Identifying Risks and Errors to ensure Patient safety

Nurse is responsible to provide best care services to the patients with in its job role. Medical care should be without errors. However, there are various incidences of errors and negligence. Facts have proved that errors happen more frequently where nurses intend to help patients instead of harm them. Only nurses cannot be blamed for these errors. These errors are combination of factors from health care environments, mis-management of health care providers, communication gaps among health professionals, weaknesses in nurse training and deficiency in nurse’s roles. Nurses must fulfill their roles with honesty to ensure patient’s safety and integrity of health care system. Our healthcare system must improve to remove any chances of medical errors in the treatment f patients. Nurses have absolute proximity to patient due to their inherited role. The significant and trusted role of nurses has imposed a responsibility to identify problems in healthcare systems and participate actively for safety of patients. Nurses must be supported, motivated, encouraged and aspired to understand the organisational changes, cultural values and problem oriented solutions. The current report evaluates the role of a nurse by emphasizing on patient’s safety, nurse training, job dedication and professional qualities. As an essential part of nurse role, a nurse should be able to identify the potentials of risk errors, ensured about patient safety, and understanding of cultural values, promotion of healthcare system and understanding of professional responsibilities.

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What is service? What is service quality? Who is service user in healthcare system? What is nurses role? How nurses should provide service to service user? These are complex questions and current report aims to answer these questions.

Service is actually a product like goods which is presented for sale to customers (Shemwell et al 1998). Service is different from goods due to its nature and properties (Ghobadian et al 1993). Best quality service has five essential characteristics; tangibility, reliability, responsiveness, assurance and empathy (Bebko 2000). Service quality (Shemwell et al 1998) and customer satisfaction (Lee et al 2000) are two important goals for any healthcare organization. Nurses can play vital role in the improvement of service quality. Service of an organization is assessed by service user’s satisfaction on service quality (Sivadas et al 2000). Service quality is a complex concept (Brown et al 1991). Service quality may be defined as customers’ attitude or judgment about the superiority of a service (Robinson 1999) or a comparison of customer expectations with performance perceptions. Sometimes, it is known as a comparison of performance with ideal standards (Lee et al 2000) or the perception of performance alone (Robinson 1999).

A nurse with professional competency is focused to provide high quality service to service user. National Health Services (NHS) in UK has top most priority to involve service user but even then its responsiveness to its users has been criticized (Donabedian 2003).

Nurse is on frontline to provide best service to service user at diversity levels. The role of a nurse is more than 140 years old when Florence Nightangle said that first requirement of nursing profession is the safety of patients in hospitals (Nightangle 1863).


Nurses are responsible to provide best nursing service to patients. Nurses should possess some essential skills to perform their role successfully. A list of essential skill cluster is available from NMC guidance. The scope of essential skills cluster is wide. I therefore have focus on following essential skills to enlighten skills required for nurse’s role and challenges faced by nurse under various circumstances while performing her role


Record keeping is essential skill for nurses. Nurses should learn a comprehensive skill of record keeping system to ensure patient’s safety and successful provision of nursing care. Various organizations have their own database system. Nurses should make themselves familiar with database system of their job placement. A nurse provides essential feedback to healthcare professionals, doctors and consultants to manage patient’s treatment. Successfully treatment of patients is not possible without correct record, accurate information and proper feedback to doctors and other healthcare professionals.


A nurse has responsibility to change an action plan according to changes to patient’s condition. Nurses consider various conditions like moving and handling capability, fall tendency, route of medication administration, behavior changes and aggression before reviewing or revising the care plan. Diversity of client’s conditions like mobility, behaviour, environmental factors, co-operation and mental issues are big challenges for nurse when updating, reviewing and revising the care plan.

Care plans are revised on a regular date but any emergency change may result in change of care plan at earlier date.

Every healthcare organize has its own database system. A nurse may feel difficulty if he/she is not familiar with the database system

Record may contain private and personal element which may create a challenge of confidentiality and privacy. Nurse has to make wise decision to present information to relevant health professionals by keeping confidentiality and privacy of client in consideration.


Nurses are trained to record vital signs. It is nurse’s responsibility to make them familiar with equipments provided for observation. Any failure to record and monitor vital signs may result in irreversible harm to service user. Therefore, nurses should make sure that they understand the importance of vital sign observation.

