Nurse Competencies and Scope of Practice in Disaster

Introduction

Competency is defined as “the quality of being adequately or well qualified physically and intellectually” (Competency, 2011). A nurse competency refers to the knowledge or the capability of a nurse to carry out particular skills commanded by the employer. This calls for the nursing stuff to exhibit “competent nursing practice, critical thinking and interpersonal relationships with patients, visitors and co-workers” (ehow.com, 2011, Para.2). They have variations and are dependent upon the employer, the job description and the area of expertise.

The most significant reason for having nurse competencies is to have secure, knowledgeable, and effectual patient care. Competencies as well assist in the prevention of errors that may be made by the nursing experts. The ‘Joint Commission on the Accreditation of Healthcare Organizations’ or JCAHO, requires that the organizations in the healthcare field in the U.S engage in the documentation of the nursing staff competency. This is a policy which boosts “competent nursing practice, skills and thinking that is required by nursing professionals” (ehow.com, 2011, para 6). The other reason for ‘annual competencies’ is continuous education intended to ensure maintenance of knowledge as well as skills. Having annual completion of competencies in place, “staff members remain proficient in infrequently used skills and procedures”(ehow.com, 2011, para.6).

Nursing Competencies in disaster

“DESCRIBE the chain of command in emergency response”

Each and every nurse is supposed to familiarize him or her self and be in a position to give a description to the lines of authority as well as communication in “emergency response, a chain of command which is on the basis of the Incident Command System” (FEMA, 2006, p.1). Even if nurses can carry out their operations in a number of abilities, there is a high likelihood of them being used for the “operations section” for the reason of bringing the motives of leadership to the basis, wider knowledge about the community systems, knowledge in regard to nursing as well as nursing abilities and skills (Gebbie & Qureshi, 2002). Each and every nurse has to be aware of the way to draw the organizational structure that is highly likely to link the nurse to the “agency command structure” in the course of an emergency (Association of State and Territorial Directors of Nursing, 2007, p.5).

IDENTIFY and LOCATE the agency’s emergency response plan

Each and every nurse has to have the knowledge about where to get the emergency response plan and to familiarize him or her self with what is contained in plan before the occurrence of a disaster (U.S. Department of Homeland Security, 2006). The program meant to orientate the nurses who are just coming in is supposed to encompass a general idea of the emergency response plan agency as well as the way to access it and where it is located and also the way to remain aware about any revisions that can be carried out on the plan. What is expected is supposed to be communicated and this is supposed to be done through job descriptions during orientation and is supposed to undergo review at least once a year (Gebbie & Qureshi, 2002). If possible, each and every nurse will possess a copy of the main portions of the agency plan and a list of contacts that will have to be easily accessible (Columbia University School of Nursing Center for Health Policy, 2002).

“DESCRIBE emergency response functions or roles and DEMONSTRATE them in regularly performed drills”

In order to have effective response, there is need to have each and every member of the team knowing what he or she is supposed to do and the way to do it (U.S. Department of Homeland Security, 2006). “The responsibility of the nurse may not be necessarily changeable or the responsibility may involve various duties and responsibilities, such as operating in a community shelter or group vaccination clinic, building up line lists and making links for disease surveillance in the course of a large scale disease epidemic, or reporting for duty at a designated ‘staging area’ in the course a disaster” (Association of State and Territorial Directors of Nursing, 2007, p.6). In order to make sure that there is competency in the course of a disaster or emergency, it is quite vital that “tasks be practiced” (Gebbie &Qureshi, 2002). The nurses are supposed to have knowledge about which kinds of emergencies have a high likelihood of occurring, which health conditions have a high likelihood of coming about as a result, and which “emergency response” roles have a high likelihood of being assigned to them (Gebbie & Qureshi, 2002).

The nurses are supposed to engage in practicing the roles that are likely to be assigned to them and they can do this through participation in local drills as well as the statewide ones. They are also supposed to do this by participating in the training programs and exercises. Association of State and Territorial Directors of Nursing (2007) points out that even as the bulk of this training has to be with “multiple and diverse partners, both external and internal to the organization, nurses must also participate in training that is specific to nursing in events anticipated for their geographical area, including weapons of mass destruction” (Association of State and Territorial Directors of Nursing, 2007, p.6).

“The use of equipment (including personal protective equipment) and the skills required in emergency response during regular drills”

In the course of an emergency, there may be need for the nurses to make use of the equipment; not being a part of the day to day practice. Carrying out the identification of the settings to which the nurses may be possibly dispatched offers them with a chance to engage in learning the way to use such equipment well ahead of time. Nurses may be required to familiarize themselves “not only with standard personal protective equipment used as part of an agency’s infection control program, but also with advanced equipment and procedures used in emergencies” (Gebbie & Qureshi, 2002).

