Introduction

Nurses play a role of patient’s advocate providing nursing and medical care during the chronic or acute mental or physical ailment. Often with the increase in the responsibilities and work pressure, the nurses are observed to suffer from job stress and frustrations due to the increased workload, lack of support and repetitive work.  Several consequences due to the dysfunctional process of working amongst the nurses have been observed to have caused stress demanding the need of established network and support from the families, superiors and peers. In the case study, Alex, who has been transitioning from being nursing to a registered nurse handling a different kind of patient, a different type of constraint, has been observed. The current study will involve in understanding the role and responsibilities that were expected of Alex and the extent he was able to achieve them. Further, the study will also analyze the possible steps that need to be adopted by Alex to have a smooth transition to his RN roles.

Role and Responsibilities of RN

In the case, it is observed that Alex has been handling four patients, of which one was for discharge while the other three were post-operative patients. In addition to his inexperience in the handling of an end-stage patient suffering from liver failure, he was stressed previously due to his inability to handle work/life balance. According to the standards provided by the Nursing and Midwifery Board of Australia, two of the important aspects of the guidelines that can be utilized in evaluating the role of Alex as an RN in handling his allotted patients are the demonstration of accountability and capability in nursing practice and ability to carry out comprehensive assessments.

As a part of the Standard 3 guideline, of NMBA, it is the responsibility of the registered nurse to understand his scope of practice and practice nursing following the legal parameters (Fisher, 2017). This can be achieved not only by practices a safe and effective practice with professional development but also involving in timely documentation and consultation. It is a crucial responsibility of the RN to identify, manage and document any risk and complexity that has been observed in the patient. This will help the nurse in following a quality practice without compromising the safety of the patient (Xu et al., 2019). In the case study, it is observed that Alex was struggling to complete his duties that involved in both caring the patient and also maintaining complete documentation of the patients.  

In several occasions, the case study highlights that Alex, during his shift, forgot to complete the admission documentation of Mr Maple. According to the clinical guidelines in Australia, nursing documentation reflects good communication. It is vital that the nurse completes the documentation within 3 hours of the admission. This makes the handover easier. However, in the case study, it can be observed that Alex handed over the patient to the next nurse without filling the documentation which can involve in consequences like poor patient care(Nagle et al., 2017). Hence, as per the NMBA guideline, it is the responsibility of Alex as RN in considering the situation and responds to them in a timely manner so that the well-being of the patient can be maintained his capability of practice.

Further, according to the NMBA guideline Standard 4, it is important for the RN to carry out a comprehensive assessment of the patient that will allow them to perform better and provide enhanced patient care (Mellor& Gregoric, 2016). The RN needs to critically gather information related to the condition of the patient so that he can utilize them in the critical analysis of the patient and decides on the care process. If required, it is important for the RN to carry systemic analysis by following certain assessment techniques. Communication of the assessment and anticipating the outcomes of the care process are some of the important basis of the nursing practice. In the case study, it was evident that Alex, at the end of his shift, was stressed; however, he realized there were certain gaps in his practice during his shift. One of them was he missed checking up the Ms O’Sullivan case history and verifying whether the patient was suffering from any post-operational complication. Moreover, even without verifying with Ms O’Sullivan’s post-operative condition, Alex initiated antiemetic drug therapy with automatic observation but forgetting to take a follow up of the patient’s condition after one hour.

Recommendations for conducting shift differently

It is necessary for any registered nurse to provide care under a diverse care setting involving a patient with different acute, residential, community and extended care setting. Under the immense workload, the RNs plays an important leadership role in the coordinated healthcare and nursing so that the patient can acquire optimal health outcome (Magtibay,Chesak, Coughlin& Sood, 2017).The professional development of the registered nurse can develop with the improvement in the quality of care that is provided by the RN. This can be achieved through effective learning, professionally developing oneself, clinical supervision, following the clinical practice and development policy guidelines (Eslami, Elahi,Mohammadi & Fallahi, 2017). 

