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Nursing and Midwifery Career Guide:A guide for newly qualified nurses andmidwives in the Republic of Ireland

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NuRSING ANd MIdwIfeRy CAReeR GuIde

Volume 1, Issue 1 2018

School of Nursing and MidwiferyTrinity College Dublin24 D’Olier StreetDublin 2D02 T283 Ireland

Email enquiries: [email protected]

First published 2018

Copyright © School of Nursing and Midwifery, Trinity College Dublin, 2018

ISSN 2565-5973

ISSN (printed version) 2565-5868

This document was developed by a working group within the School of Nursing and Midwifery including:

Elizabeth A. CurtisEmma DuffyCatherine ComiskeyFrank O’RourkeColin GriffithsFintan Sheerin


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Contents

Introduction 1

Starting your nursing or midwifery careerTransitioning from student to staff nurse and midwife: a process of discovery 2Inducting newly qualified staff into clinical practice 4Professional networks and networking 6Types of nursing and midwifery careers 8Improving your employability 9Fitness to practice 11Code of professional conduct and ethics 13Nursing and midwifery salaries and benefits 15

theory, research and practiceAdvancing your career through further education 17Applying for promotion in clinical practice 19Nursing technologies and trends 21Integrating theory into nursing and midwifery practice 23Applying for education and research grants: investing in you and addressing the global shortage of doctoral prepared nurses and midwives 24

leadership in nursing and midwiferyLeading the way in clinical practice: leadership is everyone’s responsibility 26Doing advocacy 28Don’t underestimate the importance of informal learning in your professional development 31Professional Indemnity 33Working within your scope of practice 35

travelling and volunteeringTraveling as a nurse or midwife 37

Meet the production team 38

Meet the contributors 39

Acknowledgements 42

further education 42

Career opportunities 43


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Introduction

Ms Michelle ClearyTrinity College Dublin

This guide has been developed to assist nursing andmidwifery students as they prepare to transition tonewly qualified nurses or midwives. I completed mydegree in Intellectual Disability Nursing in the School ofNursing and Midwifery, Trinity College Dublin in 2007.Although it is over 10 years ago, I can still remember themixed emotions of excitement and anxiety as Iembarked on my journey as a newly qualified staffnurse. Back then, I would have welcomed this guide as itprovides key information and guidance on commencingand developing as a healthcare professional. A career innursing or midwifery is exciting and there is a vast rangeof career opportunities available in general, children’s,intellectual disability and mental health nursing andmidwifery. Whether you are considering starting yourcareer in the public or private sectors, at home orabroad, or considering future roles in specialist practice,management, education or research, this guide will helpyou as you embark on this journey.

The transition from student to newly qualified registerednurse or midwife marks the end of formal education andthe beginning of your professional career. Even after fouryears of formal educational preparation and experiencegained during placements in clinical practice, thisprocess is daunting and it is not unusual to feel anxiousas you prepare for this transition. I can still recall myvery first shift as a staff nurse.

The reality of becoming a registered nurse brought arange of emotions from an enthusiastic eagerness tofear and a certain naivety as I prepared to start. Thesedifferent emotions continued throughout the earlyperiod of my career. Do not be afraid to acknowledgethese feelings, as knowing your capabilities as well asyour limitations are important to becoming safe andconfident healthcare professionals. My early days as anewly qualified staff nurse were quite challenging. Youmay feel a sense of achievement on days that have gonewell, other days you may feel overwhelmed. This is partof the process but you must give yourself time to reflecton your practice, learn and grow from theseexperiences.

During the early years in my career, the advice andsupport I received from my colleagues who had manyyears of experience was invaluable and I will be forevergrateful for their help. Their assistance helped me todevelop confidence and reduce my anxieties. Never beafraid to seek support from your colleagues. You canlearn so much from other team members. I also found mycollege friends a huge support during this settling inperiod. After all, they were in the same boat as me. Ifound meeting up for a chat always offered reassurance,knowing that I was not alone in this process and it madethe process feel a little less difficult. It is also important tofind a balance between work and rest. Remember to takebreaks during your shift, keep hydrated and eat well. Tryto find a suitable balance between home and work lifetoo. Take time for relaxation, hobbies and meeting familyand friends when you are on your days off.

This guide is designed to assist you as you start yournursing or midwifery career. It offers advice andguidance on advancing your career, nursing andmidwifery research, leadership in nursing andmidwifery, traveling and volunteering as a nurse ormidwife and also provides information for useful linksand contacts. It is a must read as you embark on yourcareer trajectory.


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Starting your nursing or midwifery careerTransitioning from student to staffnurse and midwife: a process ofdiscovery

Dr Colin Griffiths, Trinity College Dublin

IntroductionMoving from one role to another can be stressful at thebest of times however moving from the status of studentinto fulltime work as a qualified professional is perhapsone of the most difficult career transitions. Nursing andmidwifery are complex and involved professionsbecause, as health professionals, we are deeply involvedin the lives of those whom we support with the resultthat taking full responsibility for the lives of others canseem a daunting task. In the past the transition wasperceived by newly qualified graduates as quitehaphazard and characterised in one study in 1985 as‘fumbling along’ (Gerrish 2000). However these days,pre-registration courses are somewhat better orientedto address the shock of how to manage as a newlyqualified staff nurse or midwife.

be preparedIt is likely that as a newly qualified nurse or midwife youwill feel some degree of stress, anxiety and uncertainty.Be aware of your feelings and how to deal with them.Some days will probably be good and you will feel youhave achieved much, while on other days, things maynot go so well and you will be upset or disappointed.Accept that this will happen and try to learn from whatgoes well and what goes poorly. Do remember that yourrole has changed from student to one of qualified healthprofessional with responsibility, this greatly impacts onhow others see you and this will mean people will relateto you differently as expectations change in light of theway you are disconnected from your student past andthe way you forge a new identity.

Skills you will have to acquireThere are many clinical and practical skills andcompetencies that you learnt while doing your degreethat will be have to be developed quickly when you takeup your staff nurse / midwife role. These skills willinclude:� Organisational planning skills� Time management skills � Managing staffing issues� Interpersonal skill management.

There are two elements:

1. Managing staff:As a qualified professional you will have to managestaffing issues. This can be particularly difficult if yourresponsibilities include managing staff (healthcareassistants or nurses), who have been around a long timeas they may resent being directed by a newly qualifiednurse/midwife. This process can require tact andempathy in order to discriminate how to get the best outof each individual with whom you are working.

2. Managing inter-professional interactions: Nursing and midwifery are cooperative professions sopart of the nurse’s or midwife’s role is to bring togetherthe wisdom and abilities of a large number of others[doctors, various therapists, dieticians, clerical supportstaff etc.] with the purpose of enabling the patient orservice user to get better or at least obtain the bestpossible quality of life. Getting the best out of otherprofessionals requires a finely tuned inter-personalempathy as well as an ability to make decisions that noteverybody may be pleased with combined with acapacity to explain to the displeased the rationale forthe decision. This comes with experience but you shouldnot expect too much from yourself in this area at thestart of your career.

things you should doSeek support of other nurses: friends, more experiencednurses/ clinical supervisors. Remember: you are stilllearning and you will learn by succeeding andsometimes by making mistakes. So treat mistakes asopportunities to learn and be kind to yourself when thathappens.

what you will discoverYour confidence will grow (Kumaran and Carney 2014).As your theoretical knowledge is paired with yourpractical experience and as you develop the ability toreflect on what happens in your practice your clinicaland personal confidence will grow and your stress andanxiety should decrease. (O’Shea and Kelly 2006)


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ReferencesGerrish K. (2000). Still fumbling along? A comparativestudy of the newly qualified nurse’s perception of thetransition from student to qualified nurse. Journal ofAdvanced Nursing. 32(2): 473-480.

Kumaran S and Carney M (2014). Role transition fromstudent to staff nurse: facilitating the transition period.Nurse Education in Practice. 14: 605-611.

O’Shea M and Kelly B (2006). The lived experiences ofnewly qualified nurses on clinical placement during thefirst six months following registration in the Republic ofIreland. Journal of Clinical Nursing. 16: 1534-1542

work matters

Always work within your scope of practice. Often, newlyqualified nurses and midwives can feel embarrassed or feelthey are supposed to know everything once they have theirNMBI nursing pin. This is not true. Always ask for help from amore senior member of staff when you do not feelcomfortable to carry out an aspect of care.

Read. You will encounter a lot of information that is new toyou as you begin this career. Make a note of what you don’tyet know and read about it. It will stand you in good stead.

Learn from others. Take any learning opportunity availableto you and listen to those with experience. They were oncein your shoes. Use the internship to go over things that youforesee will come up for you when qualified.

Carry a notepad with you to note down items for the end ofshift report that you might forget.

Be organised. Take 5 minutes at the start of your shift to planyour day and prioritise your patients and duties.

Make sure to give yourself as much time as possible to dolonger tasks such as medication administration and writingup notes. It will take you longer initially so be sure to planyour day for this.

Try and go on as many training days and courses as your jobwill allow you. They will be useful for guiding your work.

If you have completed your work, help out someone else,you may need their assistance someday.

personal matters

You have four years of experience, do not put yourself down orthink that you know nothing. You have so much knowledge andyour own experiences to bring to the job.

Always ask for help and support if you are feeling stressed or underpressure. You are never on your own.

Keep a diary for yourself to reflect on your new role and your newexperiences.

Be the best you can be, every day. You have so much to bring. Youare the future of nursing. However remember no one is perfect andperfection is not expected of you.

Be kind to yourself. Remember it is ok not to know it all andcongratulate yourself on the amazing work you can do. Nobody isperfect in this career, you will always be learning.

Reflect. Give yourself time to think about your shifts, make sense ofyour busy day. Reflecting allows us to come up with areas we canimprove upon but also gives us an opportunity to acknowledge thepositives in our care.

Don’t be afraid, you are qualified, you have earned thisqualification.

Talk to others. Meeting up and chatting with your friends andcolleagues over a cup of tea will make everything seem mucheasier.

Have fun. Make the most of your time off, it is valuable. You’lldeserve your days off, that weekend away, or night out with yourfriends.

And lastly: invest in a good pair of shoes. It may save you backproblems in the future.

Compiled from contributions by Katie Flanagan, Ruth O’Neill,Sophie Ronan and Bronagh Dunning [recent graduates].


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Starting your nursing ormidwifery careerInducting newly qualified staff into clinical practice

Mr Paul Gallagher, St James's Hospital

Introduction

The transition from student to staff nurse or midwife isa rite of passage that marks the end of your initialeducational preparation in your discipline and thebeginning of the professional journey as a nurse ormidwife. This transition is often described as excitingbut it can be an extremely challenging time for many. Asa student psychiatric nurse and postgraduate student ingeneral nursing, I clearly recall the transition fromstudent and being ‘dependent’ on others, to a staffnurse who was ‘depended’ on.

experiences of newly qualified health professionalsThe experiences of a newly appointed staff nurse ormidwife are often very exciting and exhilaratingespecially after four years of life as a student. Not unlikemany other careers, the first stage of employment canoften be described as a ‘honeymoon phase’ however,this may be short-lived as the nurse discovers that therole, workload and expectations can be challenging. Atthis fundamentally important time in your new career itis essential to continue to use the supports that areavailable: colleagues, ward managers and theprofessional networks that you established during yourdegree course. Most of us have experienced this in theearly stages of our careers; however, as time passes as anewly qualified nurse and midwife you will achieve awork life balance and the confidence to continue todevelop in your roles. As you begin your career it is quiteusual to feel somewhat unsettled after you commenceclinical practice and feeling discontentment can often be

a part of settling in to such an important role. When theright approach is adopted by all stakeholders i.e. you asthe newly qualified staff nurse or midwife, yourcolleagues and employers, this time of transition can bea rewarding one.

