Case study background
Toby, a Graduate Registered Nurse (RN), is eight weeks into his first graduate rotation at the metropolitan tertiary hospital in his home-town. He is working on a medical ward at the moment. Toby worked with his nurse preceptor for the first four weeks, mostly on morning shifts. Toby is back on an afternoon shift today (Saturday) after working his first five night shifts yesterday morning. Toby is still trying to keep track of his schedule and other commitments, like going hiking and cycling with his friends. Toby is tired today and frustrated because he didn't wake up to his alarm this morning and didn't go hiking to celebrate the birthday of his best friend. He is also disappointed that he cannot participate in his evening cycling group.
On shift
Toby has arrived 15 minutes before the start of this shift. He finds out upon arrival that he has never worked with the Nurse-in-Charge before, but he has met other nurses on the shift. Toby is a little apprehensive, but he is familiar with two of the patients he has been assigned from his previous night shifts and is assigned two more patients who will be discharged this afternoon. He prioritizes these activities as he prepares his shift planner because he has never planned a discharge before. Shortly thereafter, the Nurse-in-Charge informs him that skill mix has altered his patient allocations. One patient's discharge will be arranged by a different nurse, and Toby will receive a new patient from the Emergency Department.
|
Patient |
Age |
Diagnosis |
Relevant Information |
|
Mrs Janet Jones |
71 |
Pneumonia |
New entrance from the Emergency department (ED). Febrile and hypertensive on comming to the ward. For IVAB and chest X-Ray. Urgent bloods must have to be taken. Patient's housemates present as well as appear distressed. |
|
Mr Frank Williams |
62 |
Trans Ischaemic Attack |
Need minimal help Needs IVC to be detached |
|
Ms Frances Fernandez |
68 |
Hyperglycaemia |
Prepared for release. Discharge paperwork has already done in morning shift nurse. Pharmacy has distributed discharge medications and has directed education of patient. Wait to pick up by the family. |
|
Mr Gerald Sommersby |
83 |
UTI Increasing confusion |
New arrival from ED. Mr Sommersby is basically a Nursing home occupant. He is a high falls risk. |
With all of the admissions and discharges, Toby is overwhelmed. He is unsure of his ability to handle the remainder of his shift. Toby has failed to take care of Mr. Somersby, a patient who is lost, prone to falls, and wanders the ward. He decides to keep going, and it's time to hand over soon. Toby realizes at handover that he had not given Mrs. Jones her IVAB. Toby had programmed the observation machine to make observations on their own. However, for the previous three hours, he had neglected to check on this patient. Toby has been attempting to prevent Mr. Somersby from leaving the ward, but he has not yet completed the admission paperwork for him. When this information is given, the nurse he is giving it to squirms. Additionally, none of his patient notes on the COWS machine have been completed by him. Toby continues working for the remaining 30 minutes of his shift.
The table given above consist of the patient allocation of Toby.
Following his shift
Toby is extremely stressed as he travels home and feels as though he did not provide Mrs. Jones with adequate care. He is angry with himself because he might have missed other things this shift and had to stay late to finish his notes for the patients. He reflects on his shift at home and plans to ask his nurse preceptor for any tips or advice for their next shift together.
Analyse the given case study and answer the following three questions in essay form:
- Describe and analyse if the graduate RN met or did not meet their roles and responsibilities as RN during this shift. Give at least two case study examples and use evidences including Nursing and Midwifery Board Australia (NMBA) Registered Nurse Practice Standards (2016).
- Give at least three recommendations as how the graduate RN could take this shift in different ways. Discuss the roles, skills, knowledge and attitude of RN using technological and team working skills in your discussion and support it with literature.
- It could be tough to transit in to a Graduate Registered Nurse from a student. Describe at least two strategies that could be applied for the promotion of resilience, build capacity and support work/life balance during the transition period of RN.
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