Three of the recommended steps Alex can follow so that he develops in his practice and can take effective decision while handling his work. The first aspect that Alex needs to consider is to be aware of the legal as well as the ethical responsibility of Alex as a nurse.  This will require Alex not just to have the theoretical knowledge related to care but also, he will have enhanced knowledge in terms of the accountability in practice and functioning according to the legislation that impact on the healthcare and nursing (Van Den Oetelaar et al., 2016). The second aspect which Alex needs to develop and implement in his nursing practice is critical thinking as well as analysis. Critical thinking in the nursing practice emphasizes on self-appraisal with the professional development that provides value to practice (Cashin et al., 2017). Hence, when he makes an error in the nursing practice, it is crucial for Alex to reflect on the feelings, beliefs and mistakes that he has made during the practice and what are the various consequences that can occur due to the gap in his practice.  This will help in the effective planning and management of his work.

Lastly, Alex needs to collaborate with his supervisor or preceptor as wellas peers in his work process. As mentioned by NMBA, collaborative practices help in establishing as wellas sustaining a professional relationship between the nurses. This improves the competencies of the RNs and the interdisciplinary team, thereby providing enhanced care. Hence, in the case study, it was observed that Alex failed to integrate organizational guidelines and policies when he did not complete the documentation of Mr Maple. Further, in the case, it can be observed that Alex being new he does not interact much with the rest of the nurse. This prevented him from collaborating with the other nurses and get assistance in the decision-making process.Especially, an experienced nurse would have guided him in reviewing the case history of Ms O'Sullivan before administration of the antiemetic drug. This would have helped Alex in verifying whether Ms O’Sullivan has any post-operative complications.

 Further, he would have been reminded of checking with the patient after a certain interval of time. Thus, teamwork and support would have an effective aid that will help Alex in improving his performance, avoid work-related stress and take better decisions (Haslinda & Tyng, 2016). Further, the nurse who has been handed over by Alex would have been more supportive, considering that Alex is new to the role of RN. As the case highlighted that the nurse was irritated by the lack of Alex's professionalism when he explained he could not fill the documentation for Mr Maple, which was part of his responsibility. In a better collaborative environment, the nurse would have been supportive and helped in filling the essential information and assist Alex in coping with the workload in future.

Evidence-based strategies in the implementation of promoting resilience

As the case study highlights, like Alex, it is quite common that the nurses suffer from workplace stress. As mentioned by Black and Honeyman (2020), often orientation leads to a stressful situation with enhanced occupational stress leading to burnout. These will not only impacts on the well-being and health of the nurse but also impacts on the safety of the patients.  As observed by Terry et al. (2020), the RN who has been newly licensed faces several challenges while they are going through the transition from student to the hospital environment. The complex settings with multi stimuli as well as information with the reduced time in the decision-making process for the challenging patient (Forde, McMahon,Hamilton& Murray, 2016). This will need adequate preparation time management, abilities for critical thinking and knowledge. 

Some of the evidence-based strategies and model that can be implemented can helped  in the well-being of the nurse and the patients and control stress, burnout and emotional fatigue in patients. One of the strategies includes Stress Management with Resiliency Training Program (SMART). This program will involve in the resilience training of the nurses and also help them in coping with the building stress due to workload (Birks, Davis, Smithson & Lindsay, 2019).  Some of the aspects that the participants of this program learn to include the development of the ability to reframe life experiences with the development of intentional attention. Further, as mentioned by Qiao et al. (2018), it also involves in building five principles within the new RNs that involves gratitude, forgiveness, compassion, higher meaning and acceptance.

Several feasibility studies have been carried out to study the feasibility of the strategy, and it was observed that the program helps in overcoming anxiety and stress and enhances resilience and mindfulness amongst the nurses. The second strategy that can be utilized is the Work-related support from families and coworkers of the nurses that helps the nurses maintaining work/life balance. As highlighted by Black and Honeyman (2020), an individual’s attitude plays an important role in shaping the complex context in terms of family and workplace.

In one hand, the occupational stress which is caused due to the negative attitude while the social support from families and coworkers helps in the development of positive attitude amongst the nurses (Powell, 2018).This kind of intervention is also known as ICOPE or Interactive Communication involving Openness, Passion, Empowerment that allowed the nurse to collaborate and communicate more with their peers so that the balance in their work and life were achieved.

Conclusion

Hence, it can be concluded that while making transition student phase to the hospital setting, the newly registered nurses face challenges that create excessive stress and anxiety. This results in impacting on patient care that is provided by the study. It is important that the hospital management adopts certain intervention strategies that will allow the new nurses to adapt to the different work environment with the support of the supervisor and peers that will help in higher productivity of the nurse.