The Role of Nurses in the Healthcare Facilities

The role of nurses is changing in the healthcare facilities. According to Stangeland (2010), nurses were traditionally regarded as assistants to medical doctors who were expected to follow instructions on how to handle patients in different settings. However, this role is changing as nurses find themselves in situations where they have to make critical decisions to save lives of their patients. The emergency department is one of the areas where nurses are increasingly getting engaged, especially due to the increasing number of patients that has already overwhelmed doctors in many hospitals within the country. Nurses are now expected to offer specialized care to the patients at the emergency departments to reduce pressure on the doctors. Yamamoto (2013) says that nurses can only be effective at the emergency departments if they have some core competencies in disaster nursing. They must have the right skills and knowledge on how to respond to different emergency cases and save the lives of patients in critical conditions at different stages.

Nurses may be expected to offer care to patients before they can be transferred to other departments to receive specialized care from the doctors. In other cases they are assigned the role of caring for patients who have just received specialized care but still need close monitoring to ensure that their conditions improve. That is why Australian Nursing Council Canberra came up with core competencies that all nurses working in the emergency departments are expected to have (Loke & Fung, 2014). The scholar notes that sometimes core competencies may vary depending on whether a nurse is practicing at a local, regional, or national level within Australia. In this paper, the researcher will review the relevant literatures to explain the competing issues of competencies, expanded scope of practice, ethical practices, and ability of the nurses to respond effectively in such demanding environments.

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Competing Issues of Competencies
The changing role of nurses has forced the scholars and practitioners to engage in extensive researches in order to help explain the new position that nurses currently hold in hospitals and how their competencies can be enhanced to ensure that they can deliver quality service to the clients. Kako and Migani (2010) say that nurses at the emergency department always find themselves under pressure to within the shortest time possible. Their ability to make the right decisions at the right time may mean life or death to their patients. They always find themselves under pressure to deliver quality service to their patients as fast as possible and in the most precise manner. That is why scholars have engaged in massive research to help explain some of the core competencies of nurses within this department. Jose (2010) says that nurses are ethically required to respond to any emergency medical need that may occur from time to time. When defining the core competencies for disaster management, nurses are expected to explore almost all the critical issues in the emergency department because it is never known which form of disaster may strike (Loke & Fung, 2014).

In the recent past, some parts in Australia experienced flashfloods due to excessive rainfall. The September 11, 2001 terrorist attack in the United States was another serious disaster that needed emergency attention of the nurses. In 2012, Sierra Leone had a major cholera outbreak, which was a major disaster in the country. After a couple of years, Ebola hit the country and other neighboring states such as Nigeria (Baack & Alfred, 2013). A major outbreak of any disease, , should always be considered a disaster that calls for efficient response from the medical practitioners. This means that the term disaster management in the field of nursing cannot be narrowed to a specific issue such as accidents. It has to be viewed from a broad perspective where the medical teams within a given healthcare facility are forced to address a sudden surge of patients who need emergency care to save their lives. In this section, the researcher will look at the core competencies that modern nurses are expected to have in order to work in the emergency departments.

Managing patients health in cases of emergency
According to Wynia (2007), nurses at the emergency department are expected to manage the illness status of their patients before they can be taken for specialized treatment. The nurse will collect the primary information about the patient such as determining the health needs by taking account of the disease history and conducting basic screening. Some of the patients may need basic physiological and psychological care as soon as they are brought at the emergency department. Desimone (2009) says that in many cases, the critically injured patients may need some form of psychotherapy before they can start specialized treatments. They may need the assurance that they will actually make it through all the stages. This is one of the most important roles of nurses at the emergency care. As they offer basic care while preparing the patients for specialized treatment, they should identify the fears of the patients and address them so that they can have psychological strength to undergo various specialized processes. Sometimes the nurse may need to address all the concerns of the family members, especially those that have accompanied the patient to the hospital. They may be worried about the condition of their patient and this may affect the psychological stability of the patient. Ensuring that they are comfortable will enable them to cheer their patient as he or she is prepared to undergo various corrective medications.

Nursing Education and competencies
Disaster preparedness needs sufficient training for the nurses to equip them with the necessary skills and core competencies. According to Adams and Berry (2012), disaster management is different from other normal tasks done at a healthcare clinic. Nurses working at the emergency department during cases of disaster will need special skills to ensure that their speed and precision is very high. Speed is necessary to ensure that maximum number of patients can be attended to within the shortest time possible. Precision is needed to ensure that tasks done by these nurses when handling patients are within the set standards. It also avoids cases where their tasks have to be redone by other experts because this will not only cause more pain to the patient, but also waste resources that should be used on another patient. According to Jakeway, Larosa, Cary and Schoensch (2008), ICN framework is one of the major steps needed towards improving the core competencies of the nurses to work in emergency departments during cases of disaster. This should be introduced in the nursing curriculum to prepare nurses to work such demanding environment. It enables the nurses to understand the working environment when responding to the disaster.

