The intended outcome of this assignment, which has been identified from my episode of care (See appendix 1) is to help me develop skills in time management and focus on prioritising patients. Both of which will be useful in my first position as a registered nurse. This assignment will give me the opportunity to gain a greater understanding of the process which is required for me to achieve my set goals by applying self-reflection to be able to create an action plan (See appendix 2). The use of literature will be used to critically analyse self-management, learning styles and learning theories and a reflection of the transition from student to Registered Nurse will be critiqued. Finally, strategies to support my own continuing professional development will be evaluated and a conclusion will be met.
Student nurses must obtain numerous skills and knowledge required for future profession. Time management can be defined as a product of organising skills. However, the same measures may not relate or apply to everyone in the same way (Macan, Gibson & Cunningham, 2010). Therefore, what may work for one person may not necessarily work for another (Mirzaei, Oskouie & Rafii, 2012).
The two related issues that I have identified as areas I need to develop within are improving time management and coping with stress. To make the most effective use of my time I must undertake each task as effectively as possible and prioritise. Tasks can be categorised into two dimensions: their urgency and their importance (Sellman & Tarr, 2010, p.320). A strategy that I could use for prioritising tasks could be to use a grid to categorise what is classified as important and not important (see Figure 1.1).
Figure 1.1
Classification Important Not Important
Urgent Do it Delegate it
Not urgent Plan it Leave it
There are however difficulties in prioritising in nursing which can include; personal priorities not being the same as others, different views and opinions within teams and not having anyone available to delegate to (Snelling, Harvard & Pontin, 2010, p.354). Prioritising tasks is not only key to managing myself but is also extremely important in planning and delivering care. The inability to say ‘no’ or ‘not now’ is difficult especially when on placement as a student nurse as you want to be able to assist as much as you possibly can. I personally find it hard to say no to someone and when reflecting on this when asked to do something by someone I should stop and consider the request. I need to be honest with the requester and if I simply do not have the time, I should say so in a polite manner. I must remember to consider that accepting an assignment or task that I will never be able to complete or that will create a backlog of work for myself sheds an unfavourable light on myself.
The Health and Safety Executive (HSE, 2019) defines stress as ‘the adverse reaction people have to excessive pressures or other types of demand placed on them’. Although some stress within the workplace can be helpful as it stimulates and motivates, when an optimum level of performance is reached adding additional pressure this could then reduce performance and can lead to an additional amount of stress. As burnout is the most common occurrence in leadership roles, self-awareness ensures that a leader is able to challenge situations and adjust conflicts that moves that individual to grow and develop (Porter-O’Grady & Malloch, 2013). Therefore, to be able to continually grow and develop in the role of nursing, I must self-reflect and recognise personal needs for self-development.
Delegation is a critical component of self-management for nurses and care managers. When used appropriately, delegation can not only increase time efficiency but can act as a crucial component to reduce stress (Donohue & Crenshaw, 2015, p.539). Therefore, to meet my learning need of improving time management and coping with stress, using delegation appropriately is key when moving forward into my first job as a qualified nurse. Distributing work appropriately can help to build confidence when caring for patients. Therefore, when used effectively delegation can improve patient outcomes, but used unproductively and ineffectively can result in negative effects on patient care (Murphy-Ruocco, 2015, p. 486).
To prioritise people and to practise effectively, The Code states that a registered nurse must put the interests of service users first and keep clear and accurate records relevant to their practice (Nursing and Midwifery Council, 2019). The patients care and safety are the main concern and their needs must be recognised, assessed and responded to. All service users during my episode of care were treated with kindness and compassion and care was delivered effectively and to the best of my ability. They were treated with dignity and respect and family-centred and child-centred care was given throughout. Failure to document interventions may have legal and professional consequences. During my episode of care all documentation was completed accurately without any falsification. Communication between service users, families and other members of the team was clear and peoples understanding was checked on regular occasions to keep misunderstanding or confusion to a minimum. This was confirmed in the feedback that I had received from service users and their families during my episode of care.
How members of staff provide a service to the public could be swayed by professional and political influences which could subsequently result in the care provided not being of high standard. Political influences can include many obdurate pressures including staff shortage, poor funding and Brexit. Starting in 2019/20 and over a five-year period, the government has increased funding to the National Health Service (NHS) and has requested for the NHS to come up with a 10-year plan for how this funding will be used (The Kings Fund, 2018). It is felt that the focus of the new plan should be committed to making quantifiable improvements in population health and to also decrease health inequalities. Despite recent progress in areas such as the increase of patients surviving cancer, research suggests that health outcomes in the United Kingdom (UK) are not as good as those in many similar countries (Dayan et al., 2018). Therefore, action is needed from both the NHS and across government to be able to increase the priority of prevention and to challenge the widespread factors of health and wellbeing.
Growing demand from an ageing population explains extra pressures on the NHS. As people are living for longer this means that there is an increased cost which is adding extra pressure onto the NHS (Maguire, Dunn and McKenna, 2016). Investigation confirms that overall funding increases since 2009/10 vanish when allowance is made for population growth and the impact of population ageing (Johnson et al., 2018). Staff workloads are having to increase in numbers due to patients having more complex health needs which needs more support and time to resolve.
More than often when on placement it can be more than obvious to see the stress that senior staff are currently experiencing due to funding cuts and staff shortages. This can have an effect on not only patients but also students as their teaching sessions are lessened and opportunities are narrowed as there is not enough time for extra training and outreach opportunities. The day that my episode of care took place was extremely busy and involved staff shortages resulting in an increase in pressure on not only the registered nurses who were on shift, but also on myself and another student nurse. As well as looking after my own patients I was also assisting the other members of the team with their patient load and therefore found many barriers with time keeping. The greatest barrier for me as mentioned before was not having the confidence to say no to people and not feeling confident enough to delegate to other members of the team under the supervision of my mentor. Having an increased patient load meant that each nurse was taking on more than they should resulting in work being done in a more rushed manner, which could allow room for error.