An exampleAt St James’s hospital we have identified three key areasthat both the newly qualified nurse or midwife and thehospital are mindful of, to ease and support thetransition from student to staff nurse. These aresummarised as follows:

i. Support and Feedbackii. Skill and Competence Developmentiii. Development of Critical Thinking skills

As a hospital employer it is our responsibility to providethe necessary supports for these individual areashowever, it is also your responsibility as a registerednurse or midwife to ensure that you participate andexpand on your professional practice and personaldevelopment.

ConclusionIn concluding, I wish to emphasise a few key points thatall newly qualified nurses and midwives should consideras they make the transition from student to qualifiedhealth professional. These are:

� Keep your patients safe and be their voice.� The first 6-12 months for many newly qualified

nurses and midwives can be very stressful, therefore,utilise the supports that are available to you.

� Look for career opportunities that offer a structured graduate programme with inbuilt dedicated preceptorship. If this is not available, ask your ward nurse/midwife manager to provide you with a preceptor or a role model who is experienced and who can be approached to give objective support and direction.

� Be patient with yourself. As you gain more experience you will become more confident in your practice. We all make mistakes, however, it is reflecting and learning from them that is important: this also develops your critical thinking skills.

� Self-care is often overlooked so do not forget to mindyourself and your colleagues.


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bibliographyDoody, O., Tuohy, D., Deasy, C. (2012) Final-year studentnurses’ perceptions of role transition. British Journal ofNursing. 21(11): 684-688.

Duchscher J.E. (2009) Transition shock: the initial stageof role adaptation for newly graduate registered nurses.Journal of Advanced Nursing. 65(5): 1103- 1113.

Hardacre, R., Hayes, L. (2016) The transition to becominga newly qualified nurse: a reflection. The Journal of NewWriting in Health and Social Care. 2(2): 32-43.

Hofler, L. and Thomas, K. (2016) Transition of newgraduate nurses to the workforce: challenges andsolutions the changing healthcare environment. NCMedical Journal. 77(2): 133-136.

Kramer, M. (1974) Reality Shock: Why nurses LeaveNursing. Mosby: St Louis.

Ash, R., Lemcke, P., Sacre S (2009) Enhancing transition:an enhanced model of clinical placement. NurseEducation Today. 29(1): 48-56.

Riegel, M.R. (2013) Orientating a new generation ofnurses’ expectations of the millennial new graduate.Open Journal of Nursing. 3: 461-466.

Sparacino, L.L. (2015) Faculty role in assisting newgraduate nurses to practice International Journal ofNursing. 2(2): 7-46.

Twibell, R., St Pierre, J. (2012) Tripping over the welcomemat: why new nurses don’t stay and what the evidencesays we can do about it. American Nurse Today. 7(6).[ONLINE] Available at https://www.americannursetoday.com/tripping-over-the-welcome-mat-why-new-nurses-dont-stay-and-what-the-evidence-says-we-can-do-about-it/ (accessed 28thMarch 2017).

Whitehead, B. (2011) Are newly qualified nursesprepared for practice? Nursing Times. 107(19/20): 20-23


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Starting your nursing or midwifery career

Professional networks and networking

Professor Kate Irving, Dublin City University

IntroductionNetworks are groups of people with a common interestwho exchange knowledge in a way that is mutuallybeneficial. In other words, a connection may be able tooffer direct help or put you in contact with someonewho can help. Do bear in mind also, that you may be in aposition to return the favour at some point.

dynamic professionsNursing and midwifery are highly dynamic fields. Patientcare is constantly evolving and the scope of nursingpractice continues to expand. Therefore, maintainingcurrent knowledge of trends and advancements innursing and midwifery is imperative. Findinginformation is not a problem but finding importantinformation among the ‘noise’ of information overloadis the main challenge we face. Networks are usefulmechanisms for crowd sourcing information so that youcan find the information you require.

In nursing and midwifery, in which there are manyprofessional paths, networking can be helpful for findingout about new positions, meeting mentors or learningabout interesting events and conferences. You neverknow where your professional interests may lead.Therefore, developing a professional network with abroad scope will help you to be agile throughout yourcareer. Having the support of a professional networkmay help to combat the kind of stress that leads to burnout. It is a way of getting advice from more experiencedcolleagues and may result in practical ideas to improvethings. Networking not only with nurses and midwivesbut with our allied health colleagues as well as those

outside of health disciplines e.g. business studies, willbe important for nursing / midwifery leadership if theprofessions are to deal with the many challenges facingthem. Furthermore, collaborative networks are crucial ifnurses and midwives are to achieve equal status withother healthcare professionals (Cook 2001).

professional associationsThese are useful for meeting others in the nursing andmidwifery professions; the anchor of your network is inyour own ability to develop relationships. Begin early.Use your time as a student to start joining professionalassociations and building your network by exchangingcontact information with those you meet. Attendingnursing or midwifery conferences and events is anothergreat way to network. Initiate conversations and havebusiness cards made up so that you can exchangecontacts. Aim to join networks that align with either yourcurrent role, and / or the career aspirations you have forthe future.

Social mediaThis can be an important resource for nurses andmidwives and can also act as a global voice for theprofessions, help counteract negative stereotypes, andpromote the professions. It can provide an instantmeans of communicating with colleagues; Facebook,Twitter and YouTube have opened up access to a vastwealth of information, practice experience, health caredisciplines and developments. While social media is avaluable aid, a note of caution is required. Keep a strictdivide between the personal and professional use ofsocial media and, it is vital to remember to alwaysrespect patient confidentiality as well as the dignity andrespect for others in any online communication. TheGuidance to Nurses and Midwives on Social Media andSocial Networking can help nurses understand basicguidelines for its safe use.

See more at: www.nmbi.ie/Standards-Guidance/More-Standards-Guidance/Social-Media-Social-Networking


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ConclusionNursing and midwifery are demanding professions butdo try to make time for networking. Set aside a fewminutes for updating your social profiles or committingto attend a couple of conferences each year. This is aninvestment in your career and yourself. Courtney et al. (2002) reported that nurses often fail toprioritise networking in their work schedules. You haveworked hard for your nursing or midwifery qualificationsso capitalise on this hard work to improve your profileand showcase your contribution to your respectiveprofessions.

ReferencesCook MJ (2001). The renaissance of clinical leadership.International Nursing Review 48 (1), 38–46.

Courtney M, Yacopetti J, James C, Walsh A (2002)Comparison of roles and professional developmentneed of nurse executives working in metropolitan,provincial, rural or remote settings in Queensland.Australian Journal of Rural Health. 10 (4), 202-208.


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Types of nursing and midwifery careers

Dr Angela Flynn, University College Cork

IntroductionGetting settled in your new role as a newly qualifiednurse or midwife can be very challenging. How do youknow you’re in the right place? Is it a good match for youand your interests? As you have gained experience ofdifferent specialities during your education, youprobably felt more ‘at home’ in some areas than inothers. We work best in a place where we are mostcomfortable and where we gain the most personal andprofessional satisfaction.

developing your specialismWhen we think of ‘specialist’ areas of practice, we tendto think of areas of high acuity with specific skills andknowledge required to practice safely and competently.These fields do demand additional training andqualifications in order to practice effectively, andincreasing numbers of HEIs are offering such training atpostgraduate level. Nurses working in settings such asEmergency Nursing, Intensive and Critical Care/HighDependency Nursing, Theatre Nursing, RecoveryNursing, and many others, tend to seek specialisttraining in these fields. You can pick up much experienceof these areas while working in them, but to add to yourknowledge of evidence based practice in these, it isadvisable to seek specialist training.

To develop your career in a particular area, or to getpromotion you certainly will need to have completedfurther postgraduate study, ideally to MSc level. ManyHEIs offer the modules that make up these programmesas ‘stand-alone’ Continuing Professional Development

(CPD) modules which may be more affordable andmanageable while working full time. Most nurseshowever, will find themselves working in genericsettings and currently there are very few specific coursesthat cater for career development in such settings. Tobuild up your portfolio, you should seek out CPD and in-house training courses.

Moving into nursing or midwiferymanagementFrom a very early stage in nursing and midwifery, we arecalled upon to make decisions around the managementof patients and workloads. Very soon, the newlyqualified nurse or midwife can find themselves ‘in-charge’ and will be called upon to use skills of ‘peoplemanagement’, interpersonal and communication skills,as well as decision making, often while under muchpressure and stress. Postgraduate and Higher Diplomasin management should be sought out by those wishingto move formally into nursing or midwiferymanagement. Additionally, those interested in movinginto leadership or management should complete theLeadership training course ‘LEO’ which is currently a 3day programme.

Moving into nursing or midwifery academiaMany people get great satisfaction from teaching andsupporting learners. As a preceptor you may find thatthis is an area you would like to develop further. Mostroles within academia now require doctoralqualifications however, there are often studentships thatoffer sponsorship while you complete your studies, andprovide experience in lecturing. Research goes hand-in-hand with education in nursing and midwifery. You mayalready have a subject that you would like to researchfurther. If you find you are drawn to ensuring qualityevidence based practice, then you might find you wouldlike to work in Practice Development, where you wouldwork with colleagues in developing and ensuringevidence based practices and policies.


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Starting your nursing ormidwifery career

Improving your employability

Ms Linda Ryan, Trinity College Dublin

IntroductionThere is much debate surrounding the wordemployability. It is suggested that some professionalsuse it interchangeably with; getting a job, or with theconcept of enterprise or entrepreneurship (Pool &Sewell, 2007). In this article the term is used to refer to“the readiness for work in an area you want to work in”.

Readiness definedReadiness is defined as being fully prepared and fullywilling in this case, to work as a nurse or midwife.Apart from the technical aspects of nursing andmidwifery, employability means that a graduate candemonstrate attributes and competencies such ascommunication skills, collaboration skills, ability towork under pressure, and deal with unpredictability. Agraduate needs to be able to communicate that they areethically aware and have integrity as core values. Asgraduates progress through their career, it will beimportant that they not only apply the knowledge theyacquired during the course of their studies but alsodemonstrate self- determination by mastering tasks andincreasing the depth and breadth of their knowledge.Essential to working within healthcare is the concept ofreflection. Therefore, as a newly qualified healthprofessional you are required to reflect on yourperformance: ponder on successful as well asunsuccessful initiatives / situations and learning fromboth.

Global professionsNursing and midwifery are global professions and thosewho work in Ireland do so under strict guidelines andpolicies in order to ensure public safety for those theycare for. Irrespective of where you chose to work youmust be guided by local regulations and work alwayswithin your scope of practice. Being work ready meansthat you can answer questions about employability andare competent to inform and advise others on what isexpected. Professional responsibility is crucial toworking as a nurse or midwife so demonstratingemployability and being able to articulate that you havethe required skills and qualities to potential employersis vital to securing a job.

endorsing your employabilityTo ratify your employability you must be able to vocaliseand demonstrate to potential employers that you meetthe required attributes and competencies referred toabove. Healthcare graduates can do this by drawing onall areas of life, their academic courses andachievements, their co and extra-curricular activitiessuch as committee membership of a club or society.They can also demonstrate this through informal andunrelated voluntary work experiences that they mayhave. It is important also that graduates familiarisethemselves with the hospital or healthcare facility theywish to work in prior to interview. Those who findsuitable employment tend to be individuals who arewell prepared for interview and respond positively tofeedback. They are clear about what they have to offerand are clearly able to articulate this to any potentialemployer.

