CNA346 Transition to Professional Practice

The transition from a new graduate nurse to a professional registered nurse (RN) can be a hectic one. Transitioning from a student nurse (SN) to an RN is a multifaceted and complicated process. Nursing requires a high level of competence and time management ability (Wong et al., 2018). Therefore, as a new nurse, it is important to have a comprehensive understanding of the Nursing and Midwifery Board of Australia (NMBA, 2017) RN standards of practice. It will help new nurses to guide through their daily activities. The following case study is going to discuss a new nurse, Toby; who is struggling with his work-life balance. Four patients were allocated under Toby during his shift. However, due to inexperience and work pressure, he fails to properly perform his task. This might hamper the standard of care and lead to poor patient outcomes. Therefore, the flowing essay is going to discuss what went wrong during his shift, recommendations to prevent such scenarios, and evidence-based strategies to improve his nursing capabilities.

After analysing the case study, few instances can be identified where Toby did not meet the RN standards, roles and responsibilities. Toby was assigned to Janet, who was diagnosed with pneumonia. She is newly admitted from the emergency department (ED). According to the nature of this disease, the patient can develop lung abscess and pleurisy due to the bacterial infection (Yin et al., 2017). As a result, the patient can develop airway obstruction, prolonged coughing, chest pain and shortness of breath. This condition can cause a decrease in the blood oxygen saturation level, which can cause hypoxia condition (Mandell & Niederman, 2019). Also, to minimise the level of infection, the administration of antibiotics are necessary. According to the NMBA RN standard 6 (NMBA, 2017), a nurse needs to provide safe and effective care to the patient. According to this guideline, the nurse needs to respond to their patient's needs and must perform all the necessary activities.

As per this guideline, the nurse needs to timely assess the condition of the patient, provide safe medication and identify potential risk factors. However, here Toby forgets to check on Janet for 3 hours; also he did not give Janet her intravenous antibiotics (IVAB) on time. Omission of antibiotics at appropriate times can cause sudden exacerbation of the symptoms. Moreover, Janet needs frequent observation, as she just admitted from the ED. In addition, she is hypertensive and febrile. Therefore, not providing antibiotics timely can increase the rate of fever, which can cause additional complications (DeWitt et al., 2017).

Also, as she has hypertension, it is important to take note of her blood pressure. According to evidence, increased blood pressure can cause cardiovascular problems, which can be fatal (Kjeldsen, 2018). Hence, rather than setting the machine to automatic observation, Toby was supposed to check on her vitals’ timely. Therefore, this condition can deteriorate Janet’s situation, which can impact a positive patient outcome. Hence, in this case, the NMBA RN standard 6 is violated.

Toby was struggling to manage Gerald’s condition. He fails to properly do his administration documentation, as Gerald is trying to wander in the ward. However, proper documentation during admission is important to gather patient information. Later this information can be used to develop an effective care plan. Also, Toby did not complete the patient notes. Patient notes should ideally be entered by health care professionals to document every clinically significant event which has occurred to a patient since infancy. Diseases, big and small ailments and growth milestones are examples of events (Mathioudakis et al., 2016). This will help the professional to create a care plan, which will be best suited for the patient. According to the NMBA standard 5 (NMBA, 2017), an RN is responsible for developing a proper care plan. For this, the nurse needs to document, evaluate and reassess the patient data. If the care plan is not effective, then it might not give the desired outcome. However, in this case, Toby fails to properly document Gerald's data. Also, as Gerald has a high chance of falling, wandering in the ward can cause sudden falls, which can harm the patient's condition. 

To prevent such events from happening, Toby needs to effectively manage his shift. Nurses must keep in mind that they have the authority to deny any task that they believe is problematic (Dall’Ora & Dahlgren, 2020).  However,  once the nurse accepts the assigned task, they must decide how and where to continue within the shift and satisfy the diverse requirements of analysis, health professional calls, medicine management, patient education, negotiating in particular conditions, rapid diagnostic cooperation, and family interaction (Dall’Ora & Dahlgren, 2020). Toby needs to effectively prioritise the patient who needs urgent attention. According to the case study, it looks like Toby is confused with his patients. Toby should use the ABCs principle in every patient circumstance. Prioritisation starts with identifying urgent concerns to living as an element of the first evaluation and is centred upon this ABC pneumonic, which prioritises the airway first, then respiration, and finally circulation (Bloomer et al., 2018; Bjerregård Madsen et al., 2016). According to this framework, Toby should prioritise Janet, as she has medical needs. Understanding these frameworks will help Toby to provide effective patient care, which will be safe and bring positive outcomes.

