Traditional Professional Identity Of Nursing Might Be Lost

Traditional Professional Identity Of Nursing Might Be Lost Nurse, a multitask angel, is always caring for the sick, public, patients and their families , helping with the management stuff and assisting other health care providers in order to provide holistic quality care through teamwork and caring service. This eventually brings to confusion and conflicting opinions as the professional identity of nursing become unclear and the blurring of boundaries are existing inadvertently. Barber (2002) commended that the traditional professional identity of nursing might be lost in the context of the expanded role by the nurse. The nurse tends to pass the traditional nursing role to others junior staff or healthcare assistants whenever they extended their scope of practice which usually done by doctors. As many others hospital setting, the problem in my working area are lack of doctors and the nurses appear to be the largest group in the health setting. The article( Star on line) (2010) reported that in Malaysia, the doctor and patient ratio is 1:940 in year 2009 and the nurse patient ratio is 1:645 in year 2009 and 1:375 in year 2010 as reported in The Star on line (2008). Thus, In the context of lacking of doctors, the nurses tend to takeover the expended role voluntarily as they are willing to learn and developing themselves. The expanded role usually performed by the staff in my ward is cannulation, this happened whenever the doctors are busy covering a few wards during night duty. No doubt it actually greatly increased their burdens, but they do have their key role in coordinating patients care and look after them from the organizational turbulence. Rushforth Mc Donald (2004) had done a survey on the expanded role of nurses on procedure such as IV admistration, Cannulation, ECG recording, Defibrillation and Prescibing, they found that on cannulation alone are performed by over 50% of the nurses in the respective area. The female medical ward which has 35 beds is a busy ward and one of the highest admission rate in the hospital, the turnover rate is high as the number of admissions. The bed occupancy rate was xxx% and a total number of xx patients were admitted in 2009. The average length of stay was xx days, the ward has divided into five cubicles and 2 isolation rooms for the patient either receive chemotherapy and cases of Methicillin Resistant Staphylococcus aureus (MRSA) and Extended Spectrum Beta Lactamases ( ESBL). The total number of nurses in my unit are 27 and eight out of them are senior staff nurses. Most of the patient admitted is due to hypertension, diabetes mellitus and anemia and they need the cannulation for the continuation of injection antibiotic, maintenance of fluid to prevent dehydration and blood transfusion purposes. In this paper, I will discuss the crossing boundary in the context of cannulation being done by nurses. Although the senior staffs are given the authority by doctors in performing the cannulation to the patients, sometime they are facing the situation of the role uncertainty and decision making in expending their role. In the United Kingdom, the neonatal nurse are given the title of Advanced Neonatal Nurse Practitioner after completed the course, they are able to perform the duty as the junior doctors competently and efficiently in handling the cases of the high risk infant as described by Dilon George ( 1997). The diabetes specialist nurse provide the need of the patient relating to diet control, self monitoring and treatment as illustrated by Loveman et al ( 2003). Similarly in Malaysia, the diabetes nurse who are educating the diabetes patients and neonatal nurse who are taking care of the newborn infant are not given the title such as nurse practitioner, advanced nurse practitioner and clinical specialist nurse. Those nurses are undergone specialized post basic training and most of them are quite senior but always been referred as neonatal nurse, diabetes nurse, stoma nurse, critical care nurse and so on. Nancarrow (2004) illustrated that increasing in the overlapping of the extended role is result from the growth of the interprofessional practice and training. It happened among nurses and others healthcare providers such as doctors, dietician, pharmacist and physiotherapist which has brings to the establishment of the new nursing roles. However, Cameron (2010) has found that the senior nurses felt empowered in expanding their role and appear to be more acceptable about flexible work and multi-skilling to improve continuity, efficiency and effectiveness of patient care compare to the junior staffs who felt more stressful in the expanded role. As a nurse, I think this is due to the complex situation because of time constrain, lacking resources available nor in the nursing curriculums or workplaces. I am working as a staff nurse in a medical ward and have 18 years of experience. From my experience, I noticed that the senior staff frequently making recommendations regarding patient care and they do influence decision making by providing related information about the patient. This is always happened spontaneously during the interaction in between the nurses and the doctors. In my practice setting, the ward are monopoly by doctors because of they are seen owing full professional status by having exclusive theoretical knowledge which enable them to control over nurses. However, the junior doctors are rotating every three month and they are relied on the senior nurses for guidance on the aspects of ward practice and the details of local protocols. For instance, in the treatment decision, they will seek for the nursing advice about drug dosages if they are unclear. Jones (2007) has described boundaries can be known as Interfaces, clear dividing margins between different ownerships areas or shared areas of contact . The blurring boundaries that commonly happened in my ward is cannulation which is supposed to be performed by doctor but it is done by the senior nurses in the ward. It frequently happened during night duty, usually there are only one specialist on call, one medical official and one junior doctor on call, one senior staff nurse with post basic and two junior staff nurses are on duty. The junior doctor is responsibilities to cover a few medical