ConclusionBefore concluding, your attention is drawn to some keyskills and qualities employers consider important fordeveloping clinical nursing and midwifery practice. Theliterature documents several skills and qualities but theitems below have been selected for your information.

Key skills, knowledge and responsibilitiesrequired by employers

leadership: is central to nursing and midwiferyprofessions and is everyone’s business. Therefore, beingknowledgeable about leadership is important whenseeking any job in healthcare.

Change: all nurses and midwives must recognise theimportance of change in nursing and midwifery practiceand be able and willing to facilitate it.


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education: acknowledge the relevance of life-longlearning in nursing and midwifery, cultivate andencourage informal learning, and promote continuingprofessional development in clinical practice.

Research-based knowledge: understand theimportance of research in nursing and midwifery and bewilling to avail of opportunities that facilitate this inclinical practice.

Motivation: being motivated is important in clinicalpractice – be aware of the ways in which you cancontribute to creating a motivating work environmente.g. showing energy, enthusiasm, determination, havinga positive outlook and so on.

Communication: is an essential skill for all aspects ofnursing and midwifery practice. Do your best to utiliseknowledge gained during your degree course andremember always to communicate with clarity, honestyand kindness.

ethical considerations: act ethically at all times andmake compassionate care a core value in clinicalpractice.

Critical thinking and decision making: are corerequirements in clinical practice. These skills shouldbecome easier as you gain experience but always seekadvice when in doubt.

diverse work environments: being able to work indiverse environments and treating everyone equally andwith dignity and respect (patients and staff) are centralto contemporary healthcare.

Dr Elizabeth A. Curtis, Trinity College Dublin

ReferencesPool L.D. & Sewell P. (2007) The key to employability:developing a practical model of graduate employability.Education and Training 49(4): 277-289.


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Starting your nursing or midwifery careerFitness to practice

Dr Phil Halligan, University College Dublin

IntroductionFitness to Practise (FtP) is a multifaceted concept and asa nurse intern or new graduate, you may experienceanxiety around it (Devereux et al. 2012). Fitness topractice is first and foremost about protection of thepublic (Lauder et al, 2008). Patient and public safety is atthe heart of all professional regulators and thereforetheir role is to ensure that nurses and midwives are fitfor practice at the point of entry and while registered asa nurse or midwife.

StandardsStandards of patient safety are core to all healthcareprofessionals. However, following a number of recenthealth inquires, concerns have been voiced that studentnurses are not ‘fit for practise’ due to a perceived lack ofclinical skills at the point of registration. Holland et al.(2010) suggest that registration is only the beginning of alifelong learning experience. But, what does being FtPmean to a nurse or midwife as they embark on a newcareer? FtP is not defined by the Irish regulators, TheNursing and Midwifery Council (NMBI) however theNursing and Midwifery Council (NMC) (2015) in the UKdefines FtP as nurses possessing “the skills, knowledge,good health and good character to do their job safelyand effectively”.

NMbIAn FtP committee within the NMBI deals with anyallegations about a nurse’s or midwife’s ‘fitness’ topractise which may be due to one or more of thefollowing:

� As a Registered Nurse or Midwife professional misconduct is taken very seriously because both professional groups are considered to have fallen short by omission or commission of the standards of conduct expected amongst nurses / midwives. If the registered nurse or midwife is alleged to have been involved to some degree of moral turpitude (for example, rape, forgery, robbery, and prostitution), fraud or dishonesty; then from a professional point of view it may constitute professional misconduct.

� Poor professional performance whereby a registered nurse or midwife fails to meet the standards of competence (this could be either knowledge or skills or the application of knowledge or skills) that can be reasonably expected from any Registered Nurse / Midwife carrying out similar work.

� If a Registered Nurse or Midwife has or acquires a physical and / or mental disability and this potentially impacts on their ability to practise safely; they are obliged to inform the NMBI. Although students and employees are well protected by legislation, if there is a risk to patient safety, then the Registered Nurse or Midwife must disclose to their employer who will provide additional support in the way of reasonable accommodations.

� Registered Nurses and midwives are expected to be of good character and to uphold the profession in good standing. This means that if they are involved in any criminal activity and obtain a conviction or caution (for example, addiction) they are expected toself-declare to the NMBI who will then make a decision as to how they will proceed.

� In certain circumstances, at the time of entry to the register, NMBI may attach certain conditions to a nurse or midwife registration for example, following a fitness to practise inquiry.

� Fraudulent or incorrect entry in the Register of NMBI (NMBI 2017).


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ConclusionTo conclude, FtP is not once off but a life long journey oflearning. It is really important that all Registered Nursesand Midwives remain aware of their personal andprofessional accountability and recognise anylimitations in their knowledge and experience andcontinue to seek advice from more experiencedprofessionals and keep up to date with emergingresearch evidence and skills.

ReferencesDevereux, J., Hosgood, P., Kirton, J., Jack, B.A., Jinks,A.M., (2012) Why do students fail to disclose healthproblems? Nursing Times. 108(1–2): 18–20.

Holland, K., Roxburgh, M., Johnson, M., Topping, K.,Watson, R., Lauder, W. and Porter, M., (2010) Fitness forpractice in nursing and midwifery education in Scotland,United Kingdom. Journal of Clinical education inScotland, United Kingdom. Journal of Clinical Nursing.19(3-4): 461-469.

Lauder, W., Roxburgh, M., Holland, K., Johnson, M.,Watson, R., Porter, M., Topping, K.J. and Behr, A., (2008)Nursing and Midwifery in Scotland: Being Fit forPractice. NHS Education for Scotland: Scotland.

Nursing, Midwifery Board of Ireland (2017) Fitness toPractise Department. [ONLINE] Available from https://www.nmbi.ie/What-We-Do/Who-we-are/Fitness-to-Practise-Department. (accessed 23rd March 2017).

Nursing, Midwifery Council (2015) What is fitness topractise? [ONLINE] Available from https://www.nmc.org.uk/concerns-nurses-midwives/what-we-do/what-is-fitness-to-practise/ (assessed 23rd Mar 2017)


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Code of professional conduct and ethics

Dr Phil Halligan, University College Dublin

IntroductionThe Nursing and Midwifery Board of Ireland (NMBI) is theregulator of the professions of nursing and midwifery inIreland. The primary purpose of the Board is to protectthe public, and ensure the integrity of nursing andmidwifery practice. All registered nurses and midwivesare expected to abide by the professional standards setout in The Code of Professional Conduct and Ethics forRegistered Nurses and Registered Midwives (NMBI 2014).The Code is based on five principles: Respect for thedignity of the person; Professional responsibility andaccountability; Quality of practice; Trust andconfidentiality; and Collaboration with others and eachprinciple is underpinned by a number of ethical valuesand standards of conduct and practice that registerednurses and midwives must uphold in order to beregistered to practice. This is an invaluable frameworkfor nurses and midwives and it is vital that youunderstand what is expected of you.

the CodeThe purpose of the Code is to guide nurses andmidwives in their day-to-day practice and help themunderstand their professional responsibilities in caringfor patients in a safe, ethical and effective way (NMBI2014). As a new registered nurse or midwife, you areagreeing to uphold these professional standards andthis commitment to professional standards isfundamental to being part of a profession (NMC 2015). A breach of the Code may constitute either professionalmisconduct or unprofessional conduct and this canprompt the NMBI to take action and in serious cases,

remove you from the register. It is worth noting that theCode is not just for nurses and midwives but others too,for example: service users, educators, other healthworkers; the community in general; and employers(NMBA 2008). Moreover, the Code can assist nurses andmidwives in many ways: to reflect on their practice,enhance patient safety, and assist personal andprofessional development.

The following points about the Code are important andrelevant to your practice and I suggest you considerthem carefully:� Nurses and midwives should refer to and read the

Code frequently. This can serve to reinforce your professionalism while using it as a guide to practice daily in a professional manner. Before students graduate, educators can use the Code to help students understand and reinforce what it means to be a registered professional and how keeping to the Code helps to achieve that.

� Every nurse and midwife can self-appraise their standards of care and make a judgement regarding the quality of the service they provide. Managers andeducators can also use it as a tool for staff appraisal and development. In addition, the Code often provides the basis for NMBI to assess the fitness to practise of nurses and midwives who are referred to them if concerns about their practice arise.

� The Code can be useful for every nurse and midwife who cares about good nursing and midwifery care and can be invaluable for reinforcing your professionalism. Although renewal of registration is currently not a requirement for NMBI, creating a portfolio based on the Code principles and standardscan assist you in purposeful reflection on how you meet these standards and therefore will provide robust evidence of your continued ability to practise safely and effectively. This will also give the Code significance in your professional life, and raise its status and importance for employers.

� The Code can be used by all staff to promote safe and effective practice at work. To do this it would be useful to have copies of the NMBI Code of Professional Conduct and Ethics booklet or poster available as reading materials for patients and service users, as this may assist them in understanding the roles of the nurse and midwife and contribute to greater transparency.


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ConclusionThe Code offers an excellent framework to guideconduct and professional practice in an ethical manner.However, it is unable to account for the varied andcomplex situations that may arise in practice (Sutcliffe2011). Therefore, it is incumbent upon every registerednurse and midwife to take responsibility for the carethey provide to people, society and each other in orderto remain safe competent practitioners (NMBA 2008).

ReferencesNursing and Midwifery Board of Australia (NMBA) (2008)Code of Professional Conduct for Nurses in Australia.Australian Nursing and Midwifery Council: Melbourne.[ONLINE] Available from http://www.nursingmidwiferyboard.gov.au (accessed 28th March2017).

Nursing and Midwifery Council (NMC) (2015) The CodeProfessional Standards of Practice and Behaviour forNurses and Midwives. NMC: London. [ONLINE] Availablefrom https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf(accessed 28th March 2017).

Nursing, Midwifery Board of Ireland (NMBI) (2014) TheCode of Professional Conduct and Ethics for RegisteredNurses and Registered Midwives. NMBI: Dublin. [ONLINE]Available from https://www.nmbi.ie/Standards-Guidance/Code#sthash.ma9VYBMK.dpuf (accessed 28thMarch 2017).

Sutcliffe H, (2011) Understanding the NMC Code ofConduct: a student perspective. Nursing Standard.25(52): 35-39.


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Starting your nursing ormidwifery career

Nursing and midwifery salaries and benefits

Ms Emma Duffy, Trinity College Dublin

IntroductionThe career opportunities available to newly qualifiednurses and midwifes in Ireland are vast and exciting.This range of careers offers graduates the chance towork in a general capacity as a staff nurse or midwife;public health nurse; clinical nurse or midwife and nurseeducator. Equally within these roles, discipline specificpositions are available.

employment opportunities and pay scalesAs a newly qualified nurse or midwife, you will no doubtbe eager to get started on your journey as a healthcareprofessional and take home your first salary, but it isimportant to be aware of the starting salary points andpotential salary expansion available. As you develop younaturally want your career and salary to develop with

you. There are a number of avenues you could take withregard to career growth, which can have a significantimpact on your salary. Details of these career paths willbe explored in the next article.