Developing a positive attitude at workplace
According to a research by Adams and Berry (2012), nurses working in disaster management areas always face stressful situations that they have to deal with when delivering their service. Sometimes the patients or their family members may fail to appreciate the pressure under which these nurses are working. They may become excessively demanding or sometimes even abusing. Nurses need a strong will power to overcome such stressful conditions. If they fail to manage their anger, then they can and engage in unethical practices that do not befit their profession. That is why they need to develop a positive attitude that can keep them motivated even when things do not work as per their expectations. In some cases, these nurses may be expected to work for extra hours depending on the nature of the disaster. As Jose (2010) says, it is the ethical responsibility of the nurses to serve clients who need emergency services even if this means working for extra hours. The need to work for longer hours is unavoidable for these nurses, but they need a positive attitude towards their work to do this.

The need for nursing experience in disaster management
Core competencies for nurses responding to cases of disaster may go beyond training. New nurses working in clinics have the opportunity to work as a team without much pressure, making it easy to learn concepts in a practical setting. In the clinics, these new nurses can consult with their experienced colleagues in cases where they are not sure about what they should do. Nurses working in emergency department in response to a disaster do not have this luxury. According to Adams and Berry (2012), disaster management requires experienced individuals who can work with almost no supervision. Almost all the staff members are always engaged during such situation. This means that everyone must know what should be done based on some years of experience. That is why nurses sent to the emergency department to respond to cases of emergency must be experienced. They must know what should be done and how it should be done to save lives of patients.

According to Jakeway, Larosa, Cary, and Schoensch (2008), experience may not necessarily mean several years of working with the emergency department or responding to disaster cases. Proper training and regular exposure to disaster management cases during training may be of great help. It is rare for nurses who are in training to be sent to help in response to a disaster. Most often, they are sent to clinics and other settings where there is little pressure at work. This limits their experience when it comes to dealing with cases of emergency. It is important to start exposing nurses to these stressful environments as early as possible, most preferably when they are still in college. This way, they will have some knowledge of what should be done in cases of disaster response. Jose (2010) says that such trainees may be send to undertake unspecialized tasks, working very closely with the nurses. This will equip them with the knowledge about disaster response.

Nurses ability to respond to specific emergency issues
According to Wynia (2007), many scholars have considered chest and abdominal problems as one of the most common issues during disaster management. A good example is the Chernobyl Disaster when poisonous gas was released from a nuclear reactant. When patients suffering from chest and abdominal problems are brought to the emergency department, nurses are expected to undertake some basic measures that may help ease their pain and save their lives before they can be allowed to see the doctor. Needle thoracostomy is one of the most common tasks that nurses would perform for patients having . Desimone (2009) says that for a long time, needle thoracostomy was considered a specialized task that was performed by surgeons and physicians in the emergency department. However, the changing role of nurses in the modern society has seen this activity become one of their major roles at the emergency departments when managing pneumothorax. Powers (2007) notes that this is a specialized task meant to drain blood, air, or any form of fluids that have accumulated within the pleural cavity. In absence of a surgeon or a physician, a nurse with the right skills and experience may be allowed to perform the task based on the strict guidelines from the relevant authorities within the department. Nurses working in the emergency department are also expected to have the capacity to without causing unnecessary pain to the patient or damage to the tissues. For patients suffering from cardiac arrest, the nurses should have the capacity to perform various tasks that would ease their pain as they are prepared for specialized treatment by the cardiologists.

When disasters such as major road accident or a collapse of a building occurs, survivors always sustain major injuries in their spine, back, or neck that may require a specialized medical attention. Nurses at the emergency department will be expected to receive these patients and perform basic tasks that are meant to relieve them of their acute pain. The first step that a nurse is expected to do is clinical assessment and management of the spine. The nurse may assess the level of damage of the spine and determine the appropriate management action that would be necessary. If the spine has not sustained any damage other than strain, Yamamoto (2013) says that a nurse can prescribe an appropriate physiotherapy, medication and a future date with orthopedists, most preferably after the disaster has been successfully addressed. In case the damage is serious, then the nurse can prepare the patient for a specialized task to address the condition. Nurses are also expected to perform lumber puncture. According to Dorasamy, Raman, Marimuthu and Kaliannan (2013), this is major medical process that was previously done by specialists. However, these specialists are always overwhelmed in cases of emergency, making it necessary for the nurses to step in and help. To undertake this task successfully, a nurse will need some specialized training in this field. Mistakes when carrying out the task can have life-changing impacts on the patient.

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