IDENTIFY the limits of your own knowledge, skills, and authority, and identify key system resources for referring matters that exceed these limits

“Nurses are supposed to, in general, given roles that facilitate capitalizing on the skills that they contribute to the team” (Gebbie & Qureshi, 2002). For those nurses who may be serving in new roles, the necessary measures are supposed to be taken to give “Just-in Time Training” in order to boost their ability to take care of the people who are affected. However, following the unpredictable situation that may happen during the nursing practice or work, there is no guarantee that everything will always be good and there is also not time for the additional training. So, when it comes to nursing, one should realize the responsibility of it at the fullest. According to the duties that the nurses must do, one of the most important things for the nurses is to be flexible as this work demands much effort and is quite stressful. For instance, “the nurse whose usual obligation is to work with the adults and those who are constantly ill may be given an assignment to participate in working in a disaster shelter with large numbers of young children” (International Nursing Coalition for Mass Casualty Education, 2003). Examining the health of a child that is reported to be having abdominal pain may call for carrying out the determination of whether there is any other staff on site who has the appropriate skills and knowledge to take care of young children, reaching the consultants by making telephone calls, or looking for any other help (FEMA, 2007).

APPLY creative problem-solving skills and flexible thinking to the situation, within the confines of your role, and EVALUATE the effectiveness of all actions taken.

“It is quite rare to have disasters coming about as exactly anticipated and described in the preparedness plan” (Gebbie &Qureshi, 2002). Each and every individual disaster has its own exclusive characteristics as well as exclusive onset. Failure may be experienced in the plans, systems and equipment. “Innovative problem solving calls for handling a situation with any appropriate resources that are available” (Gebbie &Qureshi, 2002). Nurses are used to employing critical thinking as well as problem solving abilities in their day to day practice. “This is part of their fundamental training in their nursing field. Nurses offer leadership to disaster plans and response activities better” (Council on Linkages between Academia and Public Health Practice, 2001).

Expanded Nurses Scope of Practice and the Ethical Issue in Disaster

The responsibility of a nurse practitioner is to take care of patients in various specialized settings. For one to become a nurse practitioner, he or she must possess a minimum of a Master’s degree and has to be a nationally registered nurse as well as a certified nurse practitioner. This professional offers primary care to patients in hospitals as well as in other healthcare facilities. The nurse is charged with the responsibility of recording as we as analyzing “a patient’s history, performing physical exams, ordering diagnostic tests, prescribing physical therapy and other similar tasks” (Education-Portal.com, 2011).

In considering public health nursing, this is defined as the activities of boosting as well as offering protection to the health of people by making use of knowledge from nursing, social and public health sciences” (American Public Health Association, 1996, p.1). “The public health nursing interventions that are based on the population are not just limited to those people who look for services or are poor or are vulnerable” (American Public Health Association, 1996, p.1). The programs as well services put in place that are linked to public health nursing may be directed toward the whole population in a community, “the systems that affect the health of those populations… public health nurses partner with communities and populations to reduce health risks and to promote, maintain, and restore health, advocating for systems-level changes to improve health” (American Nurses Association, 2006, p.50).There are some code of ethics that need to be observed by nurses in their practice. Nursing ethics is defined as “a set of shared values or principles that govern the way nurses interact with patients, a patient’s family, and even other doctors and nurses” (Medi-Smart, 2011, para 1). The code of ethics gives an outline of the ethical obligations that a nurse has and offers a “non-negotiable ethical standard” (Medi-Smart, 2011, para 1).

The services that are offered by the nurses which are intended for preparing and responding to emergencies and disasters are supposed to be in line with the scope of nursing practice for the area of specialization or the area in which the nurse, at the time, is practicing. They should also be in line with the nursing ethics. For instance, the nurses working in public place are used to apply the necessary skills towards people who really need a serious medical health and have serious health problems of different levels (Medi-Smart, 2011, para 1). But, the acuteness levels of those people who are housed in special needs shelters may need the nursing skills, which may not be in line with scope of nursing practice at that moment.