According to the Irish Nurses and Midwives Organisation(INMO), as of April 2017 following qualification, pre-registered nurses and midwives can expect to receive astarting salary of €24,361. Once registration has beenachieved you can expect your starting annual salary toincrease to approximately €28,483. Although slightlyvarying across the disciplines, salaries for nursing and midwifery roles increase annually through incrementscales. The lifespan of these increments can differdepending on the role and point in your career. Detailsof expected increment scales can be found on the IrishNurses and Midwives Organisation (INMO) webpage.

distinction between public and privatesectorsSeveral benefits are available to nurses and midwifes inboth the public and private sectors. Ranging fromallowances to flexible working hours to greaterindividual patient care time, every effort is made by bothsectors to provide the best possible benefits to its nursesand midwives. See Table 1

ConclusionAs you embark on your nursing or midwifery careers youwill have a number of opportunities to avail of. Themost obvious of these will be choosing a role in eitherthe public or private sector. Both offer different benefitsand paths for career progression, including salaryincrements; annual leave; flexibility and allowances. It isimportant to keep these in mind as you navigatethrough your career as a health professional.

table 1: benefits public and private Sectors

public sector private sector

� Allowances � Leave entitlements� Continuing professional developments � Greater individual patient time� Educational sponsorship � Flexible working time� Leave entitlements � Joining bonus� Competitive salary with additional pay for shift and differentials � Relocation bonus� Public service pension� Travel pass schemes


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bibliography

Health Service Executive. 2016. Payscales. [ONLINE]Available at: http://www.hse.ie/eng/staff/BenefitsServices/pay/. (accessed 9th March 2017).

Health Service Executive. 2013. Salary Scales for StudentNurse and Post Qualification/Pre-Registration Nurses.[ONLINE] Available at http://www.hse.ie/eng/staff/Resources/HR_Circulars/circular0242013.pdf. (accessed9th March 2017).

Health Service Executive. Nursing in Ireland. [ONLINE]Available at http://www.nursinginireland.ie/working-in-ireland/. (accessed 9th March 2017).

Irish Nurses and Midwives Organisation. Private SectorEmployees. [ONLINE] Available at https://www.inmo.ie/private_sector_employees. (accessed 21th June 2017).

Irish Nurses and Midwives Organisation. SalaryInformation, [ONLINE] Available at https://www.inmo.ie/Salary_Information. (accessed 21th June 2017).

Nurse Jobs Ireland. 2016. Advantages andDisadvantages of Nursing in Ireland. [ONLINE] Availableat https://www.nursejobsireland.com/blog/2016/05/advantages-and-disadvantages-of-nursing-in-ireland.(accessed 9th March 2017).

Mater Private. 2017. Nursing Career Opportunities.[ONLINE] Available at http://www.materprivate.ie/careers/current-vacancies/nursing-career-opportunit/index.xml?utm_source=Indeed&utm_medium=organic&utm_campaign=Indeed. (accessed8th March 2017).


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Theory, research and practice

Advancing your career through further education

Mr Frank O’Rourke, Trinity College Dublin

IntroductionContinuing education is critical to the careers of nursesand midwives. It is a requirement by theNursing and Midwifery Board of Ireland that nurses andmidwives continuously develop their knowledge andskills. Whether you are looking to change roles or applyfor promotion, the importance of having the rightqualifications cannot be stressed enough. Nursing is anever changing profession and engagement in lifelonglearning will open doors as you progress through yourcareer. In most instances advanced roles in specialistpractice, research, education and management will onlybe attainable through getting the right qualifications, sofurther education cannot be overlooked.

types of educational CoursesDepending on what you want to achieve there are manyoptions for educational courses. Courses will vary induration, difficulty and recognition, so choosing theright course for you can be as important as successfullypassing the course itself. It goes without saying thatrecognition of the course is of paramount importance.There is no point in investing time and money in acourse which is not accredited by a recognisedinstitution or professional body if you need it to helpyou in your career progression. Some types of coursesare described below.

Continuing professional education (Cpd)This is usually a short course which is focused on aspecific topic or skill. There are many providers for thistype of course and a good source of information onapproved courses is available from the Nursing andMidwifery Board of Ireland.

online coursesCan be a good way of balancing education with workand life. Universities and Institutes of Technologyrecognise the difficulties that nursing students have inmixing education and work and are offering more onlinecourses, some of which may be completely online andothers may have an online component. A blendededucation course is an option for those who like theflexibility of online learning but can also benefit fromthe classroom and social interaction aspect ofeducation. Most postgraduate courses now have at leastsome element of online education.

post-registration coursesThese courses can offer opportunities to nurses andmidwives who wish to advance their career in a differentdirection; it is important that you check that the courseyou are applying for has NMBI approval. Examples ofpost- registration programmes available in Irelandinclude Children’s Nursing, Midwifery, Nurse/MidwifeTutor, etc. A full list of registration programmes isavailable from the Nursing and Midwifery Board ofIreland.

postgraduate coursesThere is a wide variety of postgraduate courses offeredacross Higher Education Institutions in Ireland sochoosing the right course for you can be tricky. It maytake time to choose the right course and indeed theright College, but there are some useful sources ofinformation to guide you for career advancement. Sincethe introduction of a degree level entry into nursing andmidwifery in 2002 further education has become moreimportant in the profession. To be eligible to apply formany posts such as Advanced Nurse Practitioner anappropriate M.Sc. is a prerequisite.


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Sources of informationThe Nursing and Midwifery Board of Ireland websitecontains a vast array of information on courses. This is auseful resource for checking if a course is validated bythem and for giving you advice on a range of othertopics in your professional career

Higher Education Institution websites offer a wide rangeof courses and often provide other relevant advice andinformation useful to you in your career. Of course, thewebsite is only the front door to the HEI, speaking withthe relevant course contact will provide you with muchmore detail about the course and help in making theright decision for you. It is important when choosing theright HEI that it is well recognised. Particularly if you areplanning to use your qualification abroad in future aglobally recognised university can open many doors.

Colleagues, managers and mentors are an invaluablesource of information in choosing the right course.Advice from colleagues who have attended a course cangive you an insight into a course which you cannot getfrom a website. Speaking with a colleague or mentor inan area or post you aspire to will also help in choosingthe right course.

Funding and getting time off for attending classes is alsosomething you should consider. Some courses,particularly in areas of national skills shortages, canreceive 100% funding from the HSE or your employer. Itis advisable to speak with your line manager and/orHuman Resources to explore what supports might beavailable to you.

ConclusionThere are many options for further education, butpicking the right course or courses is key to helping youadvance your career. Speaking to others, particularlythose in positions you aspire to will help in makingbetter decisions about your further education pathwayand ultimately your career.


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Applying for promotion in clinical practice

Dr Rhona O’Connell, University College Cork

IntroductionOnce you are confident in your role as a staff nurse ormidwife, look around and consider where your futuremay lie. Where will you be working in five years’ time,what about ten, will you be looking for opportunities toprogress in your chosen career and what about applyingfor promotional posts? There are many opportunities innursing and midwifery to take on the challenges ofworking at a more senior level in a dynamic healthcareenvironment with its constant changing needs anddemands. This requires newly qualified nurses andmidwives to be prepared to take on future roles inspecialist or advanced practice, management, educationor research.

Newly qualifiedFor newly qualified nurses and midwives, rather thanbecoming specialised too early, it is useful to obtain abroad range of diverse experiences. Try out differentareas of practice and if you have the opportunity to workabroad this will be useful as you will learn to adapt todifferent practice settings and increase your knowledgeand skills. While you may not have a plan foradvancement at the start of your career, at some stageyou may consider the opportunities for careerprogression and become aware of roles that interestyou. The main areas to consider are practice roles,including specialist or advanced practice, managementroles at ward, unit or hospital level, and education orresearch roles in the health service or academic settings.All require a diverse range of knowledge, skills andcompetencies which you will gain from practice over thenext few years. Do bear in mind however, that additionalcontinuing professional development may be required.

Consult othersOnce you become interested in career advancement,talk to others in senior roles, ascertain if furthereducation is required to secure career progression? It isalways a good idea to avail of the educationalopportunities that come your way, not just themandatory training required by your employer but look for study days, conferences and courses thatinterest you. Attendance at Continuing ProfessionalDevelopment (CPD) programmes will improve your CVand potentially increase your competencies and skills.You may become interested in a particular postgraduateeducation programme or consider undertaking an MSc;this is increasingly important when applying forpromotional posts.

Clinical practiceIn practice settings, take opportunities that come yourway, you may unexpectedly find that you are in aleadership role when responding to a clinical situationor working with more junior members of staff, don’tback away from challenges such as ‘acting up’ forsomeone. Use the support of your colleagues andalways ask for help or advice when you are out of yourdepth. While Benner (2001) once highlighted that youcannot know what you have never experienced, beprepared to learn quickly from the good days not justthe bad ones. Even when you have a difficult day, thisadds to your skills and expertise and is amazingly usefulwhen you are preparing for interviews when you startapplying for promotional posts. Let your line managerknow if you are interested in progressing in your career,sometimes a manager can put opportunities your way.In particular, there are often acting or temporary postsbefore a post is finalised or you may be asked to ‘act up’for a shift or over a weekend. Use these opportunities tobroaden your practice experience.

promotionIf applying for a promotional post, recruitment may belocal or national. For local recruitment employers mayrequire that you submit a personal CV. The HSE oftenrecruit nationally through the National RecruitmentService (NRS). Posts will be advertised on the HSE website. There is a strict closing date so give yourself time toprepare your application and ensure all relevantdocumentation is submitted in time.


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Your application can create a good impression as it canbe seen to reflect your communication skills and abilityto complete documentation accurately. The HSE uses acompetency based assessment approach for selectionand appointment of candidates. Be familiar with the jobthat you are applying for: ask advice so that you areaware of the competencies required for the promotionalrole. Showcase situations that demonstrate (a) yourinitiative or leadership ability, (b) situations where youhave acted as advocate for a patient and which made adifference to care, (c) where you performed well indifficult clinical situations, and (d) organised ordelegated work to others in challenging circumstances.Try to select examples from practice where you havedemonstrated competency beyond the routine aspectsof practice.

InterviewIf called for interview, be sure you present yourself well,with a confidence that you have the skills andexperience required to apply for the post. Bring alongyour application form; the interviewers will use thedocumentation you sent in to decide what questions toask. Expect that the interviewers will enquire aboutyour competencies so be prepared to provide additionalinformation about the examples provided. If theinterview is for a staff nurse or staff midwife post, theinterviewers will expect you to perform well at that level.If you are applying for a promotional grade consideryour transferable skills, can you demonstrateorganisational and management skills, problem solving,critical thinking, leadership ability appropriate for thejob? You will need to demonstrate that you are the best candidate to take this post.

ConclusionWith proper preparation and effective interviewpractice, you can demonstrate that you have the skillsrequired to take on the new role, beat the competitionand be offered the new job and new salary. This is anexciting time within the health services and there will bemany career opportunities available to you. Avail ofopportunities for progression that come your way andbe open to the challenges and satisfaction of nursingand midwifery which can provide a long and fulfillingcareer.

