Leadership and Clinical Governance

Introduction

Nurses are professionals who deal with people during the most vulnerable times in their lives. It is, therefore, critical to provide clear descriptions of the duties and obligations that are an integral part of this important profession. Nurses are expected to be responsible people who follow ethical behavior. Their four primary responsibilities are to promote people’s health, to prevent illness, to reinstate health, and to lessen patient’s suffering (Wan 2003). The nurses’ code of conduct requires from them to have the highest level of commitment to the patient care since their training entails this condition. Although the competing demands of the patients, families, physicians and insurance may arise, the nurse’s main priority is to ensure patients’ safety and protect their patient while under the responsibility of the health care givers.

The definition of quality nursing care highlights that its provision is an obligation and not negotiable or optional issue. Whether one is a registered nurse, midwife or only student, quality nursing care has been entwined and required according to the nurse’s professional code of practice. It is also a part of their professional accountability and responsibilities (ANMC 2007). Quality nursing care implies assuring, ensuring, and acquiring the information that will confirm that the dignity of all individuals within their contact is uncompromised. The paper analyzes the case of HCCC v Jarrett and chooses a national safety and quality health service standards to discuss the case. The essay will also analyze how quality improvement practices, nursing leadership and management contribute to the quality and safety of the patient’s care delivery.

Summary of the Case

In this case, Ms. Janelle Jarrett was reprimanded. The commission for health care complaints prosecuted Ms. Janelle Jarrett, who is a registered nurse before a nursing and midwifery professional standards committee. The Commission had alleged that Ms. Jarrett, a senior nurse at Ballina District Hospital, between September 30th to October 1st, 2011did not thoroughly examine a patient. She even did not request a doctor to examine a certain patient who had fallen due to Valium dose. However, Ms. Jarrett denied some of the allegations and admitted some aspects of the complaints raised against her. On December 2013, the Committee had proven most of the allegations beyond any reasonable doubt. The Committee argued that being in charge of the hospital that night, Ms. Jarrett was not excused for delivering the expected care (Australian Nursing and Midwifery Council, [ANMC] 2007).  She was thus reprimanded and required to undertake a certificate in the field of acute care nursing.

This complaint is related to the nursing code of conduct which involves their role in the provision of the patient care. This was associated with the treatment of a certain patient at the hospital in 2011. The nurse was ordered to continue further professional education after being found guilty of unsatisfactory conduct. The Committee argued that the practitioner’s capacity to provide treatment was to some extent compromised. This was due to the different roles she was expected to perform in the hospital, which included being the in charge of the hospital that night as well of the ward in general. This is a good case of professional conduct, leadership, and clinical governance.

National Safety and Quality Health Service Standards

According to Koutoukidis, Stainton, Hughson & Tabbner, (2013), all nurses have the responsibility to provide safe nursing care which is in compliance with the established national standards of practice. The Australian Health Practitioner Regulation Agency (AHPRA) is the national body partnering with national boards regulating over 600,000 health practitioners in Australia. The standards for registration define the requirements that the applicants, registrants, and students ought to meet in order to be registered. The National Safety and Quality Health Service Standards (NSQHS) published in 2012 are intended to monitor clinical and non-clinical practices in the health care workplaces. The specified goals are safety care where people ought to receive care without experiencing preventable harm. Another aim is the appropriateness of care where people receive appropriate evidence-based care. The last conditions are partnering with people so that there may be effective partnerships between them and health care providers. In Australia, all the health departments in all states and territories have developed risk management programs that are underpinned by the national safety and quality framework for health care and the NSQHC.

Clinical Governance

According to Som (2011), structures, systems and standards are applied to create culture and direct clinical activities.  Clinical accountability and responsibility that are subjects to clinical governance involve monitoring and oversight of the clinical activities. This includes regulation, audit, assurance and compliance provided by the governors, regulators as well as internal and external auditors (Australian Commission on Safety and Quality in Health Care 2011).  The most important purpose of nursing by-laws in a shared governance structure is to legitimize the professional governance model of nursing organization. There are four pillars of clinical governance, but the essay concentrates on the first one.

The Partnering with the Consumer Standard

The consumer value pillar encourages health services to involve the stakeholders and communities in the maintenance and improvement of their health service performance. In health care, there are many types of consumers as the Commonwealth, consumers, local government, and NGOs.  Effective consumer participation requires leadership to ensure that all involvements are valuable and effective resulting in positive outcomes for the population’s health. Consumer value pillar has two key elements such as consumer liaison and consumer participation (Stonehouse 2013).

