Work within the limits of your competence

As a registered nurse you must practise according to the NMC Code, but adhering to these professional standards is not easy when demands are heavy and resources scarce 

There is a fine line between working hard to cover staff shortages and being asked or expected to take on tasks or responsibilities that you aren’t confident or qualified in. It can be easy to feel pressurised to help ‘just this once’. Everything may go smoothly, but what you are doing is putting patients at risk and practising outside the Code.  

Working within the limits of your competence is a key aspect of preserving patient safety.

Know your role

Firstly, you need to know what is expected of you in your role and then reflect on how competent you feel to perform all aspects safely and professionally. Take a minute to brainstorm the key skills and responsibilities that are required of you and ask yourself:

• Do I understand why I’m doing this? Nursing is no longer a task-orientated profession – to practice safely you must be able to explain the rationale behind your actions, omissions and delegations.
• Have I been adequately trained and assessed as competent? Imagine a child who watches his dad drive every day. When the child reaches 17 he may think he knows how to drive a car safely without formal tuition, but would you trust him? Similarly, you may have witnessed a senior nurse undertake an advanced role, but you won't be competent in this role unless you too have successfully passed a competency-based training programme.  
• Do I do this regularly enough? Basic life support (BLS) is a good example of a skill that, depending on your clinical area, you may not use regularly, if at all. The only way to ensure up-to-date competence is to undertake regular training. Your trust will specify frequency for BLS, but there may be other skills outside the mandatory update programme that you haven’t used for some time. It is important to reflect on your level of competence with these and identify how to raise your skills if necessary. 

Remember that conditions can change for you, your patients and the ward in general, and all of this can affect your need to update your competence. 

Be assertive 

Saying no is never easy, but it is easier than having to say sorry for a mistake. So even though you may find it hard to stand up for yourself, especially when everyone around you is working flat out, don’t risk patient (or personal) safety. Avoid getting defensive or apologising excessively for what you won't do. Instead, if possible, try to help identify a safe solution.

Mandy Day-Calder is a freelance writer and life/health coach