ReferenceBenner P (2001) From Novice to Expert: Excellence andPower in Clinical Nursing Practice Upper New Jersey:Prentice Hall


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Nursing technologies and trends

Dr Fintan Sheerin, Trinity College Dublin

IntroductionTechnological developments have taken place in allareas of our personal lives, with smartphones andtablets becoming commonplace. One of the key featuresof such devices is their interactivity and their ability tocommunicate with other smart technology. The arrivalof new devices is no longer met with wonder or disbeliefand has become a regular part of the modernexperience. Such is also true of healthcare practice and,in nursing and midwifery, we may consider these fromthe perspectives of nursing / midwifery care, patientsupport and remote monitoring.

Nursing/midwifery careWhen nurses or midwives of my vintage look back on theequipment which was used to provide nursing care inour youth, it sounds terribly antiquated. Mercury- basedthermometers and sphygmomanometers, drip- standswith no pumps, no pulse-oximetry and beds that had tobe pumped up manually! All of these have beenreplaced by new and accurate devices which have madethe work of the nurse or midwife much easier. Thewritten nursing / midwifery charts are also beinggradually replaced by computer-based documentationsystems which allow nurses and midwives to generatecare plans that are grounded in an evidence-based bodyof knowledge, embedded in the computer programme.Thus, nurses and midwives can now demonstrate clearaccountability in their documentation and develop anincreasingly large repository of information which caninform education, research and practice.

patient supportThere are many examples of how remote patientsupport devices can be employed in healthcare,including patients engaging in self-assessment or inhealth promotional / educational endeavours. Theassessment may also be undertaken by the clinic from adistance through health monitoring technologies. Theseapproaches may support patients to make their owndecisions regarding health management. They may alsoallow people to move beyond their limited abilities andmaintain as much independence as possible in thehome. There is the potential for therapies, such ascognitive behaviour therapy, to be provided distally.Information is vital to independence and to informeddecision making. The provision of accessible healthinformation through accessible media may help toensure that patients can take control of their ownhealth.

Remote monitoringeHealth also increases the potential for people to remainat home using devices to compensate for impairedfunction and for health monitoring and education. Thismay be particularly pertinent in respect of older peopleas well as those with disabilities. The movement of the’patient’ or ’service user’ away from the human interfacewith the clinician poses a challenge to healthcareproviders, but particularly to nurses and midwives whohave traditionally valued the role of interpersonalcontact and face-to-face communication in thedevelopment of trust which is central to the delivery ofquality nursing. This can be overcome throughtelemonitoring and remote electronic monitoring.Such approaches may be supported by a nurse, in asimilar way to that in which nurses provide advice andsupport to individuals in health insurance companiesand health promoting charities. Thus, the nurse can becentral to interacting with people as they live at home,offering advice or information and ensuring that there isa human link to other services that might be required(telenursing).


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Keeping up to dateNursing has traditionally associated itself with particularvalues and ideals. One of the most commonly-cited isthat of person-centeredness. The use of individually-determined remote patient support devices is in keepingwith that ideal as it recognises the individuality anduniqueness of the person and, furthermore, promotesanother important concept, self-care. In doing so, itagain allows individuals to take control of their health.There are, however, risks and challenges associated withremote eHealth devices. From a professionalperspective it is likely that a development withincreased use of eHealth applications in home basedcare will change professional roles and the way care isorganized.

ConclusionThere are many indications that home based care willincrease in importance in the future and it is importantfor nurses / midwives in general, including thecommunity nurses, to have an active role in thisdevelopment.


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Integrating theory into nursing andmidwifery practice

Dr Colin Griffiths, Trinity College Dublin

IntroductionAs a newly qualified nurse or midwife you will beconcerned about how to use your understanding ofwhat and how to care for patients and service users. Inother words, how do you apply or integrate the theoryyou have been taught as a student into clinical practice?This will involve bringing your clinical skills andtheoretical nursing and midwifery knowledge as well asyour inter-personal skills and managerial skills to bearupon what you do in practice.

Integrating theory into practiceThere are two ways to integrate: (a) in most situationsyou should approach this in a reflexive manner whereyour reflection seamlessly runs through your work, youdo not pause to reflect but engage in what you do in aconscious and reflexive manner. So ideally whenapproaching a patient or service user you shouldconsider what you know about the nursing action youare about to undertake [the theory] before itsapplication and adjust it when you are applying it inyour work with the patient/service user. You usereflexive thinking to do this; that is, always being awareof what you are doing, how you are doing it, and thepressures that are being brought to bear on you and thepatient / service user. Subsequently consider how youused what you knew [the theory] what you learned andhow you can integrate the new learning into yourpractice and your theoretical knowledge base. (b) Asecond approach involving the use of reflective modelscan be utilised to deal with more explicitly discrete [andoutstanding] nursing/midwifery events which may be

based on positive experiences or negative ones. This is amore formal approach and it uses a reflective model toanalyse events that take place in your daily nursing andmidwifery experiences.

Reflective modelsThere are quite a few reflective models such as GibbsReflective Cycle (Gibbs 1988) and Rolfe’s Framework forReflective Practice (Rolfe et al. 2001) to name just two.All reflective processes aim to get you to highlight whatyou wish to reflect upon [name it, describe it], exploreyour feelings about it [what was the experience like?],and then what you are going to do next [how what youhave learned will impact on your practice]. When you arecompleting the second approach you may examine whatothers did in the same situation by looking over thetheoretical literature and policy guidelines relating tothe experience, with a view to developing yourunderstanding of what happened in the context ofothers having gone through the same experience. Thisprocess integrates theoretical knowledge with thepersonal and professional knowledge that you gainthrough doing nursing and midwifery activities andhelps to develop a personal practice and knowledgebase that can be integrated into your way of working.

ConclusionEffectively utilizing these approaches in your workshould enable you to settle in to your life as a newlyqualified staff nurse or midwife, and you will find thatgradually the pieces of the jigsaw will fall into place andallow you grow and become comfortable in your work.

ReferencesGibbs G (1988) Learning by Doing: A Guide to Teachingand Learning Methods. Further Education Unit. OxfordPolytechnic: Oxford.

Rolfe, G., Freshwater, D., Jasper, M. (2001) CriticalReflection in Nursing and the Helping Professions: A User’sGuide. Palgrave Macmillan: Basingstoke.


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Applying for education and researchgrants: investing in you and addressingthe global shortage of doctoralprepared nurses and midwives

Professor Catherine Comiskey, Trinity College Dublin

IntroductionComiskey el al (2015) have highlighted the globalshortage of nursing and midwifery professionalseducated at baccalaureate level and beyond and theimpact of this shortage internationally. To address thenursing shortfalls within the United States, targets havebeen set to ensure that at least 10% of all baccalaureategraduates enter into a master’s or doctoral programwithin 5 years of graduation. More nurses and midwiveswith a PhD degree are needed to serve as AdvancedPractice Registered Nurses, assume faculty roles,embark on research careers, and pursue top leadershippositions.

International perspectiveThompson and Hyrkas (2014) also commented on thedemands on nursing leadership at a global level. In theireditorial they provide a summary of work from over 13contributions from more than 10 countries from Canadato Australia and New Zealand, from North and SouthAmerica to Europe, from Finland to Israel and beyond.They believe that nurse leadership needs to be activenot only in practice, but also in education, research andthe policy and political arenas. Given this globalshortage within the profession there is an urgent needfor graduate nurses to take on the mantle and plan forthe future of the profession by investing in themselves,their education and their career. The first step in thisinvestment is to find a practice-based or college mentorwhom you can emulate and learn from, and together orindependently apply for, and secure funding.

Securing fundingResponding to a call for applications for education andresearch grants. Quinn, Comiskey and Birkbeck (2017)provide details on a successful tender application andtheir ten guidelines detailed by Comiskey apply here.The first and foremost priority is to identify, clarify andconfirm the key or overarching aim of the funder. Oncethe key aim of the funder is decided upon, the applicantcan start writing. The funder may specify precisely whatinformation is required in an application, while theapplicant needs to know and be cognisant of the awardcriteria throughout the submission phase. This mayinclude some or all of the ten guidelines below:

ten Guidelines:

1. Introduction;2. Background rationale;3. Statement of the key aim and objectives;4. Study design and methodology;5. Data analysis and results;6. Timeline of outputs and deliverables;7. Project management and expertise;8. Costing;9. Ethics and good research practice;10. Added value.


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ConclusionThroughout the writing of the grant submission theresearcher should be reading and re-reading theapplication, continuing to research the background ofthe funding agent and ensuring that their submission iseasy to read, provides sufficient information on each ofthe awarding criteria and clearly meets the needs of thefunder. Do not be discouraged should your firstapplication for funding fail, no work is ever wasted andeach is a learning process. Places where funding mightbe secured are your alma mater, your place of work, theIrish Research Council, the Health Research Board,Activelink, eTenders, the Irish Cancer Society, TheWelcome Trust and a host of EU agencies. Take your firststep and start by speaking with your College mentorwho will be happy to advise you. Best of luck and do letus know if you are thinking of further education.

ReferencesComiskey, CM, Mathews, A., Williamson, C., Bruce, J;Mulaudzi, M & Klopper, H. (2015). Scaling up nurseeducation: An evaluation of a national PhD capacitydevelopment programme in South Africa, in the contextof the global shortage of nursing graduates, NurseEducation Today. 35: 647–652.

Thompson, P. & Hyrkas, K. (2014). Global NursingLeadership. Editorial. Journal of Nursing Management.22: 1–3.

Quinn, M., Comiskey, C., and Birkbeck, G. (2017)Commissioning, Procuring and Contracting Evaluationsand Research. In: S. Guerin and N. Hayes. (eds) Research,Evaluation, Policy and Practice (REPP) Project.Routledge, UK. Chapter 3.


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Leadership in nursing and midwifery

Leading the way in clinical practice:leadership is everyone’s responsibility

Dr Elizabeth A. Curtis, Trinity College Dublin

IntroductionOn encountering this article you may well ponder overits inclusion in this career guide. Well, the reason issimple: leadership is an important and necessaryrequirement for improving nursing and midwiferypractice and therefore relevant to you as you embark onyour career. Several authors (e.g.Curtis et al. 2011) haveemphasised this point and research has demonstratedpositive relationships between leadership and severalkey variables including patient care outcomes (Wong etal. 2013). Additionally, leadership is compulsory forinitiating change, transforming healthcare systems andretaining staff. Over the years, leadership has stimulatedmuch interest among people and this has resulted in ahuge amount of literature. For this reason, I havesingled out two key points to bring to your attention: (a)the distinction between leadership and managementand (b) draw attention to the call from key writers that adifferent approach to leadership is required inhealthcare.

distinction between leadership andmanagementAs would be expected with any large volume of literaturethere are several definitions of leadership but in spite ofthis the concept remains imprecise and problematic(Barr & Dowding 2012, Scully 2015). To compound thisproblem the term leadership is often usedinterchangeably with management especially in thenursing literature, and management is often affordedmore attention in clinical practice and pedagogy. The

corollary of this is that leadership can be construed asthe responsibility of those in management or seniorpositions. This of course is most definitely inaccurate asemphasised by authors such as Bennis & Nanus (2003),and Grossman & Valiga (2012). In fact it has beensuggested that leadership should bedislocated/separated from management, a view that Isupport wholeheartedly. This however, should not beconstrued negatively as the intention is to promoteclarity and improved symbiosis between the twoconcepts.

