Transition to Practice

In the case study that has been provided, it is seen that the Kelly who was a registered nurse has experienced multiple troubles in her night shift. Because of the problems like lack of sleep, too many patients in the ward, an excessive amount of work and one angry diseased individual, Kelly was unable to maintain her duty as a nurse. The implication of her nursing practice was seen on another patient who was admitted to the healthcare facility and did not have any severe problems. The patient health condition was reduced drastically and she was also taken in intensive unit care. Therefore, this case will be critically evaluated with the help of standards and guidelines that are set up by the Australian Government. Also, challenges faced by new nurses while transitioning to their new roles will be looked into. Strategies will be provided so that they can overcome the problem and challenges. In addition to that, the topic of resilience will also be discussed and its application will be seen in the practice of nursing. Two strategies will be employed for enhancing resilience in the nursing profession.

According to the Nursing and Midwifery Board APHRA (NMBA), the registered nurse should be involved with the patient via a professional and therapeutic relationship. They should give patients support and directions with the health-related matters and thus advocates on their behalf's. In addition to that, the nurse should also delegate, supervise and coordinate to achieve the better outcomes of the patients. They should foster a culture which is safe for the patient (Nursing and Midwifery Board APHRA, 2020). Hence, in this case, Kelly fails to provide the lady patient appropriate nursing condition and also did not form a therapeutic relationship with her. She also sends a junior student to assess the patient situation. Therefore, Kelly could rectify her mistake if she works by making professional relationships with patients so that their health could be improved.

NMBA standards also mentioned that the nurse should perform assessments on the patients which are holistic and are culturally appropriate. The nurse should also make use of multiple strategies to assess the condition of the patient. With that, they need to work in collaboration to identify the factors that could potentially affect the mental and physical wellbeing of the patient. Moreover, the nurse also must plan according to the resources available so that patent health status could be improved (Nursing and Midwifery Board APHRA, 2020). In the case, Kelly failed to assess the patient after 2 hours and when she got the time, the patient condition got worse. Therefore, to solve a problem like this, Kelly should timely to the assessment of the patient and should not miss it. She should make use of the best available material for the evaluation.

NMBA standards also talk about providing safe and quality nursing practice so that agreed outcomes and goals could be achieved for the betterment of the patient. The nurse with that should work in their scope of practice and should work following policies, standards, guidelines and legislation. They should also use the best evidence for planning so that the health condition of the patient could get better (Nursing and Midwifery Board APHRA, 2020). In the case of Kelly, she did not provide the lady patient with safe and quality nursing care and because of that, her condition became worse. So, to rectify the problem, Kelly should perform evidence-based nursing practice and provide the patient with the utmost quality care.

The NMBA code of conducts talks about the person-centred practise which needs to be done by the nurses to take care of the patient. The nurses are needed to give safe, evidence-based and person-centred practise for the promotion of health and mental wellbeing of the diseased individual by collaborating with the patient to make mutual-decisions. They are also needed to work with the informed consent of the patient and should address any adverse event so that there will be open disclosure (Nursing and Midwifery Board APHRA, 2020). In the case of Kelly, she did not provide the lady patient with person-centred care. Her nursing practice was not safe and was not based on the evidence thus, because of this, the patient has to suffer from the adverse problem. To solve this problem, Kelly should work with best-evidence available and should offer person-centred care to the diseased individual.

The NMBA code of conduct also mentions about teaching, supervising and assessing the nursing students and other nurses so the development of the nursing workforce could take place. The nurses need to create opportunities for students who are under their supervision so that they can learn and develop their skills and knowledge. They also need to assess the performance of the students to make sure that the highest standards of nursing practice are achieved (Nursing and Midwifery Board APHRA, 2020). In the case of Kelly, she did not teach or supervise the nursing student in the correct manner. She also did not tell the student about the mistakes that have been committed. Therefore, to correct this, Kelly could monitor and help the nursing student with the tasks so that proper care of the patient can take place.

The ICN code of ethics states that nurses have the responsibility of taking care of people and promote the environment where human rights and values are being supported. They need to make sure the care which the patient is receiving is correct (International Council of Nurses, 2012). In the case of Kelly, she did not provide a safe environment for the lady patient and also did not support her need. Therefore, she could rectify this by taking utmost care of the patient and giving them a safe and secure environment.

