Transitioning to professional practice is a critical phase for the novice Registered Nurse. Managing professional role requirements, organisational technologies and team dynamics while on shift can be challenging. This is often accompanied by changed personal circumstances, with graduates balancing shift work, working full time and socialisation with friends and family. The case study below highlights the professional and personal challenges you may face as a Graduate Registered Nurse.
Critically analyse the following case study to answer the essay questions.
Case Study Background
Alex is a Graduate Registered Nurse (RN) who is 8 weeks into his first graduate rotation at the local metropolitan, tertiary hospital. He is currently working on a gastrointestinal ward which cares for medical and surgical patients. For the first four weeks Alex worked alongside his nurse preceptor, predominately rostered on morning shifts. Alex has just completed his first five (5) night shifts yesterday morning, and is back on an afternoon shift today (Saturday).
Alex is still trying to manage his roster and other commitments like playing sport and catching up with friends. Today, Alex is feeling tired and frustrated because he slept through his alarm this morning and missed a family breakfast to celebrate his sister’s birthday. He is also disappointed that the he can’t watch tonight’s football game with his friends.
Alex has arrived 15 minutes prior to this shift starting. On arrival, he realises that he hasn’t worked with the Nurse-in-Charge before but there are other nurses on the shift that he has met.
Alex feels a little nervous, but he knows two (2) of the patients he has been allocated from his recent night shifts and he is allocated a further two (2) patients who are to be discharged this afternoon. He has not arranged a discharge before so he prioritises these activities as he prepares his shift planner.
A short time later the Nurse-in-Charge tells him that his patient allocations have changed due to skill mix. A different nurse will arrange one (1) patient discharge and Alex will be receiving a new patient from Emergency Department.
His patient allocations are now as follows:
Patient Age Diagnosis Relevant Information
Mr James Maple 64 Haematemesis and melena New admission from the Emergency department. History of Hepatitis B and is in end stage liver failure. Reviewed by the Senior Gastroenterology Registrar. Requires monitoring and investigation. Urgent bloods have been taken. Patient’s family present and appear distressed.
Ms Rashida Baqri 32 2/7 Post appendectomy Ready for discharge. Discharge paperwork has already been completed by morning shift nurse. Pharmacy has delivered discharge medications and has conducted patient education. Waiting for family to arrive and pick up.
Ms Jane O’Sullivan 55 2/24 Post Lap
Cholecystectomy Requires routine post-operative anesthetic observations. Patient is complaining of minimal pain however is feeling nauseated.
Mr Ernest Iwu 78 6/7 Post Bowel
Resection Waiting to be transferred to rehab for further strength conditioning prior to returning to his independent living unit. Vitals have been stable and patient requires minimal assistance with activities of daily living.
Alex feels overwhelmed with the admission, discharge and post-operative patients. He is unsure how he will cope with the rest of his shift. Alex has not looked after a patient with end-stage-liver-failure-before but he decides he must push on, and soon it is time for handover.
At handover, Alex realises that after he had given Ms O’Sullivan an antiemetic, he had set the observation machine to take automatic observations. However, he had forgotten to go in and check this patient for the last 3 hours. Alex has not yet completed the admission documentation for Mr Maple. The nurse he his handing over to rolls her eyes when this information is handed over. Additionally, he has not completed any of his patient notes on the computer on wheels (COWS) machine. Alex stays 30 minutes after the end of his shift to complete his work.
Following his shift
On his commute home, Alex feels really stressed and is not sure if Ms O’Sullivan has experienced any post-op complications. He is frustrated with himself that he may have missed other things this shift and that he had to stay late to finish his patient notes. At home, he spends some time reflecting on his shift and plans to ask his nurse preceptor for any advice/tips on their next shift together.
Assessment Task 2
Alex appears to be struggling during his clinical shift. He also seems to be having difficulty maintaining a work/life balance. Critically analyse the case study to help you answer the following essay questions.
1. Determine and justify whether the graduate RN met (or did not meet) their role and responsibilities as an RN during his shift. Support your discussion with at least two (2) of the Nursing and Midwifery Board Australia (NMBA) Registered Nurse Practice Standards (2016) (LO1 & 3).
2. Construct at least three (3) recommendations as to how the graduate RN could have undertaken this shift differently. Consider in your discussion the knowledge, skills and attitudes inherent in the RN role, including utilisation of technology and teamwork skills, and support your discussion with literature (LO2, 3, 5 & 6).
3. Transitioning from student to Graduate Registered Nurse can be difficult. Construct at least two (2) evidence-based strategies that could be implemented to promote resilience, build capacity, and support work/life balance during the graduate RN’s transition period (LO3, 4, 5).
• Word limit is 1800 words (+/- 10%), including the introduction and conclusion.
• Paper to be written in essay format, must answer the above questions, and should be written in academic writing style (not first person). You may use headings.
• Ensure you consider the AT2 Rubric, Appendix 2 in the Unit Outline, when undertaking this assessment task.
• Submit your paper to Turnitin by the due date.
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