Accountability for the nursing profession

We need to keep the DON position strong to ensure professional accountability for nursing practice, according to DON Eric Daniels.

An evidence-based framework for professional accountability is essential for the advancement of the nursing profession and ensuring high standards of patient care and safety, says one of the most senior nurses in the Greater Southern Area Health Service, Eric Daniels.

As DON at Wagga Wagga Base Hospital, Eric describes the most important aspect of his job as ensuring the professional accountability of nurses at his hospital.

‘It’s important that nursing practice is evidence-based and that there is a framework to monitor, review and evaluate nursing care – for the benefit of nurses as well as patients,’ said Eric.

‘One of the most important parts of my job is to provide for such a framework and ensure nursing practice complies with legislation, government policy and that it reflects the current literature on the topic.

Eric said that the recent Camden/Campbelltown Inquiry into allegations of nursing and medical malpractice at these hospitals highlighted how crucial it was that the profession has a sound framework for monitoring and evaluating clinical practice for the protection of patients – and also for nurses to be able to respond to accusations of poor practice.

‘The results of the Inquiry showed that the role of the Director of Nursing has often been lost in undertaking other areas of responsibility in hospital administration to the detriment of nursing and professional nursing practice,’ he said.

Eric has held the position of DON at Wagga Wagga’s 257-bed hospital for the past five years and held the position of acting Area DON for what was the Greater Murray Area Health Service.

As the DON of a Level 5 referral hospital, Eric is primarily a nurse manager. ‘There is limited scope for clinical practice in my role. I try to focus on maintaining my clinical practice knowledge so I don’t lose touch.

‘I am responsible for monitoring the use of nursing resources in the hospital and ensuring nursing practice is high-quality, up-to-date and reflects current literature relating to the provision of nursing care. I am also manager of the surgical and critical care streams at the hospital,’ he said.

According to Eric, another important responsibility of the DON role is encouraging the continuous professional development of nurses. This is another critical area of ensuring safe and effective nursing care of our patients.

Eric comes to the DON position with an extensive nursing background in operating theatres and paediatrics.

‘When I worked as the manager of the operating theatres, I had my first taste of management and I really liked it. I decided I wanted to move along the management path,’ he said.

‘An operating theatre management role provided me with the opportunity to develop strong management and organisational skills but it’s a discrete environment and I wanted to experience other specialty areas and a broader scope of management.

‘As DON, I have contact with a range of different clinical environments and I am responsible for a broad range of nursing specialty areas.’

Eric is also Chair of Wagga Wagga Base Hospital’s Clinical Nursing Review Committee, which is working to develop clinical practice guidelines and protocols for nurses. This Committee is also responsible for monitoring and evaluating nursing practice across the hospital as well as making recommendations for change where necessary.

A typical working day for this DON spans anything up to ten hours, commencing with a bed management meeting at 9 am.

‘Firstly I need to check the status of beds in ED and wards, check referrals and other requests for admission that have been made, surgery booked for the day and staffing levels to ensure that we are able to provide care at a safe level as well as meet industrial requirements in terms of nursing workloads.’

‘My day is often booked up with overlapping meetings. These include meetings for the Clinical Nurse Review Committee, which I chair, Surgical and Critical Care Services, as well as hospital executive management meetings. I also chair the committee that is developing a sustainable access plan for the hospital, one of the objectives of which is to address access block,’ said Eric.

‘Wagga Wagga Base Hospital is also in the planning stages for redevelopment and there are numerous meetings associated with this. I also meet with many staff individually and try to visit the wards and departments when possible.

‘There’s always a pile of routine stuff that needs tending to – such as ensuring essential equipment is maintained, responding to reams of emails and overseeing the recruitment of nursing staff.

‘Like everywhere, we have problems attracting nursing staff here. However, we’ve just implemented a very successful program to recruit overseas nurses,’ he said.

Eric has strong concerns about proposals by NSW Health to downgrade nurse manager positions in the AHS restructure.

‘There have been suggestions that the DON position be renamed as surgical stream manager. If that were the case, I would lose my Director of Nursing title. Not only is this contrary to the award, but it sends the wrong message about the importance of the professional nursing management role,’ he said.

‘Under the new restructure, it’s been proposed that the hospital’s General Manager is replaced with a cluster manager for the hospital and community health services. If this position is not physically on-site it increases the day to day responsibility of the executive management team’.

‘The hospital DON would have more responsibility but a lower grading and therefore a lower income, if the AHS proposals are adopted as they stand. Such proposals remain under negotiation between the AHS and the NSWNA.

‘There is little doubt that scarce resources need to be used better to get the best outcomes, and the Director of Nursing role is vital in ensuring that this is achieved while ensuring high-quality care and improved patient safety.’