NRSG367 

TRANSITION TO PROFESSIONAL NURSING ASSESSMENT TASK 2 CASE STUDY

AUSTRALIAN CATHOLIC UNIVERSITY

Introduction

The Health care industry is the backbone of every economy, and nurses play a pivotal role in this complex system. Patients come in direct communication with the nurses; thus, nurses have an intricate role in patient satisfaction and treatment. Registered nurses witness various problems when they come across a real-world clinical scenario.  The journey from a nursing student to a registered nurse is not easy and full of multiple feeling ranging from excitement, anxiety and stress. 

It is very rare to find nurses off duty. Being a part of the community, nurses are considered as the heroes, so it is quite apparent to have a blurred line in between their job role and daily life. Nevertheless, they must turn off their nurse role deliberately for some time and spend quality down-time with family and friends. The word “work-life balance” states a position of well-being to enjoy their personal life along with their fulfilled job responsibilities in a healthy manner. When work-life is not balanced, with constant responsibilities, one can become overwhelmed.  

In this case scenario, Alex was posted in the gastrointestinal ward as RN, who was taking care of a medical and surgical patient of the same. After completing his night shift, he was in afternoon shift and found that Nurse in charge on the afternoon shift was new for him. While entering in the ward he was nervous and anxious. Still, soon he realised that among the allocated patients, two were his known cases as he met with their medical condition during his night shift and remaining two were planned for discharge. As per his previous experience, he never prepared any discharge; so accordingly, he prioritised and did discharge work as his shift planner. Sooner he got information about changes in patient allocation through nurse in-charge due to overlapping of skills. So as per changes, he was having only one patient for discharge and the other one was replaced by new patient coming from the emergency department. Therefore, in total, he was supposed to take care of four patients out of whom one patient came from the emergency unit, second; discharge of the patient with case of appendectomy, third; the patient with post lap cholecystectomy and fourth; post bowel resection patient. After knowing about his all four patients’ conditions, he was feeling overwhelmed, and he worried how he will manage his entire shift.

Analysis of the role of the Nurse

After critically analysing the case, I found that being a registered nurse; he has not fulfilled his roles and responsibilities. As per nursing and midwifery board Australia, practice standard (3), he has to show his capability and accountability towards his practice which is not depicted by his performance (Nursing and Midwifery Board of Australia, 2018). During his shift hours, he did not do the admission process of the new patient for which he stayed for more 30 minutes. He did not show accountability towards the patient who underwent to the lap cholecystectomy having complaints of pain at surgery site and nausea. Postoperative cases require routine postoperative anaesthetic observation; instead, he set him on observation machine that did automatic observation after giving antiemetic medicine. Still, for the last 3 hours, he didn’t check patient’s vital parameters, this irresponsible behaviour which may have given rise to the significant complications towards patient health (Giuseppe et al., 2020).

Secondly, nursing standard (6), which directs the RNs to provide safe, appropriate and responsive quality nursing practice, is also not followed. (Nursing and Midwifery Board of Australia, 2018) He had a total of four patients out of which two patients were stable, but the other two needed patient-centred care. He should have prioritised the patients as per their condition and dependency so that he could maintain quality of care. In the case study, the patient who came from emergency department was in his end-stage of liver failure and it indicated that the patient needed palliative care. (Santivasi et al., 2017) In such cases, a nurse has to give spiritual, psychological and practical support to the patient’s life-threatening conditions and also to his family members (Kathpalia et al., 2016). As per the review of gastroenterology registrar, it is recommended to monitor and investigate the patient continuously.  In the given case, the blood samples of the patient were taken urgently, which shows patient condition was critical. Parallel to this, he kept waiting for the other patient who he has to shift to the rehab so that the patient can return to his independent living unit, even when the patient needs minimal assistance for his safety. Despite trying to providing safe, appropriate and responsive patient care, he was attempting to complete somehow his shift hours (Nursing and Midwifery Board of Australia, 2018).