Consumer liaison is a terminology involving the established strategies that promote a two-way communication between health service providers and consumers. They can include informed consent, patient satisfaction surveys, complaint management, and provision of information about the services to the patients, care givers, and their families. This information is crucial for making imperative decisions regarding health care.

Herzlinger (2004) argues that consumer participation includes consumers who are involved in the planning of health service, decision making, and policy development. Consumer participation will ensure that the health services are confident in the provision of equitable and accessible health care to the communities. It also ensures that they are truly responsive to all the priorities of the locals. It is difficult to measure the quality of health care services due to the inherent heterogeneity, intangibility, as well as inseparable features. Health care is dynamic with significant changes of the customers which results in the increased competition. Consequently, evaluation of the health care quality raises problems due to the size of the service, its complexity, specialization, and expertise within the respective organizations.

Health service organization leaders ought to implement systems, which support partnering with patients, their care givers and consumers in safety improvement and quality of care. The consumers, patients, care givers as well as clinicians will use the systems for consumer partnering.  This standard is intended to create a health service that is responsive to the needs and inputs of the consumer, patient, as well as care. This standard has provided the framework for active partnering with the consumers by the health care organizations. Usually, patients’ satisfaction is considered as the most fundamental objective of health care provision. The nurses exercise the ethical standards in maintaining skilled and focused workforce throughout their performance (Australian Commission on Safety and Quality in Health Care 2011). The major aims are to ensure patients’ satisfaction by ensuring safety as well as providing quality service. Moreover, the nursing role also focuses on the patient’s ability in meeting the hospital costs and expenses as well as ensuring cost effective services to the patients.

According to Herzlinger (2004), there are significant benefits of these consumer partnerships with health service organizations to the clinical outcomes and quality care. The clinical benefits are mostly identified as related to better patient-centered care, patient experience are decreased mortality, reduced stay in a hospital, decreased rates of readmission for others. There are also operational benefits, which include low costs per case, better workforce satisfaction, improved liability claims as well as increased rates of employee retention. Several factors are used in the prediction of patient satisfaction, including empathy, caring, responsiveness, and reliability. The corresponding dimensions, which influence the evaluation of the patients, include service availability, the conduct of the physician, confidence, continuity, outcomes, and efficiency. Moreover, several aspects have been established to capture the evaluation of patients in health care facilities. These include communication, professional credibility, core services, competence, and customization (Australian Commission on Safety and Quality in Health Care 2011).

Nursing Roles

Nursing care is the base for providing good health care service to the patients. The services provided by nurses to their clients are of the basic importance. Collaborations in the health care facilities are considered as a good approach to ensuring good service delivery to the clients and patients, especially in cases of acute illnesses and emergencies. Collaborations result in multidisciplinary interventions such as coordinated medical rounds enhancing efficiency in communication and in the timely provision of the health care services. Teamwork is enhanced by appropriate decision making and delegation of duties among the nurses. Mostly, the registered nurses take the responsibilities of delegating duties to the licensed practical nurses or the certified assistants (Johnstone & Kanitsakis 2007).

Koutoukidis, Stainton, Hughson & Tabbner (2013) state that professional nurses are always required for the decision making and formulation of the legal and ethical standards in the nursing practice. The nursing practice requires from the nurses to do what is ethically and morally correct than what is legally restricted. The registered nurses are mostly involved in the health care, and the practice is always aimed at achieving high standards of nursing care that rejuvenates and respects the patient’s values. Some of the legal recommendations are enshrined in the respective act to provide necessary guidelines to the nurses and trainees (Kazandjian 1999). The nursing ethical aspects are the efficiency in service delivery. This is mainly to ensure timely recovery of the patient, exercise equality and fairness, being careful and considerate to avoid pain infliction on the patient and allowing the patients to deny or accept any interventional approach.

Nursing practices are vital in the management of patient’s day-to-day health and personal needs. It gives the necessary support to the patients making the overall management easier and efficient. The good nursing system should ensure patients’ safety and full restoration of their health status (McSherry, Pearce, Grimwood, & McSherry 2012). The patient management may not be very affordable without nursing since it provides a strong foundation for many other medical interventions in patients. In addition, the management must be based on specific medical diagnoses. Nursing practice should not compromise on the client’s need and might allow the ideological expressions of the clients before commencing the care.

