatientswiththestaff

mixprovided

Stable

n Situationsinwhichapatient’shealthstatuscan

beanticipated,theplanofcarereadilyestablished

andmanagedwithinterventionsthathavepredictable

outcomes

Supervision/supervise

n Therearethreetypesofsupervisionina

practicecontext:

1.Managerialsupervisioninvolvingperformance

appraisal,rostering,staffingmix,orientation,induction,

teamleadership,etc

2.Professionalsupervisionwhere,forexample,amidwife

preceptorsastudentundertakingacourseforentryto

themidwiferyprofession,oraregisterednursesupports

andsupervisesthepracticeofanenrollednurse

3.Clinically-focussedsupervision,aspartofdelegation

Inrelationtoconsumercareactivitiesdelegatedtoanother

personbyamidwifefromamidwiferyplanofcareorbya

registerednursefromanursingplanofcare,clinically-

focussedsupervisionincludes:

-Providingeducation,guidanceandsupportfor

individualswhoareperformingthedelegated

activity

-Directingtheindividual’sperformance

-Monitoringandevaluatingoutcomes,especially

theconsumer’sresponsetotheactivity

Thereisarangeofclinically-focussedsupervisionbetween

directandindirect.Bothparties(thedelegatorandthe

personacceptingthedelegation)mustagreetothelevel

ofclinically-focussedsupervisionthatwillbeprovided.

Direct Supervisioniswhenthesupervisorisactually

presentandpersonallyobserves,workswith,guidesand

directsthepersonwhoisbeingsupervised.

Indirect Supervisioniswhenthesupervisorworksinthe

samefacilityororganisationasthesupervisedperson,but

doesnotconstantlyobservetheiractivities.Thesupervisor

mustbeavailableforreasonableaccess.Whatisreasonable

willdependonthecontext,theneedsoftheconsumerand

theneedsofthepersonwhoisbeingsupervised.


Indirect Remote Supervision

n Aregistered/regulatedhealthcareprofessionalis

availableforconsultationandguidancebutisnot

physicallypresentinthelocationwherethecareis

beingprovidedbutiseasilycontactablethrough

technicaldevices

(CollegeandAssociationofRegisteredNurses

ofAlberta2005)23

Tacit Knowledge

n ‘Knowhow’knowledgethatisembeddedinaction

orsocialpracticeandishardtoacquireoutsideofthe

contextoftheclinicalenvironment,itisseenasdeeply

rootedinindividualactionandexperienceaswellas

ideals,valuesand/oremotionsembraced

(BalogunandJenkins2003)24

Task

n Partofapatientcarefunctionwithclearlydefinedlimits


23 College and Association of Registered Nurses of Alberta, (2005). Standards for supervision of nursing students and undergraduate nursing employees providing client care. Edmonton.

24 Balogun and Jenkins. (2003). Re-conceiving change management: a knowledge-based perspective. European Management Journal, vol. 21, no. 2, pp. 247-257.


Team

n Ateamisasmallnumberofcommonlyconsistent

peoplewitharelevant,sharedpurpose,common

performancegoals,complementaryandoverlapping

skills,andacommonapproachtoitscollectivework.

Teammembersholdthemselvesmutuallyaccountable

fortheteam’sresultsandoutcomes

(Manion1997)25

Team Based Nursing

n Nursingcaredeliveredtopatientsbyateamofnurses

withorwithoutassistantsinnursingmembershipn Nursingteamsmayormaynothaveconsistent

individualmembershipovertime.n Nursingteamsfacilitatethetransferenceofprofessional

and‘tacit’knowledgeacrossteammembersn Thereisnoidealconfigurationorcompositionofateam

asitisspecifictointernalandexternalcontextual

factors.Effectivenessandefficiencyofteamsresults

fromreducinggapsandduplicationinrequiredskills

acrossteammembersn Allteammembers,includingAINs,shouldactively

participateinqualityimprovementsthatcouldlead

tochangesinthedeliveryofcareandpatientcare

outcomesn NursingTeamsareintendedtomaximisetheskillsofall

teammembers,preventduplicationofservicedelivery

andenhancetheproductivityoftheworkforce.

Healthcareprofessionalsneedtomakejointdecisions

aboutwhowilldowhattoensurethatduplicationof

effortisreducedandfragmentationdoesnotoccur

(PanCanadianPlanningCommitteeonUnregulated

HealthWorkers2008)26

25 Manion, J. (1997). Teams 101: The manager’s role. Seminars for Nurse Manager’s. vol. 5, no. 1, pp31 – 38.

26 Pan Canadian Planning Committee on Unregulated Health Workers (2008). Valuing health-care team members, working with unregulated health workers. Ottawa.

Unstable

n Situationsinwhichapatient’shealthstatusis

fluctuating,withatypicalresponses,theplanofcare

iscomplex,requiringfrequentassessmentand

modificationandismanagedwithinterventionsthat

mayhaveunpredictableoutcomesand/orrisks

(CanadianNursesAssociation2003).27

27 Canadian Nurses Association (2003) in College of Registered Nurses Nova Scotia (2004) Delegation guidelines for registered nurses Nova Scotia


AustralianNursingandMidwiferyCouncil.(2007).

National framework for the development of decision-

making tools for nursing and midwifery practice.

AustralianNursingandMidwiferyCouncil.National

Competency Standards for Registered Nurses.

BalogunandJenkins.(2003).Re-conceivingchange

management:aknowledge-basedperspective.European

Management Journal, vol. 21, no. 2, pp. 247-257.

CollegeandAssociationofRegisteredNursesAlberta.

(2003).Decision making standards for nurses in the

supervision of health care aides: restricted activities and

activities of daily living. Edmonton.

CollegeandAssociationofRegisteredNursesofAlberta,

(2005).Standards for supervision of nursing students and

undergraduate nursing employees providing client care.

Edmonton.

CanadianNursesAssociation(2003)inCollegeof

RegisteredNursesNovaScotia(2004)Delegation guidelines

for registered nurses.NovaScotia

CollegeofRegisteredNursesBritishColumbia,(2002).

Practice Standard: Assigning and delegating to unregulated

care providers.Vancouver.

CollegeofRegisteredNursesNovaScotia,(2004).

Delegation guidelines for registered nurses.Halifax,

NovaScotia.

DepartmentofNursingandMidwifery,University

ofSterling.Informationformentors.accessedfrom

http//:www.nm.stir.ac.uk/mentorson10.11.09.

Kalliath.P.&Kalliath,T.(2003)Applying action learning

concepts to role transition in a dyadic group setting.

Accessedfromhpt//:www.education.up.ac.za/alarpm/PRP_

pdf/Kalliath&Kalliath.pdfon23.11.09

PanCanadianPlanningCommitteeonUnregulatedHealth

Workers,(2008).Valuing health-care team members,

working with unregulated health workers.Ottawa.

Manion,J.(1997).Teams101:Themanager’srole.

Seminars for Nurse Manager’s.vol.5,no.1,pp31–38.

Senge,P.(1990).The fifth discipline: The art and practice

of the learning organization.Doubleday,NewYork.

References

SECTION7

SHPN (WDL) 100137

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