wards included acute medical ward which has a few ill and ventilated patients. The problem arise whenever the nurses facing difficulties in getting the junior doctors to come to the ward to set cannula resulting the burden has increase to ward staff. The nurse must undertake the cannulation themselves either in providing the continuity of circulatory antibiotic levels or to ensure the maintena nce of adequate fluid status for the patient. However, Tye and Ross (2000) has illustrate that an evaluation done by the key stakeholders within the organization indicates that the extended role of the nurses may culminate in uncertainty, individual variation and a perception of a blurring of role boundaries. Hoder and Schenthal (2007) described that professional boundaries are defined as limit-lines protection in between the nurse and the patient. The demand for professional boundaries has increasing drastically in nursing profession, resulting the limitation must be set to ensure a safe, therapeutic connection among the nurse-client relationship. An essential component of competent and ethical nursing care is required in providing better services and reducing underlying conflict. It is the responsibilities of the nurses to establish and sustain the professional relationship through the guidance of code of ethics and professional standards. Most of the nurses in my ward are facing with the challenges even though they are given the authority in setting the cannula, this is because they have to make difficult decisions and facing uncertainty whenever they are dealing with difficult situation. In minimizing the uncertainty, they are practicing a few routes to ensure the best services are delivered to the client. First, through the documentation of evidence based practice on client preference, the nurse must get the consent or agreement from the client before delivering the services to him/her. Besides that, the NNIA ( National Nursing International Audit) are implemented to ensure the current practice did not increase infection and insertion site phlebitis, the audit is carried out by the nursing team in my practice area every twice yearly. Secondly is the source through SOP( Standard Of Procedure) and protocol or guideline that is easily accessible for nurses as referral when need. The nurses are practicing the proper hand washing technique and performing the procedure under aseptic technique to avoid infection during performing the cannulation for client. From a professional perspective, the Code of Professional Conduct for nurses (1998) states that individual nurses have a responsibilities to keep up with advances in health practice and maintain their competence in nursing knowledge and skills. Aveyard and Sharp (2009) illustrate that by performing the latest evidence based practice is able to protect the healthcare provider from any legal proceedings. The third source is the intuitive knowledge that emerged from the past experience. Benner (1984) has described a nurse must passes through five stages that is from novice to expert. Although the contribution of knowledge has been acknowledge in clinical practice, most of the credibility is subjected to biasness. This is supported by Romyn et al (2003) said that credibility must base on knowledge that used to be critique and scrutinized. In order to perform the task of decision making, Dowding and Thompson (2003) stipulated the nurses must aware that the impact of decision making are influence on nursing outcome and patients experience. Simpson and Courtney (2002) emphasized that the nurses must be able to think critically to provide best care at the same time dealing with the expansion role especially in the current health care system as it appears to be more complex over the last few decades. As suggestion, Rushforth and McDonald (2004) recommended that a sense of balancing and safer policy is needed for the few senior nurses to expand their role without jeopardized to the nursing component. The nurses are fit to practice and accountable for the nursing care they provide. Oermann(2007) suggested that evidence based practice in nursing can be searched in the web sites. By using the available research evidence and clinical expertise, the nurses are able to focus on nursing knowledge in minimizing the role uncertainty and developing a culture of lifelong learning. A emergence training programme for cannulation and re-evaluation on regular interval is needed to ensure the standard is maintained accordingly. However, training alone is inadequate to bring a change in the behavior of the nurses to take on their expanded role in performing the advanced skills. The nurses perception and the support systems are some of the important factors to be address such as opportunity are provided on regular basis in maintaining ones competencies and support from supervisors to facilitate and guide the senior nurses in the overlapping role. Inevitably, there is far-reaching implication pending on how the nurses conduct themselves in their relationships. If the blurring boundaries always happened, the nurses will be confused as it bring into an ethical issue regarding their professional role. Barber (2002) suggested that all practitioners are responsible toward their action and have high awareness of legal implication of practice during performing their overlapping role. However, Molyneux (2001) described that contribution of care from multidiscipline for the same patient through collaboration, knowledge and skills. Caldwell and Atwal (2003) found that different ideologies, unequal power, overlapping role and communication are the difficulties exist within the interprofessional practice. Therefore, a clear flow and structured at several level is needed for the interprofessional team to facilitate and guide their practice effectively. As conclusion, no doubt the nursing blurring boundaries may against the professional rule, but it had bring benefit to patients especially during night time and the treatment are able to carry out on time. Nurses must understand the additional responsibility invariably probably may increase their burden. Therefore, by using evidence-based practice, critical thinking and updating knowledge in lifelong learning, the nurses are able to extend and cross the boundaries safely to meet clients needs.

