Case Scenario: Gaps and Negligence in the Nursing Profession
Nursing practice involves integrating skills and knowledge, and then applying them appropriately to the care of patients. Regardless of the level of education, all nurses must practice core competencies that they learn at school to improve the condition of patients. Some of the skills include infection prevention, monitoring the intravenous fluids, and drug administration. However, in some cases, it does not happen as expected. The first case scenario under consideration is the new graduate called Drew who has just started practicing under a preceptor. The second case scenario is about Lindsey who does not perform nursing procedures as expected. This paper examines the two case scenarios and their relevance to improving the care of patients.
The Case Scenario of Drew
Significance of Gaps in the Nursing Textbook, Hospital Policy, Published Literature, and Actual Practice
The significance of gaps in the nursing textbook. Nursing textbooks contain basic procedures that nurses have to apply to the care of patients. For instance, Weston (2014) published a book that teaches nursing students various competencies of infection prevention. However, it does not address the importance of considering particular hospital policies that may be different from the ones in the book. Such gaps are common in many nursing textbooks. Eggertson (2013) contends that such disparities influence the care of patients negatively because nurses have to start adhering to a different set of procedures for which they were not prepared adequately.
The significance of gaps in the hospital policy.The hospital policies need to align with the procedures that textbooks used at nursing school contain. Azimian, Negarandeh, & Fakhr-Movahed (2014) argue that any lack of information between the two can make nurses have challenges coping with new procedures. Consequently, it can result in job dissatisfaction among the newly employed nurses and poor patient outcomes.
The significance of gaps in the published literature.Stevens (2013) ascertains that published literature is paramount because it forms the foundation for the evidence-based practice. Any gaps between what is taught in the nursing textbooks and the published literature and what is practiced in hospitals regarding any given procedure can result in differences in practice among nurses. Eventually, it can lead to differences in executing procedures at the workplace and affect the outcome of patients negatively.
The significance of gaps in actual practice.Drew notices differences in practice between the two experienced registered nurses. The second nurse does not practice infection prevention procedures adequately like the first preceptor. Mathur (2011) contends that not embracing such critical procedures can result in increased nosocomial infections among patients.
Culture of Safety
According to the American Nurses Association [ANA] (2016), the concept 'culture of safety' involves a situation where the collective and sustained commitment by organizational managers, leadership, and healthcare workers lead to implementing important values and practices that stress on patient safety over other competing goals. The focus of the concept ‘culture of safety’ is usually on sharing the commitment to facilitate the safety procedures with the aim of improving patients` outcomes. ANA (2016) ascertains that 'culture of safety' promotes accountability and transparency among the healthcare workers and it helps them learn from their errors. According to Weaver, Dy, Lubomski, & Wilson (2013), leaders and all colleagues should work together to encourage and promote the safety behaviors in the health care environment.
In the first case scenario, the second preceptor is not performing the nursing procedures according to the expected standards despite having experience. Consequently, Drew is concerned that the patients are at risk of infection. Drew is also afraid to judge the technique of the second nurse. According to Weaver et al. (2013), the concept ‘culture of safety’ combines the efforts of healthcare providers and helps them correct one another in the case of any errors. The ‘culture of safety’ is thus necessary in this situation because it can promote collaboration between the two, which can make it easy for Drew to correct the mistakes of the second preceptor. This idea can improve the relationship between Drew and the second nurse, prevent infection of patients, and thus, enhance the outcomes of patients.
Drew’s Options for Managing His Concerns and Protect Patients from Unsafe Environment
In spite of the fear of correcting the nurse, Drew can take necessary steps to manage his concerns and prevent patients from the unsafe environment. First, Drew must focus on improving his relationship with the nurse. Improved interpersonal relationships among nurses can create order at the workplace and promote patient recovery (Lapeña-Moñux, Cibanal-Juan, Pedraz-Marcos, & Macía-Soler, 2014). Accordingly, Drew can ensure that he consults the nurse before conducting the expected procedures. Frequent consultations can make the nurse curious of neglecting the required practices. Eventually, the nurse can implement the procedures often to show Drew, which can improve the relationship between them.
Secondly, once Drew is sure of the improved rapport, he can be open to the nurse about the unsafe practices. Specifying negligent practices of the nurse and the dangers associated with them is one of the most critical steps to prevent patients from the risk of nosocomial infections. If Drew does not do it, the nurse can proceed with the unsafe procedures, and patients would continue being at an increased risk of infections.
Drew’s Role in Quality Improvement
According to Izumi (2012), providing qualitative nursing services and commitment towards improvement is a responsibility that every nurse should embrace. In this case, Drew has various duties to ensure continuous qualitative improvement. First, it is within his responsibilities to make sure that he observes the safety practices that he learned at school. Secondly, he must follow the policies of the hospitals that advocate for patients` safety. Third, Drew must remind the nurse on the importance of observing the standard precautions such as hand washing. Finally, Drew must document the procedures that he undertakes and pass the report to the incoming nurse to ensure continuity in the delivery of quality nursing services.
The Case Scenario of Lindsey
Izumi (2012) advocates for responsibility and accountability in nursing since it improves patients` outcomes. Mueller & Vogelsmeier (2013) reiterate that even when delegating duties, nurses must be responsible and ensure quality and safe interventions for their patients. Conversely, Lindsey rarely performs the required procedures and becomes angry when questioned. Being disheveled and neglecting in administrating the required drugs is a sign that Lindsey might disregard professional ethics and critical nursing duties. In this case, the first action includes making Lindsey aware of the required expectations from a nurse. Additionally, it is paramount to provide advice on the importance of upholding those expectations. In case Lindsey neglects the advice, other steps can be taken against her.
If Nothing Is Done
If Lindsey does not receive the necessary advice on the basic expectations as a nurse, she is likely to continue her unsafe practices. Eventually, the hospital might notice her irresponsible behavior and fire her. Happ et al. (2011) argue that patients in the intensive care unit (ICU) require constant nursing care, particularly pain management. Such care is associated with improved patients` outcomes. If nothing is done, Lindsey might jeopardize the expected health outcomes of patients in the ICU. Consequently, she can taint the image of the entire hospital.
Gaps in knowledge and practice are common in the nursing practice. Some nurses do not embrace the standard precautions they learn in textbooks at schools. This habit occurs in some situations when nurses are alone or in charge of the environment in which they work. Therefore, fresh graduates from nursing schools can help to emphasize the importance of upholding the safety practices. Eventually, nurses can adopt the ‘culture of safety'. Additionally, some nurses become irresponsible after practicing bedside nursing for some time such as the case of Lindsey. It is critical to make such nurses aware of their expected roles because they can adversely affect the reputation of the entire hospital negatively.