A nurse can utilise the available technological support to make their shift easier. This will reduce the chance of medical error, as well as it can help with time management; doing paperwork by hand can require extra time also it can increase the chance of error. Hence, the nurse can use the electronic recorder to make their work safer and easier (Kim, 2019). Regarding this, EI Adoly, Gheith, and Fors, (2018) mention the primary job of nursing is to care for patients to increase patient experience. Nurses, on the other hand, now devote a significant amount of time using electronic medical records (EMR) to capture health-related information to enhance care coordination.

As a consequence, on average, over half of full-time caregivers work 7 extra hours per week. In the shorter term, this arrangement may address the Nurse Scheduling Problem (NSP) in institutions. According to Garcia-Dia, (2020), Toby may utilise the "head, hand, and heart" strategy to address compassionate as well as sensitive care in the context of modern technologies that combines practical "know-how" with compassion and comprehension and technical expertise. Empathy, active listening, commitment to spending time with patients, as well as developing trust and openness will help to balance the prevalence of technology alongside providing safe, high-quality treatment.

A nurse needs to collaborate with other team members to deliver the care effectively, and manage their shift. Mayo & Woolley, (2019) mention Teams can do much more compared to any individual may gain operating individually; nevertheless, it is important to make use of the varity of data, talents, and skills available, mainly in groups that cross professional boundaries. Regarding the possibility for better performance, which comes with cooperation, the shift towards care provision in groups is well-founded. According to Mayo & Woolley, (2019), Toby can use collective intelligence skills while collaborating with the teammates, a hidden element that describes a team's overall capacity to do a wide range of tasks. Also, Toby can discuss with his shift manager and co-workers to assist him in his work.

Among the most stressful moments in an RN's career is orientation. The existence of occupational pressure among nurses has been verified by several research investigations (Chesak et al., 2015). Occupational burnout syndrome has a severe influence on nurses' wellness, as well as the safety of their clients. As nurses move into the clinical setting, freshly graduated RNs face numerous obstacles. Nurses work in complicated environments, with many impulses and types of data. They also face time shortage and worsen patients, sometimes with little preparation, knowledge, self-discipline, and critical thinking ability (Chesak et al., 2015). Such an incidence is also happening for Toby. Therefore, in this case, Stress Management and Resiliency Training (SMART) initiative can be implemented to help Toby to cope with stress, and manage his work-life balance (Chesak et al., 2015).

The program's goal is to teach learners about stress' physiology and biology. Learners learn how to use the 5 fundamental values of appreciation, empathy, tolerance, forgiveness, as well as greater meaning to cultivate purposeful awareness and reframing life events (Chesak et al., 2015). Chesak et al., (2015) mention the amounts of anxiety, awareness, worry, as well as resilience significantly improve for such experimental group but in a downward direction for the comparison group, despite the outcome not being significant statistically. These findings show a favourable tendency in consequences only among those who took part in the session, and it suggests that the SMART programme might be a useful tool for affecting tension, awareness, worry, and resilience among new nurses. Hence, Toby can take part in such kinds of programs, which will improve his stress management, thus improving his work-life balance.

McNamara, (2019) mention nursing is a very psychologically and mentally stressful job. Nurses provide care for people with complicated medical conditions as well as relatives who require assistance and consolation during difficult times (Lyu et al., 2020). Nurses might be exposed to a variety of environmental stresses, including patient pain, mortality, ethical issues, technologies, and organisational pressures. Other environmental stresses that affect nursing staff include a lack of sufficient supplies to complete duties, excessive stimulation that causes poor attention, a limited work environment, and many interruptions (Solomon et al., 2016; Wei et al., 2018). McNamara, (2019) mentions implementing a quality control initiative (QI) to help the nursing transition process. The program aims to inspire nurses to participate in daily healthy behaviours, motivate them to establish personalised care plans, and assist nursing divisions in making time for positive activities. Giving lunch-and-learn educational health services, training institutions to promote resiliency, including events on various shifts can be implemented in QI intervention. Therefore, such a QI strategy can help Toby to cope with his daily activity.

Conclusion

As a new nurse, one has to face many difficulties. Here, Toby was also struggling to manage his shift. He fails to provide effective care to his patients. He did not perform according to the NMBA standard 4, and 6. Hence, this condition can cause a poor patient outcome. Toby needs to properly prioritise his patient, use technology and collaborate with teammates to manage his shift. Also, to improve his nursing resilience and maintain his work-life balance, Toby can take part in a SMART program or QI improvement program. Both of these programs will help to cope up with stress and improve his capability.

References

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