A nurse has responsibility to change record according to patient’s response, health care professional’s advice and on consultant’s recommendation. Therefore a nurse should make sure that he/she has sufficient training, ability and capability to amend care plan under various situations.


I have work experience of working in care home. I understand that record keeping is very important in daily routine of providing care to service user. I have recently achieved some experience of working as student nurse and developed understanding that how a nurse ability to follow recording procedure can affect his/her efficiency to provide best nursing care to service user. Reflection from my previous work and placement experienced is explained on next page.

Learning from previous experience
There should be clear and obvious policy about collection of information. Books labeled with various heads should be used for recording various information. Information should be updated with every new entry and change to provide good quality of service. A double check system should be introduced by allocating duty to a member of staff to check that information is updated. There should be a monthly check of all books to make it sure that all books are updated. Phone and fax should be installed at some private place.
Learning from 1st Placement
Acute care pathway and NHS insight are trainings for development of nurse’s record keeping ability.
A nurse should record accurate and essential information on relevant register on receiving the information.
Information system has three basic components; collection of input data, interpretation and then providing output data. Adaptation of computer technology, dual copy information system, improvements in data storage, building up of a data base system and regular updating of information could improve company information system. Staff should be provided training in information collection, interpretation and quick supply to improve the standard of service.

Communication is very important skill for nurses. Therefore, communication is one of the major skills cluster recommended by NMC for development of nursing attitude. Communication may be between nurse and client, nurse and client’s family or among healthcare team.


Any communication gap may result in mistake and error in healthcare system.

Communication gap between nurse and patients may result due to abilities of client to understand and receive communication.

Communication between healthcare team may be missed due to complicated system of an organization.

Communication between healthcare team may result if a single member of health care team shows negligence to follow the professional communication procedure.

Mental health issues and severity of mental illnesses can affect the client’s ability to understand communication.


Communication between team members is essential for team effectiveness. Therefore, nurses should gain experience to communicate properly.

Nurses should make sure that communication has been conveyed.

Communications should be recorded, updated and revised time by time.

Training in communication skills can enhance nurse’s efficiency.


I have achieved understanding of communication gaps during my working at care home and my recent experience at placement.






During my work placement, I successfully communicated to staff members during meetings, one to one sessions and also gained experience of one to one communication to client. I leant to overcome communication problem due to various levels of client’s ability to understand and participate in communication.

I come across a communication gap when I couldn’t inform Commission for social care inspection (CSCI) (Now called quality care commission) about sudden death of a resident. It was our responsibility to inform CSCI about any sudden death of a resident within twenty four hours. There are more examples when other staff failed to supply required information. Similarly a senior staff told to other staff a confidential decision of management in front of residents. It was breach of confidentiality. The release of information created major discomfort among staff.

Learning from theory

There are always ways by which team members communicate with each other. Teams can coordinate with each other in already designed coordination pattern (Hackman 1987). The patterns may include the face-to-face meetings, written information, hand over’s, record keeping, use of medical terminology, electronic communications and ideas exchange.


Team is a group of people working towards achievement of goal (Nadler 1996). A team composition means the number, nature and diversity of team members. It is one of the most important variables for team effectiveness. Nurses works in team. Therefore, nurses should develop team working spirit to achieve required level of professional behavior. Team resources consist on its member’s talents, skills, knowledge, and experiences (Campion et al 1993). A good nursing team will consist on member nurses with excellent skills (Bauman et al 1997).


Nurse role cannot be completed if a nurse works in isolated pattern. A nurse should consult with health professionals if there are some concerns about patient’s treatment.

Team efficiency depends upon diversity and skills of its members (Magjuka et al 1991).

Heterogeneity among team members usually has positive effect on team effectiveness but it may cause challenge.

A nurse has responsibility to educate and supervise staff with fewer skills.

A nurse should participation in interaction, co-operation and co-ordination between team members, decision making, problem solving, team issues discussion and critiquing team effectiveness (Goodman et al 1991). It is challenging as un-co operation of one member among team may cause team work failure.

If there is less co-ordination among health care team members, then team effectiveness is decreased (Watson et al 1991).


Nurses should co-ordinate and cooperate among healthcare team.

Teamwork generates innovative ideas, thinking and alternatives (Hyatt et al 1997). Team working enables staff to use diversity of experience to solve difficult problems (Ancona et al 1989).