Need for a different approach to leadershipin contemporary healthcareSeveral leadership approaches/theories exist includingGreat Man Theory (personal characteristics or traits),Situational Theory (takes into account the situation),and leadership that accounts for organisational culture(transformational / transactional Theory).Transformational leadership has received muchattention in the leadership literature, and one of its keyprinciples is that employees sacrifice their own personalinterests for the sake of the organisation’s interest/vision (McCleskey 2014). Merits of the theory have beenreported in the literature but there have been severalcriticisms too (Yukl 2011, 2015, Northouse 2007, 2013).Chief among the criticisms is that transformationalleadership is seen as elitist given that it emphasises aleader centric view of leadership. Furthermore, theoriesof leadership have traditionally focused on individuals incharge of organisations/groups, frequently referring tothem as inspiring and motivating. Thankfully,developments in theory are taking a more pluralisticstance of leadership and are recognising that it shouldnot be confined to persons with power or those in asenior position. Recent media reports about failures inhealthcare have resulted in much anger both in Irelandand England and several reports have called forimproved leadership in nursing, midwifery andhealthcare generally. In a document about healthcareleadership Ahmed et al. (2015: 20) called for a new kindof leadership if healthcare is to be more integrated andfocused on patients. To achieve this “requires a shiftaway from heroic individual leaders to a model of ….distributed leadership across organisations andsystems”. Distributed leadership has the ability to moveaway from the attributes and behaviours of ‘theindividual’ as leader to a perspective that embraces acollective process where many individuals have theopportunity to participate in leadership. Such aviewpoint has been supported by authors such as(Chreim & MacNaughton 2016 and Benson & Blackman2011).


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you as leaderAs a student or newly qualified health professional youcan engage in leadership in several ways including;planning and leading care for a group of patients/clients, educating patients/clients and their families,participating in healthcare discussions and decision-making, appraising appropriate research evidence andusing this to guide patient/client care, and helping todevelop a work climate that nurtures participation andinclusiveness.

ConclusionAt present, the nursing profession is facing a number ofvery real challenges. Scott (2011) for example points outthat nurses are required to lead innovative care, to workas equal members of multidisciplinary care teams toredesign care that is effective, and to participate inboard and committee meetings at senior level. A finalchallenge that has also been articulated in the literatureis the lack of emphasis on developing nursing leadership(Scully, 2015). Therefore, it is essential that as a finalyear student or newly qualified nurse or midwife thatyou place leadership and its development high on youragenda now and in the coming years so that the nursingand midwifery professions can tackle the manychallenges they face.

ReferencesAhmed N., Ahmed F., Anis H., Carr P., Gauher S. &Rahman F. (2015) An NHS Leadership Team for the Future.[ONLINE] Available at http://www.reform.uk/ wp-content/uploads/2015/11/NHS-Leadership-team- A5-report_WEB.pdf. (accessed 30th January 2017).

Barr J and Dowdling L. (2012) Leadership in Healthcare2nd Edn. SAGE Publications: London.

Benson A.M. & Blackman D. (2011) To Distributeleadership or Not? A Lesson from the Islands. TourismManagement 32(5): 1141-1149.

Bennis W. & Nanus B. (2003) Leaders: Strategies forTaking Charge. 2nd edn. Harper & Row: New York.

Chreim S. & MacNaughton K. (2016) DistributedLeadership in Health Care Teams: Constellation RoleDistribution and Leadership Practices. Health CareManagement Review. 41(3): 200-212.

Curtis E., de Vries J. & Sheerin F. (2011) Developingleadership in nursing: exploring core factors. BritishJournal of Nursing,

Grossman S. & Valiga T. (2012) The New LeadershipChallenge – Creating the Future of Nursing. 4th edn. F.D.Davis Company: Philadelphia.

McCleskey J. (2014) Situational, Transformational, andTransactional Leadership and Leadership Development.Journal of Business Studies Quarterly. 5(4): 117-130.

Northouse P.G. (2007) Leadership: Theory and Practice.4th edn. Sage Publications: California.

Northouse P.G. (2013) Leadership: Theory and Practice.6th edn. Sage Publications: London.

Scott E.S. (2011) Educational Preparation to StrengthenNursing Leadership North Carolina Medical Journal.72(4): 296-299.

Scully N.J. (2015) Leadership in Nursing: The Importanceof Recognising Inherent Values and Attributes to Securea Positive Future for the Profession. The AustralianJournal of Nursing Practice, Scholarship and Research.22(4): 439-444.

Wong C.A., Cummings G.G. & Ducharme L. (2013) TheRelationship Between Nursing Leadership and PatientOutcomes: A Systematic Review Update. Journal ofNursing Management 21: 709-724.

Yukl G. (2013) Leadership in Organisations. 8th edn.Pearson: Harlow.

Yukl G. (2011) Contingency Theories of EffectiveLeadership. In A. Bryman, D. Collinson, K. Grint, B.Jackson & M. Uhl-Bien (Eds.) The Sage Handbook ofLeadership. Sage: Thousand Oaks, CA. pp 286-298


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Doing advocacy

Dr Fintan Sheerin, Trinity College DublinDr Elizabeth A. Curtis, Trinity College Dublin

IntroductionAdvocacy is a very important aspect of everybody’s life,and is about individuals or groups speaking up forthemselves, in order to influence others to make achange which will positively affect their lives. Mostpeople can advocate for themselves, but if a person isconsidered to have a cognitive or intellectualimpairment, this might be more difficult, either due tothe impairment itself or because of other people’sactions. Professionals working in intellectual disabilitypractice can play a very significant role in ensuring thatthe people have the main voice in their own lives. Theymust, however, be aware that their role may not be thatof advocate but as a supporter: ‘… who is independent ofsocial services and the NHS, and who isn’t part of yourfamily or one of your friends.’ (NHS 2016).

types of advocacyThere are two main types of advocacy, self-advocacyand representative advocacy. Self-advocacy refers to asituation whereby people can speak for themselves.It also means that they are aware of their rights andresponsibilities and are free from any coercion(Disability Rights UK 2012). Sometimes people may notbe able to do this, themselves, and may require othersto represent them. In these situations, peers and familymay assist but it is often better to have an independentperson or a representative from a legal or statutory bodyto act on their behalf, again free from any form ofcoercion, so that they can present the voice on theperson (BILD 2017; EHRC 2010).

facilitators and barriers to advocacyfacilitators of advocacy� The relationship between the provider and recipient

of service� Forming a good relationship� Listening to people and encouraging them

to express their viewpoints� Service leadership

� Listening to the voice of service recipients� Person-centeredness� Openness to independent advocacy models

� Due attention to people’s social needs and health status� Undertaking a comprehensive assessment� Making referrals as required – e.g. social

worker or independent advocate.� Professional Responsibility

� Being guided by professional standards on ethics, respect for rights and well-being

� Knowledge and skills� Clinical and theoretical knowledge is important� Continuing professional education

(Negarandeh et al. 2006)

barriers to advocacy� Conflict of interest

� Employee’s responsibility to the person and duty to the organisation where employed

� Powerlessness� Working as a team member - when a shortcoming

has been identified you do not report it� Lack of support for nurses

� Feeling that there is no support from managers for the advocacy role

� Medical team leading� Staff may feel unable to comment if a doctor is

wrong� Time constraints

� Staff amending work schedules to complete tasks in time e.g. cutting short a conversation with a person to complete another task

� Limited communication� Little time to listen to people if the unit is very busy

� Uncertainty – risk of advocate’s role� Who supports you as a staff advocate?� What if the staff member is sacked as a

consequence of taking on an advocate role?� Loyalty to peer group – work together and cannot

offend others in the team� Lack of motivation

� Because of all these potential barriers nurses may feel less motivated to take on the role of patient/client advocate. (Negarandeh et al. 2006)


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Advocacy and leadershipThe importance and relevance of leadership inpromoting nursing and health care (Francis 2013),evidence-based practice (Kvist et al. 2014) and betterpatient and client care outcomes (Ahmed et al. 2015) iswell documented. Less discussed or reported in theliterature however, is the significance of leadership inpatient/client advocacy (Antill 2015). The meaning ofadvocacy has already been outlined, but it is worthreminding the reader that it is an integral part of mostnursing codes of conduct and professional documents(e.g. The Nursing and Midwifery Council 2015, Nursingand Midwifery Board of Ireland 2014) and a pre-requisitein nursing practice. In spite of this, advocacy remainsvague and nebulous within the profession; but morealarming is that its symbiotic relationship withleadership is often overlooked. The core principlesrequired for leadership are the very ones required foradvocacy. These include adopting an adversarial role,upholding the rights of patients, listening andcommunicating clearly, trust and equality, dignity andrespect, a strong emphasis on participation,encouraging and inspiring others, and providing asupportive, enabling, and healthy work environment(Antill 2015).

putting advocacy into practice/ supportingadvocacySo, how can we apply advocacy in practice? We proposethat this be done by developing a professional standardon advocacy that utilises key elements of leadership. Aprofessional standard is a document that is created by aprofessional group outlining the accepted actions ornorms about a specific element of care. Professionalstandards can be used as a benchmark for attaining safepractice. Below are some key headings that could beused to develop a professional standard on advocacy inyour area of practice.

An example:Standard: advocacy practice in intellectual disabilitynursingIn providing clinical care and services to patients, clientsand staff, leadership principles and practices as well asnational and international policies must be used toguide decision making procedures when supportingadvocacy in clinical practice.

RationaleHealth and social care professionals face many complexproblems or situations during the course of their dailywork. As such they must consult widely, and

demonstrate leadership that supports participation byall stakeholders, when making decisions on advocacyissues for persons with an intellectual disability.

Key Considerations for writing a professionalstandard on advocacy� Assess the situation thoroughly and engage as many

stakeholders as required. This can include the person, relative, health and social care professionals,independent advocates.

� Apply principles of leadership e.g. trust, clear communication, dignity and respect and so on.

� Keep accurate and clear documentation – document issues such as self-determination, rights of person, staff member, policies used to underpin procedures, and actions, document outcome.

� All activities and decisions taken must be within ethical and legal regulations used by the profession as well as employers.

� Ensure that all key individuals and staff are fully informed and that they participate in the discussionsand decision-making processes.

� Education and training needs about advocacy and leadership must be identified and provided for staff at all levels.

Some practical tips and useful resources:� Consider the definition of advocacy you will use to

guide your actions when advocating for self or others� Consider when to advocate and use all available

resources to assist you (is there a tool kit on advocacy in your place of work)

� Consider using a structured approach when advocating on behalf of someone

� Consider where possible, the use of case studies on advocacy

� Consider the situation holistically and involve key people from the beginning when trying to advocate on someone’s behalf.

Resources and further reading: usefulwebsites� Health and Patient Advocacy Resources

http:// healthadvocateresources.com/� BILD http://www.bild.org.uk/about-bild/advocacy/

advocacy-types/� Disability Rights UK http://www.disabilityrightsuk.

org/self-advocacy� MENCAP https://www.mencap.org.uk/advice-and-

support/services-you-can-count/advocacy


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� Advocacy services - Care and support - NHS Choices http://www.nhs.uk/Conditions/social-care-andsupport-guide/Pages/advocacy-services.aspx

� SEAP www.seap.org.uk� National Advocacy Service for People with

Disabilities (Ireland) http://www.citizensinformationboard.ie/en/services/advocacy/

� Nursing and Midwifery Board of Ireland https://www.nmbi.ie/Complaints/Who-Can-Help

References Ahmed, N., Ahmad, F., Anis, H., Carr, P., Gaugher, S. &Rahman, F. (2015) An NHS Leadership Team for theFuture. Reform, London.

