Adhering to NMC Guidelines and Promoting Patient Safety

In modern nursing practice, nursing professionals must adhere to the NMC (2018) guidelines to not only provide safe and high-quality care to patients but also promote their professional accountability and integrity throughout the professional practice [NMC, 2018]. Through learning from the practical placement, a nursing professional can be transformed from the novice learner to the registered nurse who is obliged to take the right nursing decision in terms of meeting the professional care standard of NMC (2018) to proofed high-quality care and support to service users. NMC (2018) guidelines assist student nurses to follow the systematic and legislative process to implement all the health and social care policies to ensure safe and fair treatment of each patient. In this reflection, I will reflect on the clinical knowledge, professional experience and skills that I gathered throughout the three years of my nursing degree that assist me to promote my professional and personal development. In this reflective essay, I will discuss the NMC (2018) code "preserving safety, as the key category of the NMC guideline. Here I will explain that how I implemented this NMC code into my practice as a student nurse to provide holistic care and support to service users. In this reflective essay, I will use the Gibbs reflective cycle to reflect on the events that I experienced during the placement and the professional knowledge as well as professional and personal skills that I gained during the placement as the novice learner. Here I will also use Benner’s stages of clinical competence to reflect on my personal development and learning throughout my placement.

In nursing, practice reflection is fundamental to conduct a continuous improvement that enables the student nurse to not only shape existing skills and abilities but also develop the new nursing knowledge and skill. Gibbs reflective cycle is chosen for this essay because it will assist me to use the systematic pathway to reflect on my professional experiences, knowledge and professional skills that I obtained throughout the three years my placement as a student nurse, here I will follow the six different stages of reflection such as description, feeling, evaluation analysis and action plan, to reflect on the way I implemented and followed the selected NMC (2018) code “preserving safety” to promote the compassionate care delivery to the service users [NMC, 2018]. Gibbs reflective model is highly relevant to reflect on previous experiences and learning of the student nurses that enable them to analyse their professional strength and areas of improvement. Through using the Gibbs reflective cycle, I am able to not only analyse the learning experiences that I gained on effective implementation of the code “preserving safety” but also analyse the limitation or challenges that I have experienced during my practice to implement this code.

While preserving safety nursing professionals must ensure that they have proper clinical competence that is important for providing safe and effective care to patients. In my placement as the assistant practitioners, I followed Benner’s stages of clinical competence in terms of enhancing my compatibility to meet the safety needs of patients. Benner (1984) presented the five stages through which each healthcare professional needs to pass to develop the requoted clinical competence. These five stages are novice, beginner, competent, proficient and expert. While ensuring preserving safety of patients as well as staffs who are vulnerable to the harm and injuries, I passed through these five stages which assisted me to complete my journey from a novice learner to the expert.

There are four important professional standards of NMC (2018) such as practising effectively, preserving safety, promoting professionalism and prioritising people [NMC, 2018]. It is crucial for all nursing professionals including student nurses and registered nurses to adhere to all these standards to ensure that each service user is treated with proper respect and dignity (Newham and Hewison, 2021). In this reflective essay I will reflect on my roles as a student nurse to adhere to the NMC (2018) standard, ‘preserving safety’ in order to ensure patient’s safety throughout the care delivery. The NMC code “preserving safety” is associated with providing ahigh quality and safe care to patients that is appropriate to the health and care needs of the patients [NMC, 2018]. Under NMC (2018), nursing professionals must ensure that they are well-skilled and highly professional in ensuring that the patient is free from any kind of surgical and medication errors or accidents. [NMC, 2018]. The Care Quality Commission (CQC, 2015) report shows that there are many cases in which NHS professionals are failed to meet the professional standard of the NMC (2018) codes which pose the question on their professional skill and competency towards meeting the safety needs of patients [CQC, 2015].