Role of nurses can affect team performance. Nurses can improve team effectiveness by using their essential skills to improve individual performance of team members (Jacobs et al 1993). Feedback, individual performance and service user satisfaction is used for evaluating the team’s performance (Katzenbach, 1993).

Teams composed of members familiar with each other are more effective than teams consisting on stranger team members (Dubnicki et al 1991).


I have been working as team leader at care home for ten years and worked in community care team in my 1st placement.



Learning from 1st placement

Patients are strict about their confidentiality and privacy. Client does not want any information flow without their permission but nurses has to cross this limit where it is essential to disclose some information to healthcare professionals and authorities like health department. Similar issues may arise about releasing information regarding serious infections like HIV, HCV and Hbs. Therefore, it is nurse’s duty to keep balance between release of information and legal responsibility of confidentiality and privacy.

Learning from previous experience

A nurse is fully responsible for his/her role. Therefore, it is nurse’s duty to consult concerned authorities if there are some concerns or issues at work place. No excuse could stop a disciplinary action if there is negligence in treating service user. Nurse should follow rules of confidentiality and privacy while dealing with patient. Any breach of confidentiality or privacy can be a matter of disciplinary action against a nurse.

Learning from theory

Team potential is the actually team reserve by which team can be developed into effective team (Guzzo et al 1992). Effectiveness of team is actually the sum of its team member’s effectiveness (Little et al 1997). Encouraging teamwork has been suggested to enhance effectiveness in complex organizations (Campion et al 1993). Therefore, nurses should develop team working spirit as a part of their professional behavior.


Nurses are expected to possess certain level of professional knowledge for safety, dignity and privacy of service user. Nurses should understand the legal acts like DATA protection act 1998, Disability Discrimination act 1995, Race relation act 2000, Sex Discrimination act 1975 and the medical records confidentiality act of 1995. In addition to mentioned legal acts, nurses should know about the policy and procedure of the organisation of their job place.

Nurses should have sufficient scientific knowledge to understand the results of diagnostic test. Especially the nurse should know the significance of daily routine tests to provide accurate feedback to doctors and consultants. For example, a nurse should know the normal limits of blood sugar and normal values of pulse and blood pressure. In case of any doubt, nurses should immediately consult to senior staff nurses or doctors on duty. Doctors or consultants may not know about patient’s condition if a nurse fails to inform them. Therefore, a nurse has first line responsibility to observe patients’ condition and inform doctors in time.


A nurse working in different environment has additional roles. A nurse working in maternity services has responsibility to provide best care services to mother and child in ante and post-partum stages. A nurse working in specialist field should have experience and knowledge of the field.

Nurses are responsible to monitor patient’s vital signs, skin condition and welfare and convey this information to doctors, consultants and other health care professionals as a valuable feedback for successful treatment of service user. The feedback may be missed if there is communication gap in healthcare team even nurse has completed his/her job.

Nurses collect blood, urine and sputum samples for various laboratory tests as recommended by doctors and consultants. In addition to collection of test samples, nurses perform some on spot tests as well. For example blood sugar and urine analysis in the ward. It is an additional job for nurse. Due to huge amount of tasks to complete, a nurse can make mistake if not well trained in above mentioned tasks.

Nurses working at senior level are responsible for management of a full unit or even department in respect of management and financial administration.

Human system is a potential source of change (Dooley et al 1999). Research is required to explore diversity and solution of various issues in healthcare systems. Nurses participate in research activities to improve healthcare systems.


Nurses have responsibility to assist patients in dressing and preparing for examination and treatments. For example examinations like laparoscopy, gastroscopy, biopsy or treatments like chemotherapy etc.

Nurses working in Operation Theater and intensive care units have responsibility to observe patient’s condition before, during and after anaesthesia.

Nurses play a vital role in expanded programs of immunization in communities, schools, hospitals and camps throughout the world.

In Operation Theater, nurses have additional role of providing assistance to surgeon during operation. In addition to assisting surgeon, a nurse can be responsible to maintain operation theater record, sterile instruments and maintain health and safety in the operation theater.




Learning from previous work experience

A nurse has supervisory role as well. A nurse looks after other healthcare staff and provides guidance, instruction and supervision to other staff working with service user. Nurses are frontline in health care system. Nurses prepare rooms, beddings, sterile instruments, store instruments after use, order and save instruments and equipments and take care about stock of items used in normal treatments and operations.