Other than this, the ICN code also talks about the roles and responsibility of nurses and that they are accountable for their practice. With that, they need to preserve standards of personal health so that they could provide uncompromised care to the patient. The nurses need to maintain their standards of conduct also (International Council of Nurses, 2012). Kelly, in this case, did not uphold her standards so she stated that she was sleeping all night and because of that, she was not able to give proper care to the patient. Therefore, she should maintain her conduct by regulating her nursing and other duties effectively.

According to non-maleficence in nursing, it is the task of nurses to make sure that the safety of the patient is maintained and any kind of injury or damage does not happen to the person. They also need to ensure a safe environment for them so that no medical error would occur (Kadivar et al., 2017; Kalra et al., 2019). In the case of Kelly, she did not work in a way which could provide the probable harm to the patient and that lead to severe complication in the case of her patient. This problem could be solved if Kelly works following the principle of non-maleficence.

Nurses should also work with the principle of beneficence which means the obligation to enhance and promote good for the betterment of the patient condition. Their decision should make the outcomes of the care better (Milliken, 2018; Grace, 2018; Hemberg, & Bergdahl, 2019). Kelly, in this case, did not work with the principle of beneficence as she did not indulge in any activity to ensure how the condition of the patient could be made better. This could be corrected if Kelly would work for the better results of the patient so that their health status could improve.

National Safety and Quality Health Service (NSQHS) standards talk about governance for safety and quality in health service organizations. It also states that healthcare workers should perform their duties with accountability and should check the safety of the patient and the nursing quality that is being delivered (National Safety and Quality Health Service Standards, 2017). In the case of Kelly, the safety of the patient was disregarded. Thus, to correct it, more focus should be given to the patient's safety and the nursing quality by Kelly.

The NSQHS standards also discuss recognizing and responding to clinical deterioration in acute healthcare. For this, healthcare workers need to identify and make use of the response system to balance the patient condition (National Safety and Quality Health Service Standards, 2017). Kelly, however, neglected her responsibility towards the patient and that is why her condition goes worse. For this, she should be ready for timely care so that the patient condition does not deteriorate.

For the new nurses, transitioning into a registered nurse is very challenging as they feel the burden from the expectations and their job responsibilities that they have to fulfil. They need to giver safe and quality practice to the patients and have to handle various other tasks. Thus, they feel overwhelmed by all the responsibilities and feel pressured due to the number of tasks and expectations (Hussein et al., 2017; Hussein et al., 2019). For that, the support program could be introduced for them which would help them to transition to their role in a better way. The program would recognize the organizational factors and clinical supervision elements which influence their experiences to provide them with strategies to deal with the pressure of the workload and expectations. The program could also support their emotional and social wellbeing and thus facilitate in meeting the unmet needs. This will enhance new nurses' competence and confidence (Hussein et al., 2017; Rush et al., 2019; Ubas-Sumagasyay & Oducado, 2020). The second challenge which is faced by new nurses is that they find the work environment negative and as a result, they experience bad implications on their mental health and overall wellbeing. Therefore, to enhance their mental and physical wellbeing, nurses need support for developing leadership. The help from healthcare leaders will aid in developing and implementing strategies so that a satisfying environment could be created for new nurses who would assist them in developing personal skills to cope up with their new role and its demand (Laschinger et al., 2019). The third problem which is experienced by most of the new nurses is that they feel clinical stress and thus develop the intention to leave the nursing profession. With that, they also experience burnout and anxiety due to their job. To combat this challenge, hospitals could give training and supportive environment which would meet with the needs of the new nurse (Van Bogaert et al., 2017; Rozo et al., 2017; Molero Jurado et al., 2018).

Ability to come back or to cope in a successful manner with a difficult situation is known as resilience. Resilience in nursing is important because it would help nurses to overcome challenges and difficulties and thus would facilitate in better coping that would address the work-related stress and difficult working environment (Yılmaz, 2017). The first strategy that would help in building resilience in nurses is by providing them with educational intervention. Education intervention can help them to build self-confidence, have better communication and better problem-solving skills. With that, it would also help in strengthening the interpersonal relationships with other staff members. Thus, in turn, it will bring boldness and self-awareness in nurses. Therefore, nurses would become more resilient towards their work as they will work with self-confidence and boldness (Yılmaz, 2017). The second strategy that could be applied is that resilience intervention program could be introduced for nurses so that their emotional well-being will be improved by lowering the amount of exhaustion face by them. This kind of training program could help nurses to be better prepared for challenges that they will go through in future. This will enhance their level of confidence, self-efficacy and their method of coping with interpersonal problems (Yılmaz, 2017).

