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�Nurse Empowerment through Regulations and Policies

Dr.S.Anigrace Kalaimathi,

RNM.,MSN.,MBA,BGL, Ph.D.,

Registrar,

Tamilnadu Nurses & Midwives Council,

Chennai.

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Introduction

Nurses and midwives constitutes the largest component of health work force and are often the first point of contact between the community and the health system.
The need to strengthen nursing and midwifery has been reiterated in many reports and can be traced historically in recommendations by:

Bhore committee (1946),

Mudaliar committee (1962),

High Level Expert Group on Universal Health Coverage report (2012) and

National Health Policy (2017).

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The role and responsibilities of nurses and midwives has expanded rapidly in terms the range of service delivery components.
However, the involvement of nurses and midwives
in decision and policy making,
establishment procedures,
educational opportunities,
remuneration,
benefits and
the nature and quality of training has not progressed at the same pace.

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National Health Systems Resource Centre (NHSRC) has conducted a study to review the recently introduced nursing policies, reforms and governance structure across five selected states in India.

The study covered three broad areas:

(1) leadership and regulation,

(2) education and development and

(3) deployment and utilization.

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Clinical Scenario

The patient

has not passed urine for past 6hrs,
on palpation the bladder was full.

The patients complains of

severe pain on the abdomen.

The nurse is waiting for the doctors order for application of hot water bag!!!

The nurse says there is no order for Changing the position of the post operative patient.

Nurse is waiting for the order for steam inhalation

Is the nurse empowered?

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Nursing Problems and solutions

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�

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Power is authority over others

Empowerment is authority purposefully shared with others

Concept of power and empowerment

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Non empowered scenario

The nurse made an medication error, she was shouted by the doctors & nursing head.

Non compliance of the quality indicators by the nurse, what is the next step?

Adding a new form by the quality team which has to be filled by the nurse. But attitude, accountability of the nurse is not motivated.

Nurses function as a house wives - just do what is dictated by doctors

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Empowered scenario

Taking accountability, responsibility in each aspect of care
Taking ownership of the patient and the work
Innovating new products, ideas, procedures
A consultant demanding for a nurse to take care of patients.
Developing the trust in the work place.

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Nursing empowerment�

Nursing empowerment is instilling a sense of power by granting decision-making authority, and/or creating opportunities to influence decisions, and providing ability to make choices by nurses

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Responsibility and Ownership.
Working independently towards common objectives.
Understanding “Why?” so that guidelines can be applied.
Weighing the impact of decisions on all affected stakeholders.
Making more trade -offs, not less.
An earned privilege. It is not a given right!!

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What empowerment is…..

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Throwing out the rule book.
Bypassing everyone who will say “No”.
Doing the “Fun Parts” of someone else’s job.
Freedom to unilaterally make decisions that impact others.

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What is not empowerment?

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Why it is needed ?

World is becoming global village
Employee motivation and retention
Employee employer bonding
More connected to organizational goal
Brings personal and professional growth
Easy to attain real time effectiveness

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THREE FACTORS OF EMPOWERMENT

Direction: sufficient instructions to give confidence

Challenge: an element of stretch that will bring out creativity and satisfaction on completion

Autonomy/support: confidence that there is further help and direction available if needed

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Regulations

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Professional

responsibility &

accountability

Persons (patients, colleagues)

Society (public, professions, employer)

Self (integrity, conscience)

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Nursing regulations

A Regulatory body is a public authority or government agency responsible for exercising autonomous authority over some areas of human activity in a regulatory or supervising capacity.”

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Regulatory Bodies in Nursing

INTERNATIONAL AGENCIES

INTERNATIONAL COUNCIL OF NURSES (ICN)

INDIAN REGULATORY AGENCIES

INDIAN NURSING COUNCIL

STATE NURSING COUNCIL

STATE MEDICAL HEALTH UNIVERSITIES

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Role of Regulatory Bodies in Empowerment

Enact a “Nursing Practice Act” in the parliament – include independent , dependent and interdependent functions.

Nursing Licensure must entitle and mention the specific nursing practice. Eg., administration of injection in a nurse run clinic

Specialization in Nursing, eg., a junior nurse assisting a senior surgeon in surgery

Create a Vote Banking to enact a law for Nursing Practice Act

Newer designations for nurses and dress code for nurses to change the image among the public

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Ways… Nurses Empowered

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Encourage

Identify and involve

Enable

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Characteristics of empowered nurses

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Confident

Inclusive

Organized

Cooperative

influential

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Nursing empowerment is done in western countries by Magnet status to achieve nursing excellence. The major focus of magnet status are

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Nursing excellence by empowerment

Nursing leadership

Work environment for nurses

Professional development

Nursing practice

Patient care

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Essence of empowerment

Great Leaders

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Great Structures

Great Nurses

Great Knowledge & Innovation

Great Outcomes

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Pricing of nursing services

?

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Our price

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No yard stick

No Practice Act

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�Health care !!! Repair – shop model�

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Repair

Maintain

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Money for repair work

No money for maintenance

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Barriers to accept a nurse in leadership role

NURSES ARE NOT PERCEIVED AS IMPORTANT DECISION MAKERS AND REVENUE GENERATORS
NURSES ARE NOT VISIBLE IN HEALTHCARE POLICY MAKING.
PUBLIC PERCEPTION OF NURSE STEREOTYPES IN THE MEDIA.
LACK OF A SINGLE VOICE AMONG NURSES.
LACK OF UNDERSTANDING THE HEALTH POLICY.
LACK OF LONG TERM VISION (JUST A JOB).
NURSING FOCUS ON ACUTE CARE RATHER THAN PREVENTION AND MAINTENANCE.
LACK OF OPPORTUNITIES FOR ADVANCEMENT.
VARYING EDUCATIONAL LEVEL AMONG NURSES.
LACK OF ACCESSIBLE LEADERSHIP EDUCATION AND DEVELOPMENT.

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NHRSC study has shown that improving the nursing sector in states requires emphasis on all the three major themes of the health workforce –
a. Education and Development,
b. Leadership - Regulation, and
c. Deployment and Utilization.

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Few Questions for thought …

Do we have a nursing shortage in this country?
Are we making the best use of our nursing workforce?
Where do those scope-of-practice laws stand, and how do you see the nurse practitioner’s role evolving?
What competencies are most important for nurses going forward?
What are the biggest changes affecting the nursing profession today?
What must hospital and health system leaders do to address these changes?

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THE FUTURE

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(1) Predict the Future

-or-

(2) Invent the Future

Which sounds better?

We Have Two Choices

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“We

We must become the change

we want to see.”

Mahatma Gandhi

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Questions, Comments or Thoughts?

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Thanks for stopping by