North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742―Promotes an environment that enables client safety, independence, quality of life, and health.Indicator: Identifies and reports situations that affect client or staff members‘ health andsafety‖ and 4.2 ―Contributes to the evaluation of client care. Indicator: Relays information tothe registered nurse that will contribute to the evaluation of client care.‖ [Mrs E‘s] letterindicated she was not offered the nebuliser until [a registered nurse] offered it to her. There isno evidence of the direction or the care the registered nurse delivered to [Mrs E] that youwould expect given her refusal of treatment on this shift.The interview with [the] Enrolled Nurse indicated she was allocated her own patients andlooked after patients with NEWS scores of three and four which would be considered unstableand unpredictable, but she then stated she wasn‘t generally allocated such patients. Sheexplained her work was very similar to that of a registered nurse. She noted the enrolled nurseworked under/with RN staff. There is no evidence of which registered nurse was supervising[the] EN to assist with [Mrs E‘s] plan of care in the record, nor is it noted by any of the nursesat interview nor in the Waitemata District Health Board letter to HDC dated 26 February2008. The registered nurse competency states clearly 1.3 ―Demonstrates accountability fordirecting, monitoring and evaluating nursing care that is provided by nurse assistants, enrollednurses and others.‖ The principles of direction and delegation as set down by the NursingCouncil of New Zealand (Guideline: direction and delegation June 2008) apply:―(a) The registered nurse must complete a comprehensive assessment of the client anddevelop a plan of care prior to delegation….(c) The registered nurse must be moredirectly involved with the client when the client‘s responses are less predictable orchanging, and/or the client needs frequent assessment, care planning and evaluation….3(a) The registered nurse retains accountability for evaluating whether the person carryingout the delegated activities maintains the relevant standards and outcomes.‖ (p.9).The registered nurse supervision does not accord with the above Nursing Councilcompetencies. The planning and expression of caring recounted by [Mrs E] on 17 Octoberdoes not meet the registered nurse cultural competencies which state:―Competency 2.1 Provides planned nursing care to achieve identified outcomes.Indicator: Contributes to care planning, involving clients and demonstrating anunderstanding of clients‘ rights, to make informed decisions. …3.1 Establishes, maintains and concludes therapeutic interpersonal relationships withclient.Indicator: Initiates, maintains and concludes therapeutic interpersonal interactions withclients.Indicator: Incorporates therapeutic use of self and psychotherapeutic communicationskills as the basis for nursing care for clients with mental health needs. …Indicator: Utilises effective interviewing and counselling skills in interactions withclients. Indicator: Establishes rapport and trust with the client.‖The Enrolled Nurse competency states:―3.2 Practises nursing in a negotiated partnership with the client where and whenpossible.Indicator: Undertakes nursing care that ensures clients receive and understand relevantand current information concerning their health care that contributes to informed choice.Indicator: Implements nursing care in a manner that facilitates the independence, selfesteem and safety of the client and an understanding of therapeutic and partnershipprinciples.‖April 2009 97