Overview
Nursing standards are an important structure in the provision of quality nursing care and the attainment of associated outcomes. When faced with adversity and uncertainty, nursing standards are meant to help nursing professionals to get insight on what they should do and fit in an ever-changing health care environment. Newly employed and inexperienced nurses are a vital workforce in addressing the nursing shortage, but their inexperience is stressing to an organization and causes it to stretch its available resources. The new nurses are also faced with great stress due to a lack of a supportive working environment. The inexperience of such nurses forms the basis of this paper through a case study that seeks to demonstrate how the lack of application of nursing standards can be costly to nursing practice.
Application of NMBA Standards to the Case
One of the standards of NMBA is that a registered nurse should think critically about and analyze the practice of nursing. The nursing profession is demanding and involves saving lives, and while this cannot wait, adjourning some social events is harmless. The nurse is required to access, analyze, and utilize person-centered frameworks and evidence to provide safe and quality nursing practice (Nursing and Midwifery Board Aphra (NMBA), 2017). Alex was assigned to four patients, two of whom required minimal time and effort while the other two required his full time and attention. Even though he claims to be inexperienced in addressing the situations for each patient, he would have used his background knowledge and evidence to execute his duties in the best way possible. Later on, he would have sought better guidance from the nurse that was to continue with his shift. The case of Mr. Maple required a patient-centered approach due to the distress present in the family. However, Alex failed to use available frameworks and resources to manage the situation.
Critical thinking is highly recommended in integrating assessment data necessary to address a patient’s needs, and Alex failed to follow this basic principle. He was not able to follow through with monitoring Ms. O’Sullivan and did not explore available evidence-based frameworks on the development of admission for Mr. Maple. Thereby, Alex had not successfully provided safe and quality to his patients. A nurse is expected to develop the practice by reflecting on the integration of knowledge, beliefs, experience, and feelings in shaping practice. Alex does not display the development of practice using this approach during his shift. The NMBA (2017) states that a nurse should be culturally competent by showing respect for other people’s cultures. The American Nurses Association (ANA) (n. d.) also states that nursing is dynamic and requires the engagement of both the heart and the mind. Sequentially, this helps to provide care that is meant to preserve human dignity and which is guided by an additional sense in identifying patients’ needs. Thereby, he should have acknowledged the role of the family where necessary, like in the case of Mr. Maple.
Applying the relevant legal frameworks, policies, and guidelines is imperative during decision-making, but Alex fails to apply this principle in performing his duties. The frameworks are effective as they are developed following extensive consultations and reviews from experts in the field, as indicated by Cashin et al. (2017). He does not apply the ethical frameworks that seek to promote beneficence and avoid harm by failing to keep up with the automated observations for Ms. O’Sullivan. Thereby, if her condition had deteriorated for the 3 hours when Alex did not maintain vigil, would have meant that he exposed the patient to harm and poor quality care. Alex did not document patients’ information on time; thereby, the accuracy of the information was questionable.
After all, another standard advocates for the development of a plan for nursing practice. As a result, he was free to seek guidance and involve the family members who were already distressed, and by doing so, he would have gained adequate information for use in the planning of nursing practice. Alternatively, he should have inquired about the availability of resources to aid in guiding nursing practice if no one was willing to debrief him on how to handle his patients. Davis (2014) notes that professional standards are a useful guide in one’s career development; hence, when used correctly and consistently, they can enable one to adopt the right demeanor in professional and practice development. These standards reinforce the essence of engagement with other professionals and the patient. Therefore, when Alex realized he was stuck on the course of action, he would have sought assistance from fellow colleagues.
Recommendations on How Alex Would Have Taken the Shift Differently
Firstly, Alex should have used the electronic system to review previous admissions and get wind of the information that is needed and use it as a guide to preparing one for Mr. Maple. Alex should have acknowledged the new responsibilities handed over to him and developed a work plan because the transition seemed to have made him anxious. Electronic health systems are vital technological tools that other than providing patient information, act as an evidence-based reference tool in making decisions on patient care (“What is an electronic health record (EHR),” 2019). Mobile telephones are readily available and are a useful asset among nurses seeking to achieve evidence-based practice (Mather et al., 2017).