Recommendations

For the provision of adequate care and safety, Nurses should incorporate attitude, skills and knowledge so that she/he can make right decision and judgment (Nursing: Essential Knowledge, Skills and Attitudes, 2008). New graduate nurses during the first year of their practice, face various challenges and issues. This transition period is very demanding and involves varied experiences and concerns which may affect their transition process. During the transition from student to graduate nurse, I will recommend the following strategies to overcome these problems:

1. Knowledge and skills of nursing: While practising as a nurse, it is essential to have these skills. In this case, Nurse has asked to perform various clinical tasks, including blood sampling, patient admission, discharge, and transfer along with the patient care as per patient health needs and dependency. Here Alex has to work as a critical thinker based on which he can provide care to the life limit patient who came from the emergency department. The Nurse should show good evidence of clinical judgment based on which he should prioritise the patient as well their needs to prevent negligence. Alex forgot to look after postoperative patient after he shifted him to the observation machine, which is a sheer negligence. Lastly, he has to work as a decision-maker also. On this basis, he should have lined up the transfer process for the patient who was to be transferred in the rehabilitation department.
2.  Teamwork with good Communication skills:  The Nurses should have good communication skills for nursing intervention and interaction. Alex should have interacted with the nurses on duty and discussed the issues he faced, may be that would have helped him reduce his anxiety.  On the communication ground, Alex can collaborate with other health teams for shifting and sampling. Along with it, he should counsel and ensure support to the family members, who were distressed due to their loved-one’s condition. Good nurse-patient interaction is vital so that patient can have a warm, positive and passionate experience during their course of treatment in hospital stay (Dithole et al., 2017). Effective communication also helps in preventing patient harm. If checked frequently being a good listener, he can also reduce his emotional and physical distress which he was experiencing at his work (Ayuso-Murillo et al., 2017).
3. Proper time management:   In our lives, time is found to be the most valuable commodity. Here, Alex needs to observe his professional and personal time efficiently. Doing documentation about patient notes is simple and less time consuming if it is performed on computer on wheels (cows) machine for that knowing how to operate is crucial. However, Alex demonstrated poor time management while taking care of the patients. He can manage his working hours effectively by setting goals, prioritisation, planning for the action and prevention of time waste (Meiring, 2017). As he has newly joined, he has to first structure his day based on his patient assignment so that he can utilise his time productively. Naturally, stress and distress can arise while working which can be reduced if he prioritises the patient as per his knowledge so that he can impart a quality of care to the patients (Blevins & Millen, 2016).

Strategies for Effective Transition

In today’s complex health care system, a significant transition is playing a pivotal role in nursing. It is essential for nurses to sustain adverse condition, continuous focus and looking forward to an optimistic future. Resilience, work-life balance and self-protection are some essential life-saving skills. Resilience is a dynamic process which consists of internal and external factors which can be learned and build up over time. The transition from a student into a graduate registered Nurse; nurses experience many challenges to their practice setting (Wei et al., 2019). Following are the strategies that can be implemented during the transition period:

1. Resilience and Self-protection: During the early period of work behaviour of self-protection was present when nurses are having internal stress between their work realities and expected role. Holly et al., in 2018, conducted a study to find out nurse leader strategies so that resilience can be cultivated. The study depicted that cooperative strategies are essential during the early phase of transition. Under such practices, the participant has to work with the experienced staff with a positive mind-set so that one can become competent enough to cope with the challenges and work pressure. As per evidence, studies shows that self-protection under cooperative work is an effective strategy (Resilience in new nurses, 2020). 
2. Undertaking challenges:  in this strategy, the Nurses have to change themselves if they fail to change external working factors. Niuniu et al., (2020) conducted a qualitative study on the psychological experience of caregivers of COVID-19 patient and found that negative and positive emotions among nurses coexist while dealing with the patients and their positive emotions appeared gradually while negative emotions were dominant. So the development of competence is vital to deal which can be achieved by building self-confidence, clearing negative emotions, exploring knowledge and more learning. More learning is one of the vital strategies so that they can cope up with the work challenges and pressure. Under this learning activity nurse has to build up their abilities and skills like learning how to operate the new instrument, how to deal with the patient crisis, how to prevent the conflict in work-place and many more. 

. Conclusion

Hence the nurses have a substantial role to play in ensuring patient's care. Especially during the process of shift change, admission and discharge nurses have to be more careful and skilful. The nursing standards state that even during most stressful situations also, the Nurse should abide with patient-centric and compassionate caregiving plans (Nursing and Midwifery Board of Australia, 2018).  Physical, mental and emotional well-being of nurses is quite imperative to impart complete care to the patients (Whitehead et al., 2015). Thus, it is essential to focus on practices which could help Nurse to strike a work-life balance and attain total well-being.