To try and fight the nursing workforce crisis in England, a recruitment campaign has been assembled to target school leavers into entering the nursing profession and an additional 5,000 extra clinical placements for student nurses have been made available (Swan, 2019). To tackle the problem the campaign has suggested several different measures which includes additional support for students who are just starting out in employment and strategies to decrease the drop-out rate in nursing degrees. However, in the loss of the student nurse bursary and with the number of people wanting to study nursing declining by 20%, the group will scrutinise all available possibilities to try and increase the number of entrants to nursing and midwifery courses (Nursing Times, 2017).
The transition from student to newly registered nurses can be both exciting and stressful. Kramer (1974) described how newly qualified nurses (NQN) experienced ‘reality shock’ with the feeling of inadequacy, insecurity and anxiety. More recently, Duchscher (2009) findings extended Kramer’s work by outlining ‘transitions shock’ where it was believed that this is when newly qualified nurses realise and understand that they are professionally accountable and responsible for their own actions which is a challenge that I may face during transition from student to NQN. I will be taking responsibility for nursing care and justifying decisions and judgements. According to Darvill, Fallon and Livesley (2014), responsibility and accountability is the main difference between the student and staff nurse role which can be particularly overwhelming and stressful. However, having support and confidence in my own ability to deal with various situations can play a key role in successfully achieving goals through transition and how I value myself as a person (Darvill & Croughan, 2018, p.13).
For NQN’s in the UK, the Department of Health (2010) introduced a ‘preceptorship framework’ to set clear values and standards for preceptorship. Preceptorship programmes fit the needs of the individual and should be a way to build on confidence and further development competence allowing the NQN to have time in the clinical area as a supernumerary member of staff (Capital Nurse, 2017). This allows the NQN to build on basic knowledge, skills and attitudes for their new role which can lay a concrete foundation for lifetime learning (Fisher & Stephens, 2018, p. 142). This development provides acknowledgement of the importance of the transition period for healthcare professionals as well as providing a formal support system for the NQN.
It is important and necessary for me to understand learning theories to be able to achieve my learning need. In the search of new knowledge, understanding and meaning, Knowles (1984) cited in Merriam (2014) formulated the four principles of andragogy which highlights the significance of self-directed learning (SDL). Since adults are self-directed, they should convey an opinion of the content and progression of their learning. Areas that should be particularly concentrated on are adding to what has already been learned previously, matters related to their work or personal life and additionally, problem solving (Chen, 2014).
In their paper published in 1992, Fleming and Mills suggested four categories that seemed to recognise most students’ learning behaviour (Leite, Svinicki & Shi, 2009). VARK (Visual, Aural, Read/Write, and Kinesthetic) helps people to recognise each other and supports them to learn more efficiently and effectively in many situations (VARK Learn Limited, 2019). Nursing students have varied learning styles suggesting that teachers should accommodate their classes to meet the learning needs and styles of students (Alkhasawneh, 2013). As I need to be physically involved and hands-on during an activity to learn and from completing the VARK questionnaire, I have discovered that I am mostly a kinesthetic learner. Therefore, after observing my mentor first, during the episode of care I decided to use direct supervision. The reason for this being that direct supervision provides supervised learning, including management of care, teaching, research and reflective discussions with my mentor including learning interventions and frequent constructive feedback; all of which Kilminister et al., (2009) considers to be features of effective supervision. Direct supervision also includes a ‘360-degree perspective including patient feedback, inter-professional supervision together with reviewing written work, all of which I am able to reflect and learn from.
Reflection can be used to reflect on a specific incident, and the actions, thoughts and feelings associated with that moment and can be used to reflect on circumstances as they transpire and on past events (Nelson, 2012). Furthermore, reflection can be used to distinguish new skills and approaches; all of which can improve a nurse’s practice. However, Rolfe (2014) claims that reflective practice has had an unacceptable influence in nursing and practice, suggesting that it is the poor implementation of reflective practice that has resulted in this lack of progress. Despite this, reflection forms a major element of nurses’ ability to renew their professional registration.
From working under the supervision of my mentor I was able to strengthen my own professionalism and implement actions. Feedback and guidance provided by my mentor helped to promote my growth in the nursing profession which was reflected in my increasing confidence. Mentoring also involves encouraging students to consciously reflect on nursing procedures and their own learning (Jokelainen et al., 2011). From feedback provided by my mentor I was able to identify what could help guide me in the future. Such strategies included goal setting and developing a plan of action to reach the goals that are reasonable and achievable. Organisation such as preparing a timetable for the day could enhance efficiency and arranging things in an orderly fashion, such as preparing relevant paperwork in the morning before the patients arrived onto the ward, could be a powerful time-management tool. Under the supervision and with guidance from my mentor, I was also given the chance to delegate when appropriate which built on my confidence to be able to say no to people if need be.
During my reflection and action plan I was unsure of whether using direct supervision from my mentor would benefit me to achieve my learning need. However, from working under direct supervision and with constructive feedback, my confidence has increased immensely. This assignment has provided me with the opportunity to reflect on practice and learn how to improve my time management skills as well as acknowledging the importance of coping with stress. Nursing can be emotionally and physically demanding. Therefore, looking after myself is key to being a good nurse and being able to practice safely and efficiently. Throughout this assignment I have discovered that there will always be room to improve and mature and develop professionally and that good time management skills enables myself to practise effectively and prioritise people. I have uncovered that reflection is a process which provides an opportunity for a person to recollect on events which have happened in the work place and is a vital activity in which people can recapture their experience, think about it and evaluate it.
31.3.2019