Secondly, the fact that nursing standards advocate for teamwork implies that Alex could have asked for help from a more experienced nurse on how to go about handling the two jobs. Harrison (2018) asserts the essence of professional interactions in shaping clinical performance, adaptation to roles, and competence. Therefore, instead of suffering silently and enduring burnout due to feelings of frustration and incompetence, as demonstrated by Rudman and Gustavsson (2011), Alex should have interacted with other nurses. Even though some interactions can be uncivil, as noted by Parker et al. (2018) and Phillips et al. (2018), not seeking assistance is not beneficial either as one ends up feeling inadequate. As a result, the best thing for a newly graduated registered nurse to do is to form ties with those willing to establish civil interactions and liaise with them to improve nursing practice.
All the same, Alex displayed a common challenge among registered nurses who continually struggle with communication. As seen in the case of Alex, he struggled with both written and oral communication due to the fact that he failed to interact with fellow colleagues to get information on how he should handle his shift better, now that he was only getting started in his practice. Theisen and Sandau (2013) present qualitative data that affirms the struggles faced by Alex, including failure to complete shift reports, incompetency in addressing patient needs, calling a physician, and conflict resolution.
Thirdly, nurses are guided by a plan of care that Alex did not seem to have created, especially considering that he was still working towards developing his practice. These plans, as noted by Johnson et al. (2017), enable nurses to display accuracy, completeness, and detail. Roux and Halstead (2018) assert the importance of effective time management and organization, which can be achieved if the new nurse develops a strategy to manage time and organize care for patients under his or her care without making a blunder. There is, however, no standard time management method, and each nurse should develop one that fits him or her best. Thereby, in the case of Alex, he should have noted what he needed to do with each patient and walk with the plan to remind him of the shift schedule. His inexperience in managing his current shift might have left him confused and unsure of what to do. Thereby, it is no wonder that he had not managed to care for either one of his patients accordingly as far as assessment, care, and documentation were concerned.
Evidence-Based Strategies to Build Capacity, Resilience, and Support Work/Life Balance during Graduate RN’s Transition Period
Alex is on the right track towards building capacity as he planned to ask his nurse preceptor for advice or tips during the next shift. Such an initiative is the beginning of establishing professional interaction that has been shown to yield positive outcomes, and especially when it is civil (Harrison, 2018). Alex is reflecting on how he can improve capacity, which is one way of managing stress and frustration that can result from inadequately completing his shift (Mellor et al., 2017). Guided imagery is recommended as a model that newly graduated nurses can use to transition to practice (Boehm & Tse, 2013). Hence, a new nurse can review similar scenarios available online and get ideas on how to shift from school to practice.
A spiritual individual can use this sphere of their life to change their perceptions and attitudes because spirituality appreciates the reward of life. Sequentially, such a renewed attitude enables an individual to shift concern from one’s troubles to the patient and family (Clendon & Walker, 2012). In the case of Alex, it is evident he was not able to plan care based on priority, and he might have been confused, which is why could not complete his responsibilities during his shift successfully. Providing safe and quality care is the main objective of any nurse. Hence, gaining control, learning how to prioritize duties, and seeking help when needed are remedies that newly graduated nursing students can use to build resilience and capacity in the workplace. Alternatively, a registered nurse new in practice should seek directives on where to find relevant resources for use when needed (Shinners, Africa, & Hawkes, 2016). Some institutions have online drills that enable their employees to access any information related to nursing practice in various domains.
Embracing teamwork and learning to deal with challenges effectively based on one’s abilities help new nurses to maintain a work-life balance. While new nurse might not want to say no and take on every project assigned to them, they need to understand their abilities and handle tasks that they can accomplish comfortably (Duquesne University, n. d.). Such an approach helps them to gain confidence and better control of their practice, as discussed by Kumaran and Carny (2014). For example, Alex expressed his concerns about not being able to manage the patients due to his inexperience as he was still trying to build on his practice. Thereby, he should have requested to be assigned one patient with whom he would have been able to provide quality and safe care through adequate research and review of resources.
Conclusion
The case of Alex is a typical scenario of what a newly graduated registered nurse goes through in the workplace. It creates a need for newly graduated nurses to understand the nursing standards as these can help them to apply the knowledge they have effectively and successfully as they transition from school to practice. While registered nurses agree to comply with the existing laws, procedures, and other structures in their nursing practice, Alex did not show such compliance. In addition to knowing NMBA standards, newly graduated registered nurses need to implement them and be able to provide safe and quality care. A newly registered nurse should take their time to learn because bridging the gap between theory and practice requires some time. Therefore, the inexperienced registered nurse should be proactive as well as seek and utilize the correct models and frameworks to make decisions and guide practice. An organization may not show commitment in orientating a new nurse and might have outrageous expectations of them. Nonetheless, the new registered nurses should be result-driven and work towards being the change an organization needs in accommodating more graduate nurses.
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