In conclusion, it can be said that Kelly should have formed a professional and therapeutic relationship with the lady patient and should perform a holistic assessment of her. She should also work with safe and quality practice. With that, the care which she gives should be person-centred and she should also supervise her junior so that better care could be given. Moreover, she should create an environment which supports patients and take care of their human rights. Kelly should also work with accountability and ethical principles like beneficence and maleficence. She should provide safety to the patient and should recognize deterioration in patients. New nurses like Kelly feel many challenges such as they feel burden by responsibilities, experience negative work environment and clinical stress. These problems could be solved by implementing various strategies like support programs, help from healthcare leaders and hospitals. Their resilience could also be fostered with the aid of educational intervention and resilience intervention program.

References for Kelly Case Study

Grace, P. (2018). Enhancing nurse moral agency: The leadership promise of doctor of nursing practice preparation. OJIN: The Online Journal of Issues in Nursing23(1), 1. 10.3912/OJIN.Vol23No01Man04

Hemberg, J., & Bergdahl, E. (2020). Ethical sensitivity and perceptiveness in palliative home care through co-creation. Nursing Ethics27(2), 446-460. https://doi.org/10.1177/0969733019849464

Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017). New graduate nurses’ experiences in a clinical specialty: A follow up study of newcomer perceptions of transitional support. BMC Nursing16(1), 1-9.

Hussein, R., Salamonson, Y., Hu, W., & Everett, B. (2019). Clinical supervision and ward orientation predict new graduate nurses’ intention to work in critical care: Findings from a prospective observational study. Australian Critical Care32(5), 397-402. https://doi.org/10.1016/j.aucc.2018.09.003

International Council of Nurses. (2012). The ICN code of ethics for nurses. Available at https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf

Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient's safety: A clinical case report. Journal of Medical Ethics and History of Medicine10, 15.

Kalra, J. J., Campos-Baniak, M. G., Saxena, A., & Rafid-Hamed, Z. (2019). Medical error disclosure-a Canadian perspective in improving quality of health care. International Conference on Applied Human Factors and Ergonomics, 957, 26-34.

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing23(1). 10.3912/OJIN.Vol23No01Man01

Molero Jurado, M. D. M., Pérez-Fuentes, M. D. C., Gázquez Linares, J. J. G., Simón Márquez, M. D. M., & Martos Martínez, Á. (2018). Burnout risk and protection factors in certified nursing aides. International Journal of Environmental Research and Public Health15(6), 1116. 10.3390/ijerph15061116 

National Safety and Quality Health Service Standards. (2017). Available at https://www.safetyandquality.gov.au/sites/default/files/migrated/NSQHS-Standards-Sept-2012.pdf

Nursing and Midwifery Board APHRA. (2018). Code of conduct. Available at file:///C:/Users/acer/Downloads/Nusing-and-Midwifery-Board---Code---Advance-copy---Code-of-conduct-for-nurses---Effective-1-March-2018.PDF

Nursing and Midwifery Board APHRA. (2020). Registered nurse standards for practice. Available at https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Rozo, J. A., Olson, D. M., Thu, H., & Stutzman, S. E. (2017). Situational factors associated with burnout among emergency department nurses. Workplace Health & Safety65(6), 262-265.

Rush, K. L., Janke, R., Duchscher, J. E., Phillips, R., & Kaur, S. (2019). Best practices of formal new graduate transition programs: An integrative review. International Journal of Nursing Studies94, 139-158. https://doi.org/10.1016/j.ijnurstu.2019.02.010

Spence Laschinger, H. K., Wong, C., Read, E., Cummings, G., Leiter, M., Macphee, M., ... & Grinspun, D. (2019). Predictors of new graduate nurses’ health over the first 4 years of practice. Nursing Open6(2), 245-259. https://doi.org/10.1002/nop2.231

Ubas-Sumagasyay, N. A., & Oducado, R. M. (2020). Perceived competence and transition experience of new graduate Filipino nurses. Jurnal Keperawatan Indonesia23(1), 48-63. DOI:10.7454/jki.v23i1.1071

Van Bogaert, P., Peremans, L., Van Heusden, D., Verspuy, M., Kureckova, V., Van de Cruys, Z., & Franck, E. (2017). Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed-method study. BMC Nursing16(1), 5. https://doi.org/10.1186/s12912-016-0200-4

Yılmaz, E. B. (2017). Resilience as a strategy for struggling against challenges related to the nursing profession. Chinese Nursing Research4(1), 9-13. https://doi.org/10.1016/j.cnre.2017.03.004

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