Learning from 1st placement

Nurses are not only responsible to dispense medication. It is nurse’s duty to make sure that prescribed medication is administered in correct amount though accurate route.

Learning from theory

Organization consisting on interrelated and interdependent parts (Handy 1985) is impacted by internal external factors. Any change in one part of organization affects the other part. These changes can be identified and well managed by frontline staff like nurses.


Health organizations are considering public and patient involvement in health services at higher level in Western countries (Vallgarda et al 2001). Similarly activities have been seen in Canada and England to enhance general public involvement by offering public membership on the boards of healthcare organisations (Abelson et al 2007: Fooks et al 2004).


Service user may not be able to understand treatment need therefore it is nurse’s duty to provide necessary information and motivation to service user regarding their treatment. Information is necessary to create confidence and trust in patients.

Mostly, a conflict is always present between service user and organization’s preferences. In order to achieve service user’s satisfaction level, this gap should be filled up by respecting client’s preferences and priorities within safe limits.

Certain health care system’s goal cannot be achieved without participation of the service user.

Nurses teach service user about valuable procedures like infection control, advantages of immunization, prevention of disease and precautions and complaint procedure.


High level of service user satisfaction can be achieved by improving service quality (Groth et al 1999). Service quality can be improved by providing choice to service user. Therefore most of health organizations are focused to provide service of choice to service user. Patients need emotional and psychological support during and after illness. A nurse provides emotional and psychological needs to patient.

Service user satisfaction on service is achieved by involving service user in designing and revising the service.




Learning from Work experience

It is emphasized that any strategy adopted for better level of service user involvement should encourage service user’s involvement at decision level. Service users from diversities and communities should be involved in the planning, monitoring and delivery service.

Learning from 1st placement

The objective of service user involvement in healthcare system is to provide care to service user according to service user’s choice. Nurses have responsibility to respect the choice of patients as patients are service user for nursing care service. Service user involvement is an essential factor in NHS agenda according to NHS plan 2000 and Health and social care act 2001.

Learning from theory

Service user involvement is important for service provider because a valuable and quality service cannot be provided without involving service user. Service provider is much concerned about service user because service user is actual buyer of service. Service user involvement is highly demanded in healthcare settings (Minogue et al 2005). Service user involvement in the planning and delivery of health services is an aspiration of many centuries (Robledo 2001).


Nurse’s job role is different according to grade and level of training and on various job places. For example, a nurse can have additional responsibilities in Operation Theater and in maternity wards. However, general duties of a nurse are nearly same at various places.

Personal assistance is another important component of nursing care. A nurse has role to monitor personal care, privacy, dignity and confidentiality, residential services, care plans and assessments. A nurse should also monitor personal care activities like dressing, awaking up timing, personal needs, incontinence needs, moving and handling needs, meals and mealtimes, social contact and activities, community contact, autonomy and choice.


There is variety of human beings who are different from each other in respect of nature, educational level and skills.

The patient safety has become an important goal in the modern healthcare system of 21st century.

A nurse role starts with the safety of patient in modern health care system. A nurse role has become more important as healthcare system has progressed towards more complexity in modern era (Wachter 2004).

A nurse has duty to organize duty jobs in a way that everything is done properly and on time (Kohn et al 2000).

At individual level, each person has different physical, mental and emotional ability and knowledge that can result in challengeable behaviour at some instances.

A nurse should be able to monitor and understand the diversity among service user. Conflicts can arise if patient is not satisfied with treatment. Conflict should be resolved as soon as possible.

Failure of NHS to provide service user involvement has been criticised for long time.

Medical errors can cost billions for health care organizations (Gibson et al 2003). Therefore building a safer healthcare system has been a focus of service provider for long time.


Patients should be encouraged to express negative feelings and confrontation so that any conflict could be solved as soon as possible. A nurse should explain complaint procedure to service user.

In a real sense, without cooperation of nurses, it will be impossible to act on infection control program.

Nurses should be confident in dispensing correct medication at correct time and in correct dosage.

Nurses should be competent in calculating correct amount of medication and should have good knowledge of medication record system.


Learning from work experience

Nurses, doctors, consultants and other healthcare staff are responsible to involve service user to improve service quality.



