Independent, Dependent and Interdependent Functions of a Nurse
Maya is burning the midnight oil studying for her exams. Tonight, she is studying about the different functions of a nurse. With so much to read and memorize, she just can’t help but wonder why it is even needed to know about the functions of the nurse given that she has seen nurses who just rely on doctor’s orders written in the chart for patient care. Confused, she gets back to her reading, hoping to be more enlightened.
Being in a profession that deals with lives and not just paperwork, it is important that nurses know their roles and functions so as to avoid malpractice and unwanted effects in patient care. That being said, nurses must know their boundaries and be aware of their independent, dependent and collaborative functions.
Dependent Functions of a Nurse
We always find nurses who rely on doctor’s orders to function, content in knowing that what the doctor orders is right and should not be questioned. However, that should not be the scenario as the dependent function of the nurse is based on the law which authorizes his/her practice, as well as on common law and relevant statutory laws. It is not based on that which the doctor prescribes, requests or directs for the patient.,The registered nurse should still act as a professional person and should be responsible and accountable for her own acts and omissions even in accepting such direction or prescription.
By not adhering to the provisions of the nurse practice act, she becomes criminally liable and without the observance of other health related legislation she may become civilly or criminally liable. The law is the system of rules that provides order in professional practice. It is the law, and only the law, that authorizes her professional acts. She is dependent on the law for every aspect of her professional role and function.
It must be also be stressed that the locus of the dependent function of the nurse is, and remains, the law empowering her to practice, including the regulations made by the subsidiary legislative authority, namely the professional registration and controlling authority. Furthermore, it includes decisions given by the courts anent the interpretation of such laws.
Interdependent Functions of a Nurse
Nurses are not the only professionals involved in patient care, instead, they are part of a team (the healthcare team) which aims to provide quality, efficient and effective patient care. The interdependent function refers to the inter-relationship of the nurse with the patient and with other members of the health team. Specifically, it relates to the interdependence of nursing and medicine.
It should be remembered that the nurse, whether as institutional practitioner or as private contractor, is not the servant or subordinate of the doctor. She is a registered nurse practitioner, completely responsible and accountable for her own acts and omissions to the registration authority, and in the broader sense, to the courts.
Where she accepts a prescription, request or direction for treatment of a patient from a doctor, she does so as an independent practitioner on behalf of her patient and as a shared responsibility with the doctor. She acts in the interests of her patient and in so doing has a joint responsibility with the doctor for ensuring that the patient is receiving the prescribed diagnostic and therapeutic care as well as the relevant nursing care. In other words, the patient is her patient as much as he is the patient of the doctor. She cannot distance herself from this elementary fact.
Doctor and nurse have an interdependent and mutual responsibility and neither can provide all the health care the patient needs. It is a joint as well as a broader team effort. In this respect a very substantial element of co-ordination of team activities is done by the nurse in the interest of the patient. The interplay of activities between doctor and nurse epitomizes the interdependence of their functions. The interdependent function is clearly recognized in the various health professional registration acts and in the regulations made there under.
Independent Functions of a Nurse
Nurses do not only rely to doctor’s orders. We also have a share of functions we can perform independently.
The independent function of the nurse has two dimensions. One dimension relates to all those aspects inherent in nursing diagnosis, treatment and care which are the normal prerogatives of the nurse. The other dimension is concerned with the manner in which she carries out any of her duties as a registered nurse, whether this be an independent or interdependent function. Whatever she does, she does on her own responsibility and accountability for in law she is personally liable for her acts of omission or commission.
She and she alone remains accountable for her actions. Only she can decide whether she is legally able, or knowledgeable and competent enough, to accept a specific prescription or direction from a doctor, or is able to participate in the care provided by other members of the health care team.
Once she has indicated acceptance she has made an independent decision and accepts full responsibility and accountability for her decision and actions. Even her decision to observe the provisions of the nurse practice or related laws is an independent function for which she is personally responsible and accountable. It is important to note that neither the nurse, nor the doctor, nor any other member of the health team is an autonomous practitioner, for such a practitioner does not exist. All the members of the multi-disciplinary health team are responsible and accountable to the patient, the registration authority and the law of the land, which is the vigilant sentry before the door of everyone’s professional life. All are accountable, and if one is accountable one cannot be autonomous, be one doctor, nurse, psychologist, social worker, physiotherapist, or any other member of the health team.