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Strategies For Transition Into Practice: The New Nurse Case Study Assessment 3 Answer

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.


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.


1. Introduction

In a demanding and unique environment of more patient- to – nurse ratio and compound needs of the patient, new nurses are incoming. Their exposure towards real-world clinical scenario before practice is limited due to the issue of their license.  Moreover, they have the feeling of insecurity due to a multitude of problems which develops a sense of insecurity. This transition of becoming a registered nurse not only has the feel of excitement, happiness; however, anxiety, uncertainty, and fear also reside within them.

In this given case scenario nurse was in night shift alone, taking care of 7 patients out of which one was acute ill. Meanwhile, one patient arrived, and she found her stable complaints. Later on, her admission documentation carried out by a student nurse along with all subjective and objective data, and the student nurse detected that the patient is in escalation condition as she scored six or above which is an alarming state. Then, the nurse consulted with the doctors immediately and assessed physical parameters, including temperature, signs of infection and left the patient for rest. After 3 hours, the nurse did reassessment and found patient’s condition was deteriorating; too low blood pressure, high heart rate, breathing difficulty, lowered oxygen saturation and also altered conscious level. After critically analyzing the case, the nurse found that patient had sepsis which is one of the fatal health problems that shows altered regulation of normal physiological reaction towards infection. Life-threatening organ failure condition may get arise by both pro-inflammatory and anti-inflammatory (Rhodes et al., 2017).

The nurses must follow the Professional standards of NMBA’s in order to practice in Australia (Australian Nursing and Midwifery Accreditation Council 2013; Duncan, 2015)

2. Three Nursing Practice Standards 

In this scenario, three relevant standards for nursing practice are (Ordre des infirmières et infirmiers du Québec, 2016):

  1. Maintains the capability of practice (standard 3): As a professional practitioner a nurse has to do a thorough assessment of the patient and then based on the analyses of the obtained patient’s data she has to make diagnoses which should be priorities as per need. Henceforth, the expected outcome is formulated. However, in this case, after obtaining a warning alarm by patient score, she left patient unattended for 3 hours. This situation requires the frequent reassessment to prevent clinical deterioration.
  2. Critical thinking and analysis (standard 1):  Being a critical thinker a nurse has to analyze and evaluate the patient condition skilfully. Being a critical thinker in this case nurse has to plan to solve the problems of a patient who was drug addict though she knows that withdrawal from drug or alcohol causes immense pain and leads to the degrading condition.
  3. Collaborative and therapeutic practice (standard 2): For the delivery of the safe, comprehensive, therapeutic care interdisciplinary collaboration is essential. As in this condition, nursing demands increases due to heavy patient loads which may lead to communication gap or miscommunications. Here, the assigned nurse immediately contacted to multidisciplinary department like ECG, USG, laboratory, after the health condition of lady declined. In this case, to decrease the chances of undesirable events inter-professional collaboration, communication, teamwork was enhanced, and it accounted for the prevention of loss of life.

3. Principles of NMBA Code of Conduct

  1. Person-centred practice (principle 2): For the health and well-being of the patient a nurse has to give client-centred care (Epstein & Turner, 2015). But in this case, a patient who was admitted with the complaint of groin abscess was demanding for the medication for his pain, but allocated nurse left the patient without medicine though he was unwell. However, evidence-based practice for the quality of care is expected (Nursing and Midwifery Board of Australia, 2018).    
  2. Teaching, supervising and assessing(principle 5): Highest standard of practice has to be taught by the nurse to the student nurse so that they all can work efficiently and effectively and by which standards of practice can be gain (Nursing and Midwifery Board of Australia, 2018). In this case, the supervision of the third-year student during the admission process was neglected. The nurse could supervise the student while doing patient assessment so that early detection and early management is initiated.

4. Elements of the International Council of Nurses (ICN) Code of Ethics

  1. Nurses and people: The nurse has to consider the values, customs, spiritual beliefs, human right of the patients and their family members as well. In this, she was expected to reflect responsiveness, compassion, and trustworthiness as a professional value so that optimum health can be achieved, but here assigned nurse was waiting for the staff that was allocated for routine morning observation despite knowing that lady needs reassessment as per her obtained health alarm. (The ICN code of ethics for nurses, Revised 2012; American Nurses Association, 2015b).
  2. Nurses and practice: The nurse should not compromise with the capability of giving care. In this given case, the nurse was tired and was sleepy due to which she could not attend patients properly. A total number of patients in the ward were seven among which one was unwell, and level of consciousness was on the wrong side of sleepy. Moreover, she did not do the admission work of the new coming lady patient, and for this, she asked the student to do. However, Personal conduct should be maintained every time, and while delegating responsibility, it is important to be judgmental related to the competency of the individual (The ICN code of ethics for nurses, Revised 2012).

5. Ethical Principles 

Ethical principle relates to the best action. In this patient perspectives and values are accounted for by the nurse (Presidential Commission, 2015). Two ethical principles are (The ICN code of ethics for nurses, Revised 2012):

  1. Beneficence, Principle 2 (do well): This principle of beneficence is about nurses’ action for good work and patient-centred care. In their haste, she needs to give care carefully not on the base of her perception or patient perception it should rely on the demands of the patient health condition so that good action can intervene but in the present case without thorough assessment nurse concluded that patient is all right. (Pieper & Thomson, 2016). 
  2. Non-Maleficence, Principle 2 (do no harm): As per this principle, one should not harm the patient. Here even after knowing that the patient is in escalation condition nurse left the patient for rest without reassuring any deteriorating changes.  As an obligation nurse has to promote good health by preventing and removing bad situation among patient. All the actions should be as per patient risk, benefit and consequences (Pieper & Thomson, 2016). 