Antill, C. (2015) Rocking the Boat: The Link BetweenTransformational Leadership and Advocacy. BritishJournal of Healthcare Assistants 9 (2) 93-99.

British Institute of Learning Disabilities (2017) Types ofAdvocacy. Online. Available:http://www.bild.org.uk/about-bild/advocacy/advocacy-types. Accessed 13th January 2017.

Disability Rights UK (2012) Self-Advocacy Fact Sheet F37.Online. Available:http://www.disabilityrightsuk.org/self-advocacy.Accessed 13th January 2017.

European and Human Rights Commission (2010)Advocacy in Social Care for Groups Protected UnderEquality Legislation. Manchester: EHRC.

Francis R. (2013) Report of the Mid Staffordshire NHSFoundation Trust Public Enquiry. London, TheStationery Office.

Kvist, T., Tahka, K., Ruotsalainen, M. & Tavo-Heikkinen, T.(2014) The Impact of Nursing Leadership Training onEvidence-Based Leadership and Practice. Journal ofNursing Care 3 (4).

National Health Service (2016) Advocacy Services. Careand Support. Online. Available:http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/advocacy-services.aspx. Accessed 16thJanuary 2017.

Negarandeh R., Oskouie F., Ahmadi F., Nikravesh M. &Hallberg I.R. (2006) Patient Advocacy: Barriers andFacilitators BMC Nursing 5 (3), available fromhttp://www.biomedcentral.com/1372-6955/5/3.

Nursing and Midwifery Council (2015) The Code:Professional Standards for Practice and Behaviour forNurses and Midwives. Online: Available:https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf. Accessed 16th January2017.

Nursing and Midwifery Board of Ireland (2014) Code ofProfessional Conduct and Ethics for Registered Nursesand Registered Midwives. Online: Available:http://www.nmbi.ie/Standards-Guidance/Code.Accessed 16th January 2016.


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Don’t underestimate the importance of informal learning in yourprofessional development

Dr Siobhan Corrigan, Trinity College DublinDr Elizabeth A. Curtis, Trinity College Dublin

IntroductionLearning is central to the success of individuals insociety (Van Noy et al. 2016) as well as organisations(Bjork et al. 2013). While formal learning is a well-researched topic the same is not so for informal learningespecially by nurses and midwives. Evidence however,suggests that most learning that takes place at work isinformal (Fahlman 2013) particularly in healthcare(Wihak & Hall 2011) where it is considered to be anintegral part of “holistic learning” especially in clinicalpractice (Kelly & Hager 2015:376). Work environmentsoffer an ideal setting for integrating work activities andformal learning from your degree course. In this articlewe highlight the significant role and value that informallearning processes will play as part of your professionaldevelopment in an ever-changing healthcare system.

distinction between formal learning andinformal learningFormal learning typically includes a specifiedcurriculum, taught by expert teachers/lecturers andinvolves ongoing assessment, certification andaccreditation. These are largely planned and prespecified activities which take place in colleges,universities, and schools, just like the BSc degree coursesome of you are currently completing. Informal learning

on the other hand can be indeterminate, opportunistic,and should be seen as an ongoing lifelong learningprocess. Coffield (2002: 1) sums up the importance ofinformal learning by stating that “if all learning were tobe represented by an iceberg then the section above thesurface of the water would be sufficient to cover formallearning, but the submerged two thirds would beneeded to convey the much greater importance ofinformal learning”.

Research evidence for the Value of Informal learningResearch in nursing (Bjork et al. 2013) has shown thatopportunities for informal learning occurred amongyounger nurses (a) when they were given moreresponsibility, (b) when guided by experienced staffduring the execution of complicated tasks/situationsand (c) by the way leaders’ organised work. Bjørk et al.(2013) carried out research investigating whatpossibilities nurses had for informal learning in theirwork-place. Their research found that there were severalopportunities for informal learning, for example pre-rounds with physicians, getting the medications ready,‘floating’ around in the staff room while talking to otherstaff to name but a few. Further support for informallearning has been reported by The Directorate forEducation, Education and Training Policy Division of theOECD (2010) in their document entitled “pointers forpolicy development” which states “…. learning thattakes place outside formal education institutions - canbe a rich source of human capital” and should be aprominent item on policy agendas (OECD 2010: 1).

ConclusionIn concluding, we wish to remind you of the critical roleyou will play in the smooth running of complex everchanging healthcare environments. Participating in andfacilitating informal learning will in our view, help toprepare you for the many challenges you will face in thatrole. Furthermore, nursing and midwifery are highlyregulated professions and you will need to takeresponsibility for maintaining your own knowledge baseand professional competence throughout your career.Learning does not stop after you complete your formaleducation, in many ways it is just beginning. Yourcurrent degree course will provide you with an excellentplatform for your career and much of continuingprofessional development will occur informally. As such,it must be recognised for its potential contribution inprofessional nursing and midwifery practice.


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ReferencesBjørk, I.T., Tøien, M., & Sørenson, A.C. (2013) ExploringInformal Learning among Hospital Nurses. Journal ofWorkplace Learning. 25(7): 426-440.

Coffield, F (2002) The Necessity of Informal Learning. ThePolicy Press.

Fahlman D. (2013) Examining Informal Learning UsingMobile Devices in the Healthcare Workplace. CanadianJournal of Learning and Technology. 39(4): 1-21

Kelly. M., & Hager, P. (2015) Informal Learning: Relevanceand Application to Health Care Simulation. ClinicalSimulation in Nursing. 1(8): 376-382.

OECD - Organisation for Economic Co-operation andDevelopment (2010) Recognition of Non- formal andInformal Learning Pointers for PolicyDevelopment. [ONLINE] Available at http://www.oecd.org/edu/skills-beyond-school/recognitionofnon-formalandinformallearning-home.htm (accessed on 8thJune 2016).

Van Noy M., James M. & Bedley C. (2016)Reconceptualising Learning: A Review of the Literature onInformal Learning. Rutgers Education and EmploymentResearch Centre, The State University of New Jersey.[ONLINE] Available at: http://actfdn.org/wp-content/uploads/2016/04/Informal-Learning-Lit-Review-Final-April-2016.pdf. (accessed on 9th June 2016).

Wihak C. & Hall G. (2011) Work-Related InformalLearning. Centre for Workplace Skills. [ONLINE]Available at http://www.workplaceskills.ca/ (accessedon 8th June 2016).


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Leadership in nursing andmidwifery Professional indemnity

Dr Edward Mathews, Irish Nurses andMidwives Organisation (INMO)

Dr Michele Glacken, St Angela’s College, a college of the National University ofIreland,Galway

IntroductionIt is very clear in the Code of Professional Conduct &Ethics for Registered Nurses and Midwives (NMBI,2014)that nurses and midwives are accountable both legallyand professionally for their practice, that is, for thedecisions they make and the consequences of thosedecisions. Nurses and Midwives are accountable to thepatient, the public, their regulatory body, their employerand any relevant supervisory authority.

Legal accountability involves you as a nurse or midwifebeing responsible for ensuring you have professionalindemnity insurance. This insurance allow patients/service users to be compensated if they have beenharmed in any way because of any professionalnegligence on your part. Many healthcare organisationsprovide professional indemnity for their nursing andmidwifery personnel.

how do I know if I am covered through myplace of employment?If you are working in the public health service, you arecovered under the State Clinical Indemnity Scheme(CIS). The scheme provides professional negligenceinsurance for all nurses and midwives. The public healthservice includes HSE facilities, and many voluntaryservice providers who provide service for the HSE in

alignment with Section 38 of the Health Act. It isimportant if you are working outside of the HSE that youcheck with your employer that they do participate in theState Clinical Indemnity Scheme, and thus you areprotected under the scheme. If they do not, you mustensure you have appropriate insurance arrangements inplace. It is also important to remember that even if yournormal place of nursing practice is in a public healthcarefacility and they are part of the CIS you should notassume that you are covered for any additional workyou may partake in, for example in a nursing home. Youneed to check whether you are covered by thisadditional employer.

To date, the NMBI do not require nurses and midwives toself-declare they have professional indemnity to eitherattain or maintain their registration. However, for thoseof you who may consider working in the UK in thefuture, you need to be aware that you are legallyrequired to declare that you have or your employer willhave the relevant indemnity insurance in order to attainand maintain your registration with the Nursing &Midwifery Council. This requirement to self-declare is aresult of the Health Care and Associated Professions(Indemnity Arrangements) Order which came into effectin 2014.

where can I obtain professional indemnityinsurance?The easiest way to ensure you have sufficient clinicalindemnity insurance is through joining a professionalorganisation such as the Irish Nurses & MidwivesOrganisation who provide a clinical indemnity schemeas an inherent part of membership. If you opt to obtainprofessional insurance outside a professionalorganisation you should ensure that you are coveredadequately for all of the activities you engage in.

Is professional indemnity insuranceenough?No, because it is more likely that nurses and midwivesare subject to a fitness to practise complaint than beingsued for negligently treating a patient/ service user. Youtherefore need to have an insurance policy in place toensure that you can be appropriately defended if youare the subject of a complaint to the Fitness to PracticeCommittee of NMBI. The defence in a basic case beforethe NMBI can cost up to €5000, and that cost canescalate very quickly if you are the subject of a fullhearing. The only way to effectively ensure that youhave the appropriate defence resources available to youis through joining a Professional Organisation such asthe INMO who offer a legal defence insurance policy.


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ConclusionNurses and midwives must take care to work within theirScope of Practice at all times as they are accountable fortheir actions. They must ensure that they haveprofessional indemnity insurance through theiremployer or through securing such insuranceindependently through a professional organisation orthrough an insurance broker. If they opt for the latterchoice they must ensure that they are adequatelycovered. They also need to consider legal defenceinsurance.

Please note the majority of the content was supplied onrequest by Edward Mathews, Director of Regulation &Social Policy, Irish Nurses and Midwives Organisation.

ReferencesNursing and Midwifery Board of Ireland. (2014). Code ofProfessional Conduct for Registered Nurses andRegistered Midwives (2014) Dublin: Nursing & MidwiferyBoard of Ireland.

Department of Health (2014) Health Care and AssociatedProfessions (Indemnity Arrangements) Order London:Department of Health.


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Working within your scope of practice

Ms Caroline Dalton, University College Cork

IntroductionAs a newly qualified nursing or midwifery graduate, youare proficient in understanding your role andresponsibilities in maintaining the standards of yourprofession: which includes, providing a safe clinicalenvironment and ensuring patient/client safety.However, nursing practice is continually evolving and atsome point in your career you may encounter a situationwhere you are unsure of your competence to perform aparticular skill, undertake certain responsibilities ordelegate to support staff (Casey et al. 2014).

Strategies to support your Scope of practiceWhen faced with evolving or new professionalsituations, nurses and midwives can use a number ofstrategies to assist in decisions relating to their scope ofpractice. As newly qualified health professionals, youwill begin to develop the skills of self-reliance andprofessional judgement used by nurses and midwives asyou make day to day decisions regarding your scope ofpractice. You may also turn to more experiencedcolleagues and managers for advice and support whenmaking such decisions. Nurses and midwives may alsouse clinical guidelines, care pathways andorganizational policies and supports (Fealy et al. 2015).In situations, where nurses are practicing in isolatedenvironments without the support of colleagues andwhere organizational policies and supports might not beavailable the nurse or midwife may avail of onlineresources, publications and the online Help Centreprovided by the Nursing and Midwifery Board of Ireland(NMBI) (Brady et al. 2015).

