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Healthcare: Safety in the Nursing Field

Drew’s situation

The significance of gaps in nursing textbooks, hospital policy, and procedures, published literature, and actual practice hospital policy and procedures may differ from what textbooks teach nurses owing to several reasons. This may include the failure of nursing educators to connect with clinical situations due to too much focus on academic life. Some hospitals may also fail to prioritize theory in their practice.

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If the gaps emanate from a deficit in the nursing school, then new nurses may place patients at risk. Nonetheless, they could learn from experienced nurses if they adhere to the hospital procedures. If the problem emanates from the hospital, then chances are that new nurses may become frustrated by the complacency of their institutions. Only a few, new nurses dare to report or challenge these gaps in hospitals, so a culture of risk may likely continue.

Gaps between what textbooks teach Drew and what is in published literature may also expose patients to danger. This is true when new research indicates that previous nursing practice was faulty. For instance, in the past, instructors taught nurses to shave expectant mothers before surgery; this was information that they could find in textbooks. However, a lot of high-quality research has proven that shaving increases infections after surgery (DiCenso, 2003). Therefore, if Drew did not familiarize himself with new evidence in the published literature, then he might continue to practice nursing using outdating techniques that put patients at risk. New evidence is continuously emerging in the nursing profession, so Drew must not rely on the dated knowledge he learned as a nursing student alone.

Gaps may also exist between what Drew learned in nursing textbooks and actual practice. In this regard, an institution may have procedures and policies that match guidelines in nursing schools, but nurses may not implement them. If this occurs, then new nurses may have redress by taking their concerns, on patient safety, to the concerned authorities. Drew can protect patients by utilizing this avenue.

A culture of safety and how it would benefit Drew’s case

A culture of safety is a collection of perceptions, values, and behavior that cause commitment and response to safety and health issues in an organization. In such cultures, individuals focus on why the mistake occurred rather than who committed it. Analyzing risks and learning lessons from errors are synonymous with this culture. In Drew’s case, the hospital in which he works could evaluate why an experienced nurse is sloppy and uncommitted to infection control. They could establish procedures to ensure that such situations do not arise (Hughes, 2004).

Drew’s options for managing his concerns

Drew has the option of doing nothing. He might do this out of fear of insubordination or ignorance of the reporting procedures in the organization. He may also fear reprisal from others who may think of him as a sell-out. If the report will not yield change, then Drew may do nothing. The consequences of this choice are catastrophic. Patients’ conditions might deteriorate, and they could increase their stay in the hospital. They could develop new infections that emanate from poor infection control. If this sloppiness causes drug overdoses, patient falls, or missed medications, then death may result. The problem could devastate patients’ families and even make the institution liable to litigation.

This new nurse has the option of talking to the experienced nurse about it. However, such a choice is also ill-informed as it could lead to backlash from the nurse. The individual may use insubordination as a counterattack and turn this matter on Drew. She may also get defensive about it. Nonetheless, if the temperament of the senior nurse is such that she is open to criticism, then Drew may resolve the problem before harm occurs to patients.

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Drew may report the matter to a hospital manager or senior nursing professional. The chain of command should determine the choice of the person to whom to report. He should select the next person above the senior nurse’s rank. Verbal reporting may need to be seconded by written documentation. This is one of the most effective choices for Drew because it would ensure that a culture of safety exists in the institution. He can protect patients through this avenue. Alternatively, he may take the matter to an external agency. This may be necessary when the institution appears to do nothing about his concerns.

Drew’s role in continuous improvement

Drew must familiarize himself with new clinical knowledge as well as new hospital policies and procedures. He needs to gather sufficient information about a patient before providing care. It is imperative to engage in training as well as proper orientation whenever he transfers to a new hospital as these will lead to continuous learning.

Lindsey’s case

What one should do first

First, one should verify the concern; so far, Lindsey’s friend is relying on her instincts to establish that a problem exists in the institution. Now, she needs to gather evidence to support claims that an unethical situation exists in the institution. Objectivity is critical in gathering this information. One must ask oneself whether the issue will harm patients; this is true for Lindsey. One must determine whether the situation is likely to continue.

Since this is a common problem, then the answer is yes. One must identify the legislative policy that a colleague is breaching. In Lindsey’s case, one should gather information from patients concerning the medication they received. Even documentation of the same may also show some gaps. Lindsey’s best friend should consult with managers and other quality assurance professionals on how to deal with an ethical situation.

Once verification has occurred, then the nurse should take appropriate action. One way of doing it would be to report to the immediate superior in the institution. This may lead to several reactions from the hospital. The institution may decide to suspend Lindsey to conduct further investigations, or it may terminate her employment immediately. Alternatively, the matter may be taken to the nursing association to prevent Lindsey from putting other patients, in different hospitals, in danger. This issue may involve documentation (Association of Registered Nurses of Newfoundland and Labrador, 2008).

Consequences of doing nothing

If Lindsey’s friend chooses to do nothing, then more patients could be subjected to untreated illnesses. Their conditions may get worse, and this could result in longer hospital stays, spiraling medical costs, as well as insufficient care on the part of the hospital. Some clients may notice the problem and could take legal action against the institution. This could tarnish its reputation and thus compromise its sustainability in the future. Therefore, all parties will lose if Lindsey continues with her behavior.


Association of Registered Nurses of Newfoundland and Labrador (2008). Registered nurses professional duty to address unsafe and unethical situations. Web.

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DiCenso, A. (2003). Evidence-based nursing practice: How to get there from here. Nursing Leadership, 16(4), 20-26.

Hughes, R. (2004). First, do no harm. Avoiding the near misses: taking into account one ever present factor: man fallibility. American Journal of Nursing, 104(5), 81-84.

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