Principles of regulation of two care professionals (nurse and doctor) To become a nurse or a doctor you need to have the appropriate education, a nurse has a degree which take place at an NMC approved institute and takes three years to achieve, you will also need to choose a specialism, adult, children, mental health or learning disability, after the three years you will obtain a bachelor of science (BSc) degree in you chosen nursing field , compared to a doctor who needs to do a 5 year degree in medicine or surgery, it takes five years for you to obtain a bachelor of medicine or surgery degree , after you have achieved your degree you will need to undertake two foundation years (fy1-fy2) in which you will rotate through 3 specialties each year for 4 months at a time in various speciality’s for two years, after the two foundations years fy1 and fy2 are completed you then have a licence to practice and can take time out from training, irrespective of being in training or not every doctor has to an appraisal carried out, this can be done either privately r by the Nhs after fy2. You will then need to complete three to seven years specialist training i.e. medicine, surgical, the length of your training will depending on the speciality you have chosen. As a nurse or a doctor, you are required to register with a governing body. To register as a nurse, you will need to register with the NMC (nursing midwifery council) pay the yearly fee of £120, fill out the online application form, send a declaration of your good health and character, when registering online you will need to declare any police cautions or criminal convictions . As a doctor you are required to register with the GMC (general medical council), To register you will need to be a medical graduate who has completed their medical degree, Pay the yearly fee which varies between £150-£400, you will have to do this before you begin your foundation year 1 (FY1). For nurses you are expected to revalidate every 3 years this requires you to have completed 450 practice hours, complete 35 hours of continued practise development at least 20 hours must have included participatory learning, you must obtain 5 pieces of practice related feedback and 5 written reflective accounts. Doctors revalidation is slightly different they have annual appraisals based on good medical practise, a five yearly recommendation from a responsible officer or a suitable person, this recommendation is based on the output’s from the appraisals and clinical governance information, at appraisals you have to demonstrate that you meet the criteria set out by the GMC (general medical council) for appraisal. It involves collecting CPD points by going to conferences and training days, watching lectures, teaching students and reflections, then presenting said points in a portfolio that proves you are committed to continued professional development1, after 5 year the aim is to collect 250 CPD points and gain 5 signed off appraisal. As a doctor you also need to have indemnity insurance which can cost £350-£400 per year and increases you progress and have more responsibility. The NMC have a code of conduct that sets out common standards of conduct and behaviour for those on the register, these are to prioritise people, practice effectively, preserve safety and promote professionalism and trust. The professional commitment to work within one’s competence is key to underpinning principle of the code which should always be upheld. The code puts the patient at the heart of care, it sets out professional standards that nurses, midwifes and nursing associates must keep to. These are shown every day by good health and care professionals across the country. Doctors follow the GMC code of conduct which members of the GMC are expected to uphold there seven principles, selflessness, integrity, objectivity, accountability, openness, honesty and leadership , there ethical behaviour can be based on these four pillars which are autonomy-respect patients right to self-determination, Beneficence- to duty to do good, non-maleficence-the duty to not do bad and justice- to treat all people equally and equitably. These codes and ethical behaviour help protect, promote and maintain the health and safety of the public by ensuring proper practices in the practice of medicine. Accountability is about taking responsibility for your actions, always ensuring that you are competent to do the job you’ve been asked to perform and always putting the patient or client first, the patient and the public must be able to trust nurses and doctors to provide and high quality of care, to act lawfully, uphold their professional reputation, be approachable and make the care of the patient their first and primary concern. Registered nurses are also accountable to regulatory bodies they are professionally accountable to the Nursing and midwifery council (NMC), and for doctors are also accountable to a regulatory body the general medical council (GMC). In comparison to each other doctors and nurses are both accountable to the public and register body’s and themselves for their actions in and out of the workplace and both uphold similar standards for accountability. It is key that both nurses and doctors know their own limits and abilities, for this both professions need to clearly understand the limits of their role and only undertake tasks in which they are authorised to carry out, in both professions where there is an identified gap in knowledge a development plan should be put in place with your supervisor, it states in the professional code of conduct for doctors that, “A doctor shall not persist in unsupervised practice of a branch of medicine without having the appropriate knowledge and skill or having the required experience.”2 Doctors and nurse should refer there patient on when they need a specialist opinion, specialists often can have a different opinion that might better benefit the patient, when they struggle to make a diagnosis again sometimes another opinion is what is needed for the patient to get the best experience and best chance of having a fast recovery. When the doctor looking after the patient wants a specialist opinion, specialism often can have a different opinion that could benefit the patient. When they want to improve patient access, if a doctor is struggling to communicate to a patient or is overbooked referrals could benefit the patient.3 In comparison a nurse will make a referral also when a specialism is requires, if a patient is needing a new catheter and has other medical conditions that may cause medical complications a nurse will usually refer this on to urology in this instance, this keeps the nurse working in the parameters of their job description and helps keep patient centred care and safety at the forefront of care. Professional supervision is important in health a social care, it can help both doctors and nurses keep up to date with training which helps promote the best patient care possible and ensures both professions work safely, legally and effectively, Supervision aims to provide accountability for both the supervisor and supervisee exploring practice and performance,4 Clinical governance is, “A system through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.” (Scally and Donaldson 1998, p.61) 5. Health and social care organisation have a duty to maintain the quality and the safety of care to the communities that they serve. The NHS Clinical and care governance strategic framework 2017-2019 sets out corporate objectives, these include to provide patient centred care, to protect individuals from avoidable harm, to promote and support people to live a longer healthier life and to continually improve and modernise healthcare.6 Clinical governance is an umbrella term which encases 7 pillars these are clinical effectiveness, risk management, patient experience and involvement, communication, resource effectiveness, strategic effectiveness and learning effectiveness.7 clinical governance also mean that organisations have a duty to seek quality improvement through clinical governance. Reference: 1 Gmc-uk.org. (2018). Guidance for doctors; requirements for revalidation and maintaining your licence. [online] Available at: https://www.gmc-uk.org/-/media/documents/revalidation-guidance-for-doctors_pdf-54232703.pdf [Accessed 14 Oct. 2019]. 2 Medicalprotection.org. (2019). Practising within your expertise. [online] Available at: https://www.medicalprotection.org/malaysia/casebook/casebook-september-2012/practising-within-your-expertise [Accessed 10 Oct. 2019]. 3 PatientPop. (2019). The Rule of Three: When and How to Refer a Patient | PatientPop. [online] Available at: https://www.patientpop.com/blog/running-a-practice/physician-to-physician-referrals-reducing-liability-and-improving-patient-care/ [Accessed 10 Oct. 2019]. Anon, (2019). step into leadership. [online] Available at: http://www.stepintoleadership.info/supervison.html [Accessed 10 Oct. 2019]. 5 Scally G and Donaldson LJ (1998) Clinical governance and the drive for quality improvement in the NHS in England. British Medical Journal 317 (7150) 4 July pp.61-65 6 Gov.scot. (2019). Clinical and care governance framework: guidance – gov.scot. [online] Available at: https://www.gov.scot/publications/clinical-care-governance-framework/ [Accessed 14 Oct. 2019]. 7 bmj.com. (2005). what is clinical governace?. [online] Available at: https://doi.org/10.1136/bmj.330.7506.s254-b [Accessed 8 Oct. 2019].
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