Professionalism in Nursing Practice

Nursing professionalism includes the skills, values, attitudes, and behaviors of those who are undertaking the practice of medicine (Bostock-Cox 2015). It involves concepts such as adhering to the ethical codes of conduct, maintaining competence, demonstrating accountability, being dedicated to the provision of service, personal integrity, etc. Although professionalism is important in the practice of nursing, many nurses possess less knowledge required for good performance. Unprofessional nursing practice leads to different errors and provision of low quality services. Nursing professionalism can be either value-based or behavior-based. Value-based professionalism centers on issues of competency or excellence, humanism, and altruism. Behavioral-based professionalism focuses on nursing service and ethical code of conduct (Koutoukidis, Stainton, Hughson & Tabbner 2013).

Effective nursing practice plays a crucial role in enhancing their professionalism. Nurses can display effective practices in two ways. The first way is conscientious objection. Bostock-Cox (2015) argues that some forms of clinical practice can be a challenge to the moral values of a nurse. Consequently, the affected nurse may refuse to do what he considers as morally wrong. The second way, in which the nurses can demonstrate effective practice, is to deal with the issue of conflict of interest. The clinical practice of nursing and patient care is normally associated with various competing interests (Ausserhofer, Schubert, Desmedt, Blegan, De Geest, & Schwendimann 2013). These include participating in a given research, pursuing further education, seeking managerial or administrative positions, etc. The nurse should avoid such private interests. They should rather prioritize the interests of their patients.

Leadership in Nursing

Nursing is the core of health care provision. Many health care institutions focus on the nursing leadership as the best way of improving the health care service. The nurses are considered to be the core stones of the comprehensive health care delivery. They remain the hospital’s major assets that determine patients’ satisfaction as well as the overall competence of the health care institutions (Jeffs, Beswick & Campbell 2013). The quality of the service delivery relies on the recruited health care providers. In addition, their experience determines the overall performance of an institution in the health care delivery.

Anderson (2006) states that leadership in nursing is one of the most important aspects of the modern health care systems. Apart from providing their specific health care services, nurses have been increasingly involved in direct patient care. Rowland & Rowland (1997) suggest that nurses assume a variety of management and leadership roles to ensure that the patients receive safe and quality care. Due to this factor, there is the need for the nursing students to possess powerful leadership skills. This will enable them to become experienced nurses who can be able to cope with challenges faced in the nursing field (Andre & Heartfield 2007). In nurse-patient relationships, nurses play important management and leadership roles to ensure that their patients receive safe and quality care.

As suggested by Weiss & Tappen, (2015), one of the leadership roles that a nurse can play in such relationships is advocacy. This will to ensure that their patients are safe. A nurse who is a leader can also play an educative role. This will enable him to address the issues and concerns of the patient from an informative point of view. However, in order to fulfill their duties effectively, there must be effective communication strategy between the nurses and the patient. This will help in promoting a positive nurse-patient relationship (Lawton, McEachern, Giles, Sirriyeh, Watt & Wright 2012). Effective communication in this kind of relationship is likely to be affected by physical, psychological, or social barriers between nurses and patients (Jackson, Speedy, & Daly 2015). Therefore, it is important to eliminate the existing barriers, which will ensure successful nurse-patient relationship.

Nurses in leadership positions should follow the set example. They should work towards empowering their fellow nurses. They should not undermine them. For those who work in the education sector, it is important to ensure that they instill professionalism to the nursing students (McSherry, Pearce, Grimwood & McSherry 2012). This can be achieved by creating health care curricula that provide students with opportunities of learning professionalism. It is also important for nurses to adopt a “can do” attitude in their practice. They should realize importance of their work by being flexible and ready to try new things and challenges.

Conclusion

The measures taken to improve the quality of care are critically important to the nursing practice, overall delivery of health care and the quality of care delivered to the society. In order to improve the health care environment, the essential role of nurses in ensuring quality, and the impacts of changed effects on nurses and patients ought to be considered and understood better. Patient satisfaction is a crucial and commonly utilized indicator for measuring health care quality. Patient satisfaction influences clinical outcomes, malpractice claims, and patient retention. It affects the efficiency, timeliness, and patient-centered delivery of quality health care. Therefore, patient satisfaction is important and extremely effective indicator for determining success of the doctors and hospitals. The patient-centered literature on healthy quality determines inconclusively the direction of quality and satisfaction from the perspective of the patient. Quality is positively interrelated with satisfaction; nonetheless, the strength and direction of the predictive interrelation between satisfaction and quality remains unclear.