During my first placement in the emergency ward, I was assigned to work under my mentors (senior nurse) to take care of a 70 years old lady Jenny. Jenny suffers from complex health condition such as COPD (chronic obstructive pulmonary disease), Type 1 diabetes, primary lung malignancy and bipolar disorder. This patient had been admitted to the emergency ward with severe breathing issues, chest tightness, severe weight loss and manic episodes. Here I was assigned to assist my mentors in several ways in relation to providing personalised complex care to Jenny. Under NMC (2018), nurses must adhere to the standard “preserving safety” in terms of determining the individualised needs of the patients thereby developing an effective care plan based on these needs to provide safe care to patient (Henderson and Jones, 2017). On my second day of this placement, I was asked to carry out the physical test of Jenny such as checking her oxygen saturation, BP, pulse rate, sugar level and Complete Blood Counts (CBC). As this was my first placement I had no practical experiences in performing the physical test. Therefore, I was very nervous to perform these tests safely and effectively. Under NMC (2018), while adhering to the standard "preserving safety" nursing professionals need to ensure that they work under the level of their professional expertise and knowledge in terms of providing high quality and safe care to each patient (Rubio-Navarro et al. 2020). Although I performed the BP, oxygen saturation and pulse rate of Jenny easily, I experienced a lack of self-confidence to perform the CBC as I had no practical knowledge on collecting patient’s blood safely and check the blood counts. In this context, I implemented the guidelines of the NMC (2018) standard “preserving safety” to ensure high-quality care delivery to Jenny based on her needs [NMC, 2018]. I informed my mentor that I am not confident that I can perform the blood test effectively therefore there might risk of surgical errors to the patient that can interfere with the entire care outcomes. While prioritising the personalised needs of a patient suffering from a complex illness, student nurses must ensure that they use the right techniques and care processes that can eliminate chances of any medication or surgical errors (Stonehouse, 2019). Under NMC (2018) standard I had a clear confession in front of my mentor regarding the limitations of my professional skill that assisted me to receive the guidance and training from the mentors that are required to shape my skills [NMC, 2018]. Although at the starting of the placement I was nervous and had poor self-confidence in the middle of the placement I started to adapt myself to the goals and work process of my team.

During the first week of this placement, I had a mixed feeling of emotion, excitement, nervousness and shyness. I felt introverted to discuss my weakness regarding performing any care-related task to my mentors which interfered with my skill in meeting the standard of "preserving safety" (Quinn, 2017). During the first week, I felt highly disappointed and hopeless as I was unable to meet the target of performing the blood test of Jenny. I felt that my confession regarding the lack of skill and knowledge in performing the CBC might spoil my image in front of my mentors. While implementing the standard Preserving safety, nursing professionals need to ensure that they must have a clear knowledge and understanding of the systematic care process and techniques that are going to be used in meeting the care needs of the service user (Dahlke et al. 2019). However, I also felt that by handing over the task of checking CBC to my mentors I had implemented the NMC (2018) standard, ‘preserving safety’ effectively into practice, in which I ensured that the entire physical assessment was done by the highly skilled nursing professionals to develop an effective care plan for Jenny [NMC, 2018]. After few weeks of the placement, I was able to develop good nursing knowledge and professional skill which made me feel highly confident and self-esteemed. My mentor guided me in how to put the patients at the centre of care by prioritising the care needs of patients and consider these needs while implementing a care plan.

By analysing and evaluating the overmentioned events that I had experienced in the first placement had assisted me to learn many aspects in relation to implement the NMC standard “preserving safety”. The placement was highly informative to me that developed my knowledge and understanding of how to prioritise the care needs, preferences, personalised choices of services users by taking a holistic care approach. Throughout the placement I was able to develop my nursing skill and professional abilities in implementing the guidelines associated with preserving safety, thereby promoting the emotional, psychological, physical and spiritual health of service users (Scott, 2017). While assisting my mentors to prioritise the complex care needs of Jenny I understand the importance of effective communication, clear information delivery and an interprofessional approach in prioritising the personalised needs of patients. The feedback that I received from my mentors regarding my work progress as a student nurse assisted me to develop an effective action plan to shape my existing nursing skills and develop the new professional skills that are crucial for nursing professionals to meet NMC (2018) standard ‘preserving safety’ into practice.

In my second placement, I was assigned to the dementia ward under a multidisciplinary team in relation to taking care of a 67 years old man, Morris. Here I worked under the senior registered nurses. My roles were to make regular observation of patient's physical and psychological health condition. Here I use to check the BP, pulse rate, oxygen saturation, heart rate and breathing rate and sugar level of Morris. As Morris was dementia patients, I use to follow regularly that if there was any change in his behaviour, activities and interactive ability. Here I feel that I need to strictly follow the NMC (2018) standard, preserving safety, in terms of determining the behavioural, emotional and psychological needs of this patient [NMC, 2018]. One day I noticed that Morris received rude behaviour from the senior nurses due to his several attempts for throwing the antidepressants outside through the windows. Under NMC (2018) code, while preserving safety, it is the responsibility of nurses to use an empathetic and polite approach to patients, especially to vulnerable patients like people with dementia (McCarthy et al. 2018). I faced difficulties many times to ensure the timely delivery of foods and medicines to Morris. This is because most of the times Morris showed irritation and stubbornness to reject to take the food and medicines that interfered with the quality of personalised care delivered to him (Nutting, 2017). In this context, I faced difficulties in implementing the standard preserving safety into practices. I had made discussion with my seniors and other care professional in my team regarding this issue. My mentors guide me to hold my patience level while prioritising the needs of mentally ill patients like Morris.

