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Assessment 3 Case Study

The New Nurse: Strategies for Transition into Practice

“Success is not final, failure is not fatal: it is the courage to continue that counts.” —Winston Churchill

Kelley’s story….

Night shifts are horrible, and anyone who says they don’t mind them is lying. I was on my third in a row and I was tired – the sort of tired where your eyes feel hot and sunken, and blinking takes three to four seconds, and you never knew a reflex could be so torturous. That night I had come into the ward and it appeared nothing had been done during the day. It was only the beginning of the shift and I already felt like I was so far up s**t creek without a paddle that I was off the map.

The night wore on and one patient was taking up a lot of my time. He had a groin abscess – I had admitted him the previous night and he had been very unwell. He had had a large amount of heroin and alcohol in his system, and his level of consciousness was the wrong side of sleepy. Now, however, he was wide awake and angry. Withdrawal from drugs or alcohol is painful and degrading; it’s not easy. That said, it’s not nice to be used as a verbal punching bag.

It’s 4am and I’ve got seven patients, one of whom is acutely unwell, while another is following me around the ward demanding drugs I cannot give him. The other five have a range of problems.

Mr groin abscess, when he isn’t following me around and swearing, is trying to smoke in the toilets on the ward, conveniently placed next to oxygen cylinders; he denies everything when we’re forced to call security.

Everyone is busy and I feel like I’m drowning. It’s now that the gods of the hospital decide to kick me in my already battered shins. There’s another patient coming up into the remaining bed. I eyeball her as she comes in. She looks all right. I take her history and her presenting complaint doesn’t sound terrifying.

I send the third year student nurse to do her admission – it’s common practice on my ward. An hour later and the student nurse is still going through the paperwork – nothing can be that wrong as the woman is fully alert, with no complaint of pain and talking normally. It’s 5.30am and I’ve just managed to sit down and start my notes. I see the student nurse and ask what the new patient’s score is – like most hospitals we use a scoring system that amalgamates clinical observations and tells us when to panic. We’re supposed to escalate a score of five and above.

This is ​the time​ when my “difficult” patient pins me against a wall, still demanding ​he needs ​his medication

The student replies that she’s scoring a six. This pisses me off as the student should have flagged this up as soon as she had got the score. I repeat the observations – she’s a six, almost a seven. I call the doctor; we reason that some of the alarming problems are normal because of her medical history. We deal with the temperature and the underlying infection, and leave the lady to sleep, with a promise that I will return in two hours to check on her.

This is when my “difficult” patient attempts to pin me against a wall, still demanding his medication. Dealing with the situation takes ages. It gets to 6am when all the morning jobs start. I haven’t told anyone that I was planning on rechecking my new lady but I reason that a nurse has been allocated to do the routine morning observations. The problem is that the nurse is also dealing with a tough crowd and doesn’t get round to my lady. By the time I remember, three hours have passed. I go to her and she’s in a bad way. I will never be able to articulate the feeling of looking at a patient who isn’t supposed to be dying and knowing that they are.

There’s a well-documented phenomenon called an impending sense of doom, often experienced as part of a quick demise or a sudden onset of fatal illness. This sweet lady looked me dead in the eye and said: “Something’s not right. Something is very wrong with me.” For a second I was paralysed with fear – she wasn’t breathing well, her heart rate was too high, her blood pressure too low, her oxygen saturation levels were dropping and she was confused. She was septic – people die of sepsis – nurses are supposed to recognise this.

I call the team. They are at a crash call one floor below. The nursing team is in handover – the worst time to get sick. My remaining colleagues spring into action and within 15 minutes we’ve got her on a cardiac monitor, given her oxygen, done an ECG, scanned her bladder, inserted a urinary catheter, given her all the medication we can, taken bloods and tried to reassure her.

The senior nurses are discussing whether to put “the call” out, well aware that most of the doctors are working on someone whose heart has stopped downstairs. I’m already an hour and a half into overtime at this point and am told to go home. When I get home I can’t sleep. I shut my eyes and I see the look in hers, silently begging for someone, me, to help her.

A colleague told me the lady was taken to intensive care. She is confident that she’ll be OK and that we did all we could on the ward. I am not. I call a friend who has never worked in healthcare, who is not a girl in her early 20s who just watched somebody the same age as their mother fight for their life and tried to fight with her. I cry for an hour and try to persuade myself and her it’s not my fault. I tell myself I was tired, that my colleagues shouldn’t have left me with so much to handle, that the student should have told me sooner, that there should have been more doctors around.

There can be no excuses when somebody’s life is at stake – it’s my job, it’s what I’m supposed to do. I need to be able to handle the confused, the aggressive and the very unwell. It’s my job to comfort and care, to organise and fix by watching and recognising, to listen and to always prepare for the worst.

I failed to do my job that night and a women nearly died. I suspect all healthcare professionals have a scary moment of “what ifs” and sweaty palms when the responsibility of our job hits home and leaves us with a charcoal taste in our mouth. I don’t think we get over it, we just have to deal with it.

Task

The transition from student nurse to Registered nurse can be fraught with many emotions…

Not only happiness and excitement, but also fear, anxiety and uncertainty.

It can be a time when new graduates are questioning everything from their ability, to whether they made the right career choice, and whether they will ever be like the nurses they are now working with on their new ward.

This transition period is often described by people as a complete reality shock, and let’s face it, apart from nursing not many other occupations come with the added chance that you can severely hurt or kill another human being.

But fear not! Every nurse, at one point or another, has experienced these feelings.

It is common for new nurses to feel insecure and unsure about their ability to be a registered nurse, and there is a multitude of issues that may arise, which only serve to add to these feelings of insecurity.

1. Draw on the literature and critically analyse what has occurred in the case study provided in relation to:

• 3 applicable Nursing and Midwifery Board AHPRA (NMBA) nursing practice standards,
• 2 principles of the NMBA Code of Conduct
• 2 elements of the International Council of Nurses (ICN) code of ethics
• And 2 ethical principles
• Discuss and apply 2 National Safety and Quality Health Service (NSQHS) Standards relevant to the case that now seek to protect the public from similar events

2. Draw on the literature and discuss 3 challenges faced whilst transitioning from novice to registered nurse and with reference to the literature identify strategies to over come such challenges.

3. Define resilience and its application to the nursing profession. Identify strateigies one can employ to foster resilience.

When writing this assessment refer to the task, presentation guidelines and marking rubric.  

Presentation guidelines

• Complete the footer as prompted i.e. lastname_studentnumber_NUR345_ Assessment 3
• Format your assessment with size 12 point Arial font, single spacing in incident report; 1.5 line spacing for essay; double line spacing for end-of-text reference list.
• Complete spelling and grammar check using English (Australia) default.
• A minimum of 10 peer reviewed journals or texts no more than 5 years old.
• Use APA 7th referencing.
• 2000 +/- 10% word limit (incident report; essay). Markers will stop marking at the maximum allowable word count. The end-of-text reference list is NOT included in the word count.
• Essay should be written in the third person in an objective, non emotional language
• Use headings to signpost your work.
• Save the final version of your paper using the filename of lastname_student number_NUR345_ Assessment 3

APA 7th referencing