6. Safety and Quality Health Service (NSQHS) Standards

These NSQHS standards are formulated for improving the quality of provision of health services and for public protection. As per relevancy, in this case, two NSQHS are:  

  1. Comprehensive care standard: Under this standard comprehensive care is provided so that specific risk of harm while providing care to the patient can be prevented. In this case, a nurse has to evaluate the patient issues and their impact upon well-being and life. By targeted strategies, risk of harm for the patient can be managed and prevented (OHSC, 2016). 
  2. Communicating for safety standard: Across the health organization, effective communication is essential with the multidisciplinary team, patient and families while providing health care to the patient. In this case, the nurse has to communicate effectively about the critical information that when the emergency situation emerges or changes, she was expected to do documentation of essential information, handover of the patient so that safe patient care can be planned (The Joint Commission; 2016).

7. Three challenges faced whilst transition from novice to registered nurse and the strategies to overcome such challenges

Transition is the process when one state or condition is changed to another. During the transition from the novice nurse to the registered nurse, not only happiness and excitement exists, but also fear, anxiety and uncertainty are experienced.  At this time, new graduates think about their ability, and career choice as multitudes of issues are raised, which give a feeling of insecurity. People often describe this transition period as a complete reality shock, and it has to be faced because nursing comes with the extra possibility that you may badly hurt or kill another person. Every nurse has faced some challenges as a turning point from being a registered nurse from studentship (Wong et al., 2017).  The transition period is considered as first 12 months after graduation when a nurse transit from a student into a qualified nurse. 

Though many challenges are being faced by novice nurses and out of the three are; (Wong et al., 2017):

1. Performance anxiety

Fresh nurse graduate feels stressed due to the performance anxiety, particularly in the change of role and change in the working environment. During the clinical orientation, continuous observation and evaluation are done to determine the progress. This observation, along with inexperience, leads to performance anxiety. This performance anxiety is also increased by the work overload in the ward.

2. Communicative problems

Lack of communication is an important challenge that is faced by new nurses. This includes communication with staff, colleague and patient. New nurse face difficulty in development of connection with the patient, family of the patient, a patient of the opposite sex and with the staff. Many times this problem also exists while reporting the status of the patient to the doctor. The communication problem may have serious consequences for the patient with an emergency.

3. Managerial challenges

The managerial role is also an important challenge for the new nurse, and it is due to lack of practical experience, lack of knowledge about the policies and interaction with the team. This challenge reflects the ability of a new nurse as an administrator and coordinator of care teams. Due to the lack of nurses, the new nurse is given the responsibility of shift manager and lack of competence will create problems (Hazaveh et al., 2013).

Strategies to overcome such challenges

Transitional challenges like work satisfaction and stress may lead fresh graduates to leave their jobs. Including this, the gap between educational training and practical clinical practice at the hospital may cause to decrease of quality patient care and performance of novice nurse. Nurses require some time for adaption for a change of roles and responsibilities, identity, and new environment, basically in a situation when they are switching from a protected college environment to real-world where the care of the afflicted is required.  The duration of adaptation varies from nurse to nurse (Wong et al., 2017). The many approaches, like residency, mentorship, and internships, have been implemented to solve the challenges faced by novice nurses. The educational mentors, nursing managers and other relevant persons need to create an environment for adaptation of novice nurses by providing appropriate orientation programs and training at the beginning of work. Including this, revision and amendment of the nursing curriculum may be helpful in solving these challenges to some extent (Hazaveh et al., 2013). 

8. Resilience and its application to the Nursing Profession

Resilience is a crucial aspect of the nursing profession. It is defined as a virtue to remain focused and composed in adverse situations. The nursing profession is accomplished in a stressful environment. Some common stressors are long working hours, dealing with sick people, professional demands and lack of time. These pressures have the negative effect of nurses and can impact their efficiency and personal well-being. Different complex and demanding situations in healthcare can cause physical and mental problems. Henceforth, healthcare professionals, including nurses, should learn to cope with these negative emotions and situations (Whitehead et al., 2015)

Resilience is a vital virtue which enables nurses to deal with work-related stress. Resilience helps an individual's to keep faith and aim in life by adapting to the unfavorable situation. Nurses working with critically ill patients and in an emergency, wards are more prone to such situation (Yilmaz, 2017).

Resilience can be learned with time and personal experiences. This virtue can be inculcated by involving in educational activities, and mentorship program for improving interpersonal characteristics. To Foster resilience, nurses can work on personal, workplace and social skills.  These interventions might help by developing positive professional relationships, by increasing optimism, spirituality and emotional strength (Min Leng et al., 2020).

The nurses can strike a work-life balance and can to deal with demanding situations by developing resilience.

Personal characteristics like optimism, hope, control, humour, adaptability, spirituality and cognitive skills can contribute to resilience. Similarly, developing workplace skills like sharing, learning, and work satisfaction can immensely help in developing resilience. At the workplace, it is essential to accept the point of view of mentors, colleagues and seniors. Lastly, improving Social network and developing healthy professional relation can largely contribute to this virtue. The nurses should develop a supportive, positive and healthy social network. They should try to strike a balance in life by practising self-care and taking time for activities like exercise, hobbies and rest.  

The mentorship programs, along with personal development, can immensely help in fostering resilience.

9. Conclusion

Hence, a nurse has to provide the utmost care to the patient who is unstable as the patient need can grow and can change. Most of the patients are dealing with the frightening conditions which have to be addressed immediately. In this situation, nurses have to expand their knowledge, and with her skills, she has to provide immediate assistance so that optimum care can be achieved. 

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