The ethical issues the nurses face during a disaster or an emergency include Individual liberty, Protection of the public, Proportionality, Privacy, Duty to provide, Reciprocity, Equity Care, Trust And Solidarity and Stewardship. Considering the issue of the duty to provide care, it is pointed out in the code of ethics for registered nurses that in the course of a disaster or emergence, the nurses have a duty to offer care by using suitable safety precautions (Canadian Nurses Association, 2008). It is also explained in this code of ethics that “a duty to provide care refers to a nurse’s professional obligation to provide persons, receiving care with safe, competent, compassionate and ethical care in which it is acceptable for a nurse to withdraw from providing care or refuse to provide care” (Canadian Nurses Association, 2008, p.46). Considering reciprocity, this requires that the society offers support to the people who face an “unbalanced burden” in offering protection to good of the public and takes appropriate measures to bring down the level of the impacts as much as possible. During a pandemic for instance, steps taken to protect the public good have a high likelihood of placing an unbalance burden to the healthcare workers as well as on the patients together with their families. It is stated that in case of a Pandemic such as influenza pandemic, “the healthcare workers will be the first group to receive the pandemic influenza vaccine as soon as it is available” (Kotalik, 2005, p.423).

The Ability to Respond in Disaster

The ability to respond to disaster depends on effective communication. Communication is defined as “the exchange and flow of information and ideas from one person to another; it involves a sender transmitting an idea, information, or feeling to a receiver” (U.S. Army, 1983, p.1). Effective communication is only realized when the one receiving the information is able to comprehend the exact information that is being passed over to him or her by the sender as initially intended. A large number of problems that come about in any organization are “either the direct result of people failing to communicate or processes, which lead to confusion and can cause good plans to fail” (Mistry, et al., 2008, p.5).

The capability to respond in disaster involves having reputable communication systems in place within “the agency, the media, the public and with personal contacts” (Association of State and Territorial Directors of Nursing, 2007, p.7). Each and every organization is supposed to define definite responsibilities that are appropriate to the interior as well as external communications. Each and every individual has to have a “family disaster plan” which covers the way the members of the family engage in communication amongst themselves when a disaster arises and a “back-up plan” of the initial level of communication turns out to be dysfunctional. Every nurse is supposed to be aware of which specific TV or radio stations will have to be used in learning about the workplace closings (Association of State and Territorial Directors of Nursing, 2007)..

During the time there is occurrence of disasters or emergencies outside the normal working time, the nurses are supposed to have the knowledge about what is expected in regard to checking in with their seniors, supervisors in this case, and others in order to carry out the first assessment and also to have periodic updates. All of these details are supposed to be recorded in the emergency plan and a review of these is supposed to be made at least once a year with the entire staff. Each and every nurse has to make sure that the agency “maintains current and complete contact information” (Association of State and Territorial Directors of Nursing, 2007, p.7). In order to improve the nurse’s ability to respond, he or she is supposed to be able to describe the chain of command in emergency response and also to identify and locate the agency’s emergency response plan.

References

American Nurses Association. (2006). Public health nursing scope and standards of practice. Washington, DC: American Nurses Publishing.

American Public Health Association. (1996). The definition and role of public health nursing. American Public Health Association. Web.

Association of State and Territorial Directors of Nursing. (2007). The role of public health nurses in emergence preparedness and response. Association of State and Territorial Directors of Nursing. Web.

Canadian Nurses Association, (2008). Code of ethics for registered nurses. Ottawa: Canadian Nurses Association Columbia University School of Nursing Center for Health Policy. (2002). Bioterrorism and emergency readiness competencies for all public health workers. Atlanta (GA): Centers for Disease Control and Prevention.

CouncilOnLinkages. (2001). Council on Linkages between Academia and Public Health Practice. Competencies Project. Web.

Education-Portal.com, (2011). Nurse practitioner education requirements. Education-Portal.com. Web.

Ehow.com. (2011). Reasons for nurse competencies. Ehow.com. Web.

Farlex. (2011). Competency. Free Online Dictionary. Web.

FEMA. (2007). National Incident Management System Integration Center. FEMA. Web.

FEMA. (2006). NIMS Basic Incident Command system. FEMA. Web.

Gebbie, K. M., & Qureshi, K. (2002). Emergency and Disaster Preparedness: Core Competencies for Nurses: What Every Nurse Should But May Not Know. American Journal of Nursing, 102(46), 11- 28.

Homeland Security. (2006). National Response Plan. Homeland Security. Web.

Kotalik, J.(2005). Preparing for an influenza pandemic: ethical issues. Bioethics, 19 (4), 422 – 431.

Medi-Smart. (2011). What is nursing ethics? Medi-Smart.

Mistry, K., et al. (2008). Using Six Sigma Methodology to Improve Handoff Communication in High Risk Patients. Rockville. MD: Agency for Healthcare Research and Quality.

Stanley, J. (2003). Educational Competencies for Registered Nurses Responding to Mass Casualty Incidents. Nursing Emergency Preparedness Education Coalition. Web.

U.S. Army. (1983). Military Leadership. Washington. DC: U.S. Government Printing Office.

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