Learning from 1st placement

The professional role of a nurse to patients includes participation in care plan, assistance in examination, helping in procedures, counselling, follow up and personal care, respect of service user’s right of choice. Nurses are integral part of quality patient care. Service user involvement in healthcare system ensures a joint approach for the provision of good quality Service. Nurses have vital responsibility to provide best services to service users to build up mutual trust and respect. Nurses have a vital role in infection control program at hospitals and in community. Nurses teach community and public to follow infection control procedures

Learning from theory

Monitoring bodies are concerned in maintaining health care standards. Organisations re-design, plan and organize health care services to follow monitoring bodies’ standards. A good service is accessible, desirable and choice oriented for service users (Carrier 2002).


Generally, the prime purpose of user involvement is to improve the way, service is designed, reviewed, planned and provided because it helps to ensure that service is relevant to service user. Therefore service user involvement is the only method to get maximum satisfaction confidence, trust and quality in service. Client’s participation can involve many levels within organisation like participation in treatment and care, participation in service delivery and evaluation, participation in policy and planning, participation in education and training and even participation in staff recruitment. In hospital environment, it means giving patients more information, and encouraging healthcare professionals to treat patients as equal partners in the decision making process . The service modification, designing and further planning is only possible if feedback is available from service user (Speed 2006). Not only positive feedback but negative feedback is also valuable because it can help service provider to modify service according to service user’s need. For example, complaints and appeals are a source of service evaluation data.

Information system has three basic components; data collection, interpretation and then providing output data. Providing inadequate, inaccurate, out-of-date or insensitive information will result in negligence. Nurse should develop professional knowledge and essential skills of ddata collection, information recording, communication, privacy and confidentiality and patient’s safety.


Nursing and Midwifery council of England provides comprehensive guidance for nurses to develop essential skill clusters to become successful nurses. It is therefore responsibility of training institutes as well as nurses to develop essential skills clusters mentioned in NMC guidance for successful nursing care. Nurses should be aware to their professional responsibilities and should develop sufficient professional knowledge to ensure safety of healthcare system. In addition to pre-registration nursing training, nurses should continue to develop their professional knowledge. Therefore a professional developmental portfolio has become an essential and important document for nurses. In short nurses plays important role in health promotion, patient’s education, prevention of illness in public, provision of best nursing care, participate in rehabilitation, provision of physical, psychological and social support to patients before, during and after treatment in hospital, community, camps or prison. A nurse should respond according to feedback received from service user, service user’s family and health professionals during meetings, inspections and provision of nursing care.

Patients in hospitals, community and long term care settings with illnesses of wide range are service users in nursing profession, In addition to patients, their families, friends, health care professionals, monitoring bodies and everybody having interest in service user are stakeholders in nursing service.

Safety of patient is the ultimate goal in nursing. However nursing role is not limited to the safety of patient but also include personal, psychological, medical, social and moral support to patients. A skills frame work has been described by NMC for development of nurse’s skill to ensure safe working environment. Why nurses should develop these skills clusters? The answer is very straight and come from Florence Nightingale’s wording that first role of nurse is patient’s safety.


I have selected few skills to get focus in my assignment. I focused on recording, communication, patient’s safety, service user involvement and professional knowledge. However, the scope of this assignment may be wide but limited in my assignment due to limitation of words count. I have deep learning from this assignment. I learnt to evaluate my skills, look at my existing skill level, reminding of my learning from my previous work experience, recent learning from my placement and planning for my future experience and placements.

I learnt that every service is concerned with service user’s needs, wants and choices. The quality has various dimensions which affect the service and preference of service users. Quality of service is not achieved by hardworking and random efforts but by developing professional knowledge and essential skills required to be a good nurse. Multiple factors affect the delivery of service. These include nurse’s competency, skill level, professional knowledge, training opportunity, practice and experience, behavior and attitude and compliance with NMC standards. Development of negotiating skills like communication, planning, risk assessment, conflict resolving and motivational tactics is important components of essential skills.

The assignment has given me a clear idea and understanding of skills required to be a professional nurse and how a nurse can safely provide services to client in his/her role. The assignment provided me basic knowledge to evaluate information system, to find out weaknesses in my skills level, planning for development for existing and new skills, communicating to client and healthcare t