Biographical Narrative Essay

â€Å"Work isn’t to make money, you work to justify life†-Marc Chagall When I was younger, everything was handed to me. Well, not everything but most of what I wanted or thought I needed like new clothes, toys, the latest electronics things that cost money. When the economy started to crash thing had to change around my house. My mother lost her job and my dad’s pay was cut short plus on top of that he was sick for 8 months with a type of liver disease. We had to cut down on how much money we spent especially on the wants compared to our needs.With our financial struggle I had to learn how to live with the things that I already had and not want what other people had. Having my first job as a snow cone maker I also had to learn that you have to work for the things you want in life. Nothing in life is just handed to you, you have to earn it. My parents always reminded us that we had it better than others which helped me appreciate the things I had a little more. Wh en I got my first job I started to appreciate the money that was spent on me because I knew what hard work it took to earn it.I started working at age 15 for a kettle corn and snow cone vendor called Hunsaker Bros Kettle Corn. I can remember my first day at work, shaking nerves up and down my spine, thinking of smart word that I can put in my sentences when I talk to my first costumer. All I wanted to do was to please my boss and be the best worker I can be. By working hard, I learned that it takes great responsibility to maintain a good work ethic. Learning these responsibilities and good work ethics I have managed to provide for myself.I now know how to pay bills, separate necessities with desires and manage my funds. Before, when my parents would always pay my Iphone bill and complain to me that it is too expensive, my response was always â€Å"Well, if you can pay for a brand new refrigerator we can pay for my I phone! It’s something that we ‘have’ to pay fo r†. Having a job has given me a different perspective on what money is spent on. I never thought how much money is wasted on things that don’t even matter in life. In life, we get side tracked on useless material objects.It is very controversial on what we believe are wants versus our needs. I remember going school shopping for clothes and I asked my mom for a pair of rock revival jeans. In my mind it was a necessity, it was a piece of clothing that I â€Å"needed† to make me cool and dress like everyone else. But in reality, it was a pair of jeans that was more for luxury and high price which I ended up getting four pairs of off brand jeans for the price of one. I now understand why my mom managed to spend money on my sibling and I so wisely.Each penny that was spent on us was worked hard for and then given to us. I have learned from my parents that if I want something in life, the only way to accomplish it is to work hard, and then I will deserve it. Earning my own money at a young age has impacted my life as I enter adulthood by giving me goals that I want to accomplish later in life and setting morals and responsibilities. I also realized that life isn’t about living for making money or how much money you make but what you have to leave behind as a person. Nothing in life is given for free you have to work hard and earn it.

