Task
Case Study Background
Toby is a Graduate Registered Nurse (RN) who is 8 weeks into his first graduate rotation at the local metropolitan, tertiary hospital. He is currently working on an Medical Ward. For the first four weeks Toby worked alongside his nurse preceptor, predominately rostered on morning shifts. Toby has just completed his first five night shifts yesterday morning and is back on an afternoon shift today (Saturday).
Toby is still trying to manage his roster and other commitments like cycling with his friends and hiking. Today, Toby is feeling tired and frustrated because he slept through his alarm this morning and missed hiking activity to celebrate his best friend’s birthday. He is also disappointed that the he can’t join his cycling group in the evening.
On Shift
Toby has arrived 15 minutes prior to this shift starting. On arrival, he realises that he hasn’t worked with the Nurse-in-Charge before but there are other nurses on the shift that he has met.
Toby feels a little nervous, but he knows two of the patients he has been allocated from his recent night shifts and he is allocated a further two patients who are to be discharged this afternoon. He has not arranged a discharge before so he prioritises these activities as he prepares his shift planner.
A short time later the Nurse-in-Charge tells him that his patient allocations have changed due to skill mix. A different nurse will arrange one patient discharge and Toby will be receiving a new patient from Emergency Department.
His patient allocations are now as follows:
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Patient
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Age
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Diagnosis
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Relevant Information
|
|
Mrs Janet Jones
|
71
|
Pneumonia
|
New admission from the Emergency department (ED). Febrile and hypertensive on arrival to the ward.
For IVAB and chest X-Ray.
Urgent bloods have been taken. Patient’s family
present and appear distressed.
|
|
Mr Frank WIlliams
|
62
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Trans Ischaemic Attack
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Requires minimal assistance Needs IVC to be removed
|
|
Ms Frances Fernandez
|
68
|
Hyperglycaemia
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Ready for discharge. Discharge paperwork has already been completed by morning shift nurse. Pharmacy has delivered discharge medications and has conducted patient education. Waiting for family to arrive and pick up.
|
|
Mr Gerald Sommersby
|
83
|
UTI
Increasing confusion
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New admission from ED. Mr Sommersby is a Nursing home resident. He is a high falls risk.
|
Toby feels overwhelmed with the admissions and discharge. He is unsure how he will cope with the rest of his shift. Toby has not looked after a patient (Mr Somersby) who is confused, high risk of falls and wanders around the ward. He decides he must push on, and soon it is time for handover.
At handover, Toby realises that after he had not given Mrs Jones her IVAB. Toby had set the observation machine to take automatic observations. However, he had forgotten to go in and check this patient for the last 3 hours. Toby has not yet completed the admission documentation for Mr Sommersby as he has been trying to stop him from wandering out of the ward. The nurse he his handing over to rolls her eyes when this information is handed over. Additionally, he has not completed any of his patient notes on the computer on wheels (COWS) machine. Toby stays 30 minutes after the end of his shift to complete his work.
Following his shift
On his commute home, Toby feels really stressed and feels that he did not provide sufficient care for Mrs Jones. He is frustrated with himself that he may have missed other things this shift and that he had to stay late to finish his patient notes. At home, he spends some time reflecting on his shift and plans to ask his nurse preceptor for any advice/tips on their next shift together.
Question
Toby appears to be struggling during his clinical shift. He also seems to be having difficulty maintaining a work/life balance. Critically analyse the provided case study to answer all the following three questions within an essay format:
1. Determine and justify whether the graduate RN met (or did not meet) their role and responsibilities as an RN during his shift. Provide at least two case study examples and support your discussion using evidence, including Nursing and Midwifery Board Australia (NMBA) Registered Nurse Practice Standards.
2. Construct at least three recommendations as to how the graduate RN could have undertaken this shift differently. Consider in your discussion the knowledge, skills and attitudes inherent in the RN role, including utilisation of technology and teamwork skills, and support your discussion with literature.
3. Transitioning from student to Graduate Registered Nurse can be difficult. Construct at least two evidence-based strategies that could be implemented to promote resilience, build capacity, and support work/life balance during the graduate RN’s transition period.
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