During the first session of the second placement, I felt nervous as well as excited as I never work with dementia patients before. Although in the first few days of this placement I feel exhausted, helpless and depressed as I get a lack of support from Morris in prioritising his care needs. Under NMC (2018), while it comes to implement the code ‘preserving safety’, nursing professionals must involve the patient in the care process to ensure that they receive proper collaboration and support from the patient in terms of gaining a clear understanding of what patients needs from the care professionals and what impacts the illness has on their mental and physical health [NMC, 2018]. As mentioned by Weeks et al. (2019), while implementing the NMC code into practices to preserving safety, student nurses must develop clear knowledge on how to determine the psychological and physical needs of patients which is important to develop a holistic care plan for meeting the personalised needs. In the middle of the second placement, I have developed a good understanding of how I can implement the NMC (2018) code, ‘preserving safety’ into practice to ensure that I will put all the mental and physical needs of the patient in the centre of the care process thereby design an effective support mechanism that will assist me and my team members to promote the holistic wellbeing of the patients.

By analysing the events in the second placement I can conclude that the entire placement is full of negative and positive aspects. On a positive note, the placement assists me to learn how to implement the NMC (2018) code ‘preserving safety in case of promoting positive health and wellbeing in mentally ill patients. Moreover, in the second placement, I was able to develop the skill of forming empathetic communication with vulnerable people to prioritise the health needs of patients thereafter meeting these needs to improve their quality of living [NMC, 2018]. On a negative note, sometimes I face poor guidance and support from mentors and care professionals in relation to deal with the personalised needs of vulnerable patients such as dementia patients which reduce my self-confidence and self-esteem.

Despite the negative and positive aspects of the second placement this overall placement was highly effective to develop my nursing skill in conducting the effective implementation of the NMC (2018) code preserving safety thereby assisting me to enhance my competencies in promoting the holistic wellbeing of patients [NMC, 2018].

My third placement was in the emergency ward, in which I was assigned to assist the senior nurses in providing pre, intra and post-operative care to a 12 years old girl, Lisa. The patient had been admitted to the emergency ward with a 1-day history of lower abdominal pain. After the admission of this patient, I followed the APIE (assessment, plan, implementation and evaluation) assessment tool to determine the physical and psychological health status of this patient (Nurse-Clarke et al. 2019). In assessing the physical condition of Lisa, I used the ABCDE assessment process, which assisted me to check her airways, breathing rate, circulation, disability (if any) and exposure. Based on this assessment it had been diagnosed that Lisa had inflammation on the appendix therefore she needed an immediate appendectomy. I was very excited to work first time with senior nurses and care professionals in the OT (operation theatre) in relation to ensure the safe removal of the appendix. While prioritising the physical needs of patients, nursing professionals must ensure that they use safe and effective medication or surgical process that are appropriate for the current health needs of the patient (Small, 2019). Here I assisted the surgical team in various ways such as dressing the patient before surgery, checking her BP, pulse, oxygen saturation and heart rate and ensuring the aseptic techniques are used inside and outside the OT to eliminate chances of any surgical site infection. Here I followed the NMC standard “preserving safety” by prioritising the safety needs of this patient that are important to improve her health condition.

Throughout the third placement, I felt quite confident to adherer to the NMC (2018) standard to prioritise the personalised needs of the patient thereby promoting the holistic wellbeing of the patient [NMC, 2018]. In this context, I analysed that the entire placement was highly effective to develop my professional skill as a nurse to meet the chosen NMC standard in terms of treating each service user with compassionate and high-quality care.

Based on the experiences that I gathered throughout the three placement I have developed a care plan I which I include many objectives that will gain the effective transformation from student nurse to registered nurse one of the objectives is to develop my written communication skill, as I identified during the placement that I have the poor grammatical knowledge and lack of sentence formation skill that interfere with my ability to form a clear patient’s case study or drug-related documents. The other objective is to develop my clear understanding of the implementation of the other three NMC codes which will assist me to meet the chosen NMC standard ‘preserving safety’ by following the right as well as effective care and support approach.

All the three placements were highly informative to me that assisted me to go through all the five stages presented by Benner (1984). While preserving safety of patients in each placement I had developed lots of understanding and knowledge that shaped my existing skills and assisted me to develop new nursing skill. The challenges that I faced during these placements to preserve safety of patients assisted me to learn new professional knowledge and expertise that enhance my clinical competence. Finally, I can say that throughout the three years degree course nursing I had developed good clinical knowledge and professional skill that assisted me to transform from a novice learner to the clinical expert.

From the above-mentioned discussion it can coincide that, in nursing education, it is crucial to follow the simulated practices and systematic approach to adhere to the NMC standard. Student nurses and the registered nurses need to implement all the NMC standard into their practices to ensure that effective and safe care delivery to patients. Through implementing the NMC standard to prioritise people, nurses are able to determine the personalised needs of patients by taking a person-centred approach that enables them to develop an effective care plan to meet the needs thereby promoting the holistic well-being of patients.

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