Scope of Nursing frameworkThe NMBI have identified five core principles to supportprofessional decision making which are identified in theCode of Professional Conduct and Ethics for RegisteredNurses and Registered Midwives (NMBI 2014):

principle 1: Respect for the dignity of the personprinciple 2: Professional Responsibility and

Accountabilityprinciple 3: Quality of Practiceprinciple 4: Trust and Confidentialityprinciple 5: Collaboration with others

These principles are embedded in the Scope of Nursingand Midwifery Practice Framework developed by theNMBI (2015) to support you as you make decisions aboutyour own scope of practice.

The framework emphasises that each nurse and midwifeis accountable for decisions made about their scope ofpractice. It further emphasises that protecting the rightsand needs of the patient/client and promoting andmaintaining quality care should be the main impetus ofscope of practice decisions. As a newly qualified nurse ormidwife you should familiarise yourself with thisframework. The framework includes a user friendlydecision making flowchart to support you when makingdecisions to perform a particular skill or undertakecertain responsibilities and can be accessed onlinehttps://www.nmbi.ie/Standards-Guidance/ Scope-of-Practice/Decision-Making-Flowchart .

ConclusionAs you settle into life as a newly qualified nurse ormidwife, you will find your scope of practice will growand expand, allowing you to provide quality, person-centred care. You can rely on your own professionaljudgement as it develops during your career, elicit theadvice of colleagues, or use policies and scope ofpractice frameworks. Irrespective of the strategies youuse, it is imperative that you recognise that you areresponsible for the decisions you make and as suchmust ensure the outcomes of your decisions result insafe and effective patient/client care.


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ReferencesBrady, AM., Fealy, G., Casey,M., Hegarty, J., Kennedy, C.,McNamara, M., O’Reilly, P., Prizeman, G & Rohde D (2015)Am I covered?’ An analysis of a national enquirydatabase on scope of practice. Journal of AdvancedNursing. 71(10): 2402-2412.

Casey, M., Fealy, G., Kennedy, C., Hegarty, J., Prizeman,G., McNamara, M., O’Reilly, P., Brady, AM & Rohde, D.(2014). Nurses’, midwives’ and key stakeholders’experiences and perceptions of a scope of nursing andmidwifery practice framework. Journal of AdvancedNursing. 71(6): 1227-1237.

Fealy, G., Casey, M., Rohde, D., Brady, AM., Hegarty, J.,Kennedy, C., McNamara, M., O’Reilly, P and GeraldinePrizeman (2015). Scope of practice decision making:findings from a national survey of Irish nurses andmidwives. Journal of Clinical Nursing. 24: 2871–2880.

Nursing and Midwifery Board of Ireland (2014) Code ofProfessional Conduct and Ethics for Registered Nursesand Registered Midwives. Dublin, Nursing and MidwiferyBoard of Ireland.

Nursing and Midwifery Board of Ireland (2015) Scope ofNursing and Midwifery Practice Framework. Dublin,Nursing and Midwifery Board of Ireland.


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Travelling and volunteering

Traveling as a nurse or midwife

Dr Fintan Sheerin, Trinity College Dublin

IntroductionDegrees in nursing and midwifery offer graduates anopportunity to move directly into the health serviceworkforce in Ireland. They also allow such graduates thepossibility of moving beyond these borders to work in awide variety of countries, where they can hone theirskills, explore different contexts for their practice andbroaden their views. The possibilities are many but, formost people, this involves either working orvolunteering.

working abroadIn order to work as a nurse or midwife outside Ireland,you must be registered to practice in the relevantcountry. You will be required to obtain a verificationcertificate from the NMBI(www.nmbi.ie/Registration/Working-Outside-Ireland).European directives have led to a situation wherebythere is harmonisation of basic nursing and midwiferytraining / education across the European Union,meaning that there should be straightforwardrecognition of Irish qualifications. It should be noted,though, that, in terms of nursing, this only applies togeneral nursing, and recognition is not as easilyachievable where the nursing division does not exist inthe state you are travelling to. Outside the EU, itbecomes more complicated and advice should besought before travelling to ensure that you will be ableto achieve compliance with specific requirements.

Volunteering abroadMany nurses and midwives opt to spend a period of timeworking, either on a voluntary basis or as part of a non-governmental organisation. A list of such organisations

is available via the Dochas website (www.dochas.ie).This is a rewarding but intensely challenging activity andyou may often find yourself working, with limitedsupport / supervision, few resources and in situationsfar removed from the clinical sites that you trained in!For that reason, it is often advisable to gain some post-registration experience to build up skills and confidencebefore going down this route.

Concluding thoughtsAnother way to engage with your profession abroad is toattend conferences in your area of interest and to makeyourself available to volunteer as a committee member.This was my initial foray into such waters and myengagement with a European organisation has becomea central feature of my career to date, spanning 20 years.Whatever you do, plan well in advance, get advice andenjoy yourself!

useful linksww.nmbi.ie/Registration/Working- Outside-Ireland

www.nursingmidwiferyboard.gov.au/

www.nursingworld.org/foreigneducatednurses


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Meet the production team

Dr Elizabeth A. Curtis Lead, MA (jo) PhD MEd Dip. Res Meth. Dip. Comm. Health and Health Prom. DMS, ENB148 RN ONCAssistant Professor, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Professor Catherine Comiskey BA (Mod) MA MSc PhD CMath FIMA.Professor in Healthcare Modelling, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Ms Emma Duffy BSc Administrative Officer, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Dr Colin Griffiths MSc MA (jo) PhD RNID RNTAssistant Professor, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Mr Frank O’Rourke BSc Dip. Geog. MSc MASchool Manager, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Dr Fintan Sheerin B.N.S. Cert. Nat.Sci. Pg. Cert. UT Pg.Dip.Ed. M.A. Ph.D. RNID RGN RNT MRSB FEANS FNILecturer in Intellectual Disability Nursing, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Ms Jeni Ryan BA (Hons), M.A. (jo) Administrative Officer – Events, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)


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Meet the contributors

Dr Elizabeth A. Curtis Lead, MA (jo), PhD, MEd, Dip. Res Meth., Dip. Comm. Health and Health Prom., DMS, ENB148, RN, ONCAssistant Professor, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Ms Michelle Cleary BSc MSc RNIDTeaching Fellow, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Professor Catherine Comiskey BA (Mod) MA MSc PhD CMath FIMA.Professor in Healthcare Modelling, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Dr Siobhan Corrigan BSc MSc PhDAssistant Professor in Organisational Psychology, School of Psychology, The University of Dublin, Trinity College Dublin (TCD)

Ms Caroline Dalton BNS MSc BNS RNIDProgramme Lead for Intellectual Disability Nursing and Lecturer, School of Nursing and Midwifery, University College Cork (UCC)

Ms Emma Duffy BSc Administrative Officer, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)


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Dr Angela Flynn Pg.Dip.Ed. M.Sc. Ph.D. RGN RNTDirector of Undergraduate Education, Lecturer, School of Nursing and Midwifery, University College Cork (UCC)

Mr Paul GallagherDirector of Nursing, St. James’s Hospital (SJH). Adjunct Associate Professor, School of Nursing & Midwifery, The University of Dublin, Trinity College Dublin (TCD). Fellow of the Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI)

Dr Michele Glacken B.Sc. Pg.Dip. Adv. Nurs. Ph.D. RGN RM ENB A09Head of Department of Nursing , St. Angela’s College,National University of Ireland Galway (NUIG)

Dr Colin Griffiths MSc MA (jo) PhD RNID RNTAssistant Professor, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Dr Phil Halligan Dip.H.A. M.Sc. Ph.D. RGN RM FFNMRCSILecturer, School of Nursing, Midwifery and Health Sciences, University College Dublin (UCD)

Professor Kate Irving B.Sc. (Hons) Nursing, Ph.D.Professor of Clinical Nursing, School of Nursing and Human Sciences, Dublin City University (DCU)


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Dr Edward Mathews B.L. L.L.B. L.L.M. T.H.D. RNIDDirector of Regulation & Social Policy, Irish Nurses’ & Midwives’ Organisation (INMO)

Dr Rhona O’Connell B.A. M.Ed. Ph.D. RGN RM RNTLecturer, School of Nursing and Midwifery, University College Cork (UCC)

Mr Frank O’Rourke BSc Dip. Geog. MSc MASchool Manager, School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin (TCD)

Ms Linda Ryan B.A. Couns. Psych M.A. Add, Adv.Dip. Cex Coaching, CIPD Dip. LADCareers Consultant, Careers Advisory Service, The University of Dublin, Trinity College Dublin (TCD)

Dr Fintan Sheerin B.N.S. Cert. Nat.Sci. Pg. Cert. UT Pg.Dip.Ed. M.A. Ph.D. RNID RGNRNT MRSB FEANS FNILecturer in Intellectual Disability Nursing, School of Nursing and Midwifery,The University of Dublin, Trinity College Dublin (TCD)


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Acknowledgements

Prof Anne-Marie Brady, Head of the School of Nursing and Midwifery, Trinity College DublinMs Lisa Fitzgerald, Executive Officer, School of Nursing and Midwifery, Trinity College Dublin

A special thanks to Prof Ruth Northway OBE, University of South Wales who undertook the role as External Reviewer.

Further education

the university of dublin, trinity College dublin (tCd) nursing-midwifery.tcd.ie/postgraduate/index.php

dublin City university (dCu) www.dcu.ie/snhs/postgraduate-listings.shtml

St. Angela’s College, National university of Ireland Galway (NuIG) www.stangelas.nuigalway.ie/departments/index_per_dept.php?dept=Nursing,%20Health%20Sciences%20And%20Disability%20Studies

university College dublin (uCd) www.nmhs.ucd.ie/study-with-us/graduate-programmes

university College Cork (uCC) www.ucc.ie/en/nursingmidwifery/courses/postgrad/

university of limerickwww.ul.ie/nm/postgraduate

Athlone Institute of technologywww.ait.ie/courses/department/dept-of-nursing-health-science

Institute of technology, traleewww.ittralee.ie/en/InformationAbout/Courses/HigherDiplomaandPostgraduateStudies/

letterkenny Institute of technologywww.lyit.ie/full-timecourses/

waterford Institute of technologywww.wit.ie/schools/health_sciences/department_of_nursing/postgraduate_study


page 43

Career opportunities

tallaght hospitalwww.tallaghthospital.ie/careers

St James’s hospitalwww.stjames.ie/Careers/

St patrick’s Mental health Serviceshttps://www.stpatricks.ie/careers

health Service executivewww.hse.ie/eng/staff/

Stewartswww.stewartscare.ie/aboutus/recruitment/

Muiríosa foundationwww.muiriosa.ie/menu.asp?Menu=56

Coombe women and Infants University Hospitalwww.coombe.ie/index.php?nodeId=999

the Rotunda hospitalrotunda.ie/careers/


Notes


CoNtACt uS

School of Nursing and Midwifery, The University of Dublin, Trinity College Dublin, 24 D'Olier Street, Dublin 2,Ireland, D002T283. T: (01) 8962692E. [email protected]: www.nursing-midwifery.tcd

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