The quality of care is certainly a topical subject, but not new for a nursing profession which has always been concerned with providing patients with quality care while continuously improving it. In recent years, this trend has represented a considerable stake both for hospitals which have signed up to a quality approach, and for health professionals who are discovering new ways of improving the delivery of care and services (Beverly, 2007). This is the reason why the managers of the care units have a capital role to play in the implementation of the quality approach and to be the driving force of their team. Being a manager of the quality of care / services in a health establishment consists of planning organizing, every day, and nurses demonstrate leadership. Some formally occupy leadership positions, while others deploy their leadership skills informally, within an interdisciplinary team. We strive to provide exemplary care to cancer patients, which is why, in this increasingly complex and resource-constrained healthcare system, we need nursing leadership more than ever. If head nurses in oncology are looking to effect change and improve the system, informal leaders must also be part of this process by sharing their expertise and experience. (Bennis, 2003)
The development of the nursing profession is not only managerial, but also clinical and for this reason it is of fundamental importance to recognize the specializations and their training path to professionals, not only as a professional in-depth study related to masters, but as a real level of higher university education. (Curran, 2010)
Speaking of the Nursing Profession and in particular of the role of the Nursing Manager, we clearly see how the evolution of a profession is possible. We can well say that among the health professions, nursing has been the one that has contributed most to the safeguarding of the Health System with its professionals, who over the years have managed to evolve professionally, scientifically and by building a new figure of Nurse. (Curran, 2010)
The picture of the new nursing profession linked to educational growth goes from the generalist nurse who works in general care, participating in the identification of health needs, planning, managing and evaluating the nursing intervention on people or groups of people, healthy or sick, in territorial and hospital structures to the specialist nurse with advanced skills who works with ample autonomy in assisting complex and vulnerable patients of a given specialist type, contributes to the development of the profession by expanding clinical skills to those of training, organization and research and exercises leadership effectively and profitably, as the international models (WHO for example) require. (Hansen-Turton, 2009)
The administration of drug therapy is a complex process and, as required by one’s professional profile, is one of the main functions of the nurse to guarantee the correct application of therapeutic prescriptions.
The professional responsibility of the nurse regarding the administration of drug therapy is not attributable only to the specific act, but to all that complex of actions which, taken together, allow to achieve a protected and effective management of the therapy for the patient. (Jiang, 2008)
In order for the nurse to legitimately administer the therapy, the presence of a medical prescription is essential.
A medical prescription of drugs must consist of the following elements:
• the type of drug, i.e. the trade name;
• the dosage;
• the timing of administration;
• the route of administration;
• the pharmaceutical form (vials, tablets, etc.);
• the doctor’s signature.
Administration requires a complex interaction of decisions and actions often carried out under inadequate conditions, which increase the risk of error. (Curran, 2010)
In fact, often the frenetic pace of the ward, too much bureaucracy, the tight times that can be created following an emergency, always lurking in a ward and the lack of staff, always reduced to a minimum to reduce costs, lead the nurse to a state of stress and deconcentration that exponentially raise the risk of clinical errors.
The correct procedure for administering drugs has been summarized internationally for many years, in the “7G” rule:
• Right medication: The medication you are taking must be the one actually prescribed.
• Right dose: The drug should be administered in the prescribed dose.
• Proper route of administration: The drug should be administered by the prescribed route
• Right time: the drug should be administered with the prescribed frequency and at the time indicated by the protocols in use.
• Right Patient: The drug should be administered to the person for whom it was prescribed
• Proper registration: it is recorded in the clinical documentation of the administration taking place (or not taking place with the relative reasons)
• Right control: both on all phases of therapy management, i.e. from reading the prescription to administration, and on the execution of any subsequent checks (for example, the detection of blood pressure in the case of administration of an anti-hypertensive).
It is deduced from the seven “G” rule that the administration of drug therapy is an indivisible act and as such must be performed by a single person, sequential and chronological. (Bennis, 2003)
In this sense, incorrect practices must be avoided, which can generate errors, such as the administration of drugs previously prepared by other operators.
THE PROFESSIONAL RESPONSIBILITY OF THE NURSE
Although indivisible, the act of administering the therapy can, from a legal point of view, be broken down into two distinct moments:
• the statute of limitation, of medical competence;
• the act of administration, of nursing competence.
If these two moments are kept separate, the nurse will answer only for errors related to the administration while, otherwise, he may be challenged for acts that are institutionally of medical responsibility.
Nursing responsibility is directly related to the type of error and the type of event caused.
Most of the errors consist in the error of the prescription, in the exchange of patients, in the dosage or dilution error and in the error in the administration route which are errors that are substantiated in professional fault (negligence and inexperience).
The crimes that the nurse may face most frequently are personal injury and manslaughter.
The nurse’s criminal liability is personal.
If it is not possible to identify the error of the individual, the fault is attributed to those who have organizational, surveillance and verification responsibilities.
A frequent source of responsibility is given by the transcription error from the medical record to the nursing record. If the copying of the therapy correctly prescribed in the medical record is wrong, the nurse will answer for negligence.
Patient safety is a priority aspect of health care to which the State, the Regions and the Autonomous Provinces, and all health professionals must compete to identify uniform solutions throughout the country, enhance the skills of health professionals and take actions to protect the health of citizens. (Katzenbach, 1993)
Bennis, W. a. (2003). Leaders: Strategies for taking charge . New York.
Beverly, C. J. (2007). The Arkansas aging initiative: An innovative approach for addressing the health of older rural Arkansans. Gerontologist.
Curran, C. R. (2010). Expanding the role of nursing in health care governance. ursing Economic$, 44-46.
Hansen-Turton, T. A. (2009). Developing alliances: How advanced practice nurses became part of the prescription for Pennsylvania. Policy, Politics, & Nursing Practice .
Jiang, H. J. (2008). Board engagement in quality: Findings of a survey of hospital and system leaders. Journal of Healthcare Management .
Katzenbach, J. R. (1993). The wisdom of teams: Creating the high-performance organization. Harvard Business School Press.