Marshal and Gordon Case Essay

Outsourcing is the contracting out of an organization’s business activities (functions and processes) to an outside service provider where the provider is responsible to carry out the activity that was currently, or could be, undertaken by the organization. Earlier outsourcing was usually carried out for organization’s non-core activities to save money but now outsourcing is omnipresent. Firms are outsourcing a wide range of activities ranging from research and development to marketing, from production to assembly, distribution to after sales service. Today, even activities like security and public relations are outsourced. Predominantly, there are two kind of outsourcing: With manpower – where the service provider’s employees work inside the premises of the organization. For example, company X has outsourced its security department to company ABC, then ABC’s employees operate at the location of company X. Without manpower – the service provider’s employees do not work inside the organization premises. For example, if company X is an electronics company and has outsourced the after sales services of its products then the service The world longest strike, which lasted nearly a decade has come to end by hospitality workers at the Congress Plaza Hotel in Chicago on the night of 29th may 2013. The strike was started on June 15, 2003 and the striking workers had long called for wage and benefit increases and job security. IRound The World provider’s employees work need not work at the parent organization’s location but will extend services at the customer’s location. Why Outsourcing ï‚ · Save Costs: To save the costs associated with defined benefits for permanent employees in labor-union contracts and as guaranteed by various labour laws in the country like ï‚ · Increased Effectiveness: Companies by outsourcing non-core activities can focus their resources on the management of the core activities leading to enhanced organization effectiveness ï‚ · Access to world class experts: Outsourcing to specialized companies gives organization access to experts and the latest technologies for limited time frame for specific project related work leading to improved quality ï‚ · Increased flexibility: Outsourcing business functions to external service providers, the organization doesn’t need to maintain fixed assets and invest on infrastructure. This gives the organization flexibility to meet changing business needs and respond to the dynamic environment. Laws related to outsourcing Outsourcing, as already discussed, is of two types: Outsourcing with manpower, and outsourcing without manpower. Outsourcing without manpower When outsourcing is done without manpower, it is essentially a contract between two parties and only the Indian Contract Act, 1872 (hereinafter referred to as the ICA) becomes applicable. Both the parties are bound by the ICA and the terms of the contract agreed upon by them. Outsourcing with manpower Outsourcing with manpower is also essentially a contract between two parties and hence ICA becomes applicable. However, because the activities are carried out on the premises of the outsourcing party, the Contract Labour (Regulation and Abolition) Act, 1970 (hereinafter referred to as CLRA) also becomes applicable, provided twenty or more workmen are employed as contract labour in the establishment. Thus in a nutshell, we can say that ICA becomes applicable in all cases of outsourcing, whereas, CLRA becomes applicable only in case of outsourcing with manpower, provided that the establishment (outsourcing party) employs or had employed in the preceding twelve months, twenty or more workmen as contract labour. Relation between players   In case of outsourcing without manpower, the only relation providing the service is the second party. The outsourcing organisation has no relation with the employees of the second party. However, in cases of outsourcing with manpower where CLRA becomes applicable, there are three players, vis-à  -vis, Principle Employer, Contractor and Contract Labour. The outsourcing organisation is the Principal Employer, the organization providing the service is the Contractor, while the employees of the Contractor working on the premises of the Principal Employer are the Contract Labours. The Contractor is responsible for the health, welfare and payment of wages of the Contract Labour. It is only when the contractor fails to meet those responsibilities does the Principal Employer become liable. However, the Principal Employer, as per section 20 and 21 of CLRA, can recover the costs incurred for meeting such liability from the Contractor. Employer-Employee Relationship Looking at the present scenario, with outsourcing activities increasing exponentially, it can be said that the employer employee relationship is becoming more of a myth. The contract labour, who carry out the activities in the premises of the Principal Employer, are not the ‘employees’ of the Principal Employer. The Principal Employer does not hire, fire, or control the contract labour. Neither is it directly responsible for their health, welfare and wages. Thus, we can say that there is no direct relationship between Principal Employer and Contract Labour. References: 1. https://en.wikipedia.org/wiki/Outsourcing 2. Padhi, P.K., Labour and Industrial Laws, Eastern Econo- Pratham, an NGO based out of Mumbai, working for child development announced that it had reported to the police 1,817 cases of children sweating it out in intensive activity in the Mumbai in June, that it spotted during a two-month study. Clearly shows that even the fundamental rights are just on paper.

Meaning and Origin of Surname Jenkins

Jenkins is a double diminutive of John, literally meaning little John. It derives from the medieval given name Jenkin, which itself is a diminutive of the given name John, meaning God has graced me with a son. The Jenkins surname most commonly originated in Cornwall, England, but became quickly popular in Wales. Jenkins is the 95th most popular surname in the United States and the 97th most common surname in England. Origin English, Welsh Alternate Surname Spellings JENKIN, JENKYN, JENKING, JENCKEN, JINKIN, JUNKIN, JENKYNS, JENCKENS, JINKINS, JINKINS, JUNKINS, JENKENS, JENNISKENS, SIENCYN (Welsh), SHINKWINN (Irish) Famous People with the Surname Jenkins Albert Gallatin Jenkins, American politician and Confederate soldierElla Jenkins, American folk singer Source: Cottle, Basil. Penguin Dictionary of Surnames. Baltimore, MD: Penguin Books, 1967. Menk, Lars. A Dictionary of German Jewish Surnames. Avotaynu, 2005. Beider, Alexander. A Dictionary of Jewish Surnames from Galicia. Avotaynu, 2004. Hanks, Patrick and Flavia Hodges. A Dictionary of Surnames. Oxford University Press, 1989. Hanks, Patrick. Dictionary of American Family Names. Oxford University Press, 2003. Smith, Elsdon C. American Surnames. Genealogical Publishing Company, 1997.