Like any other field of medicine, the nursing profession is a calling to care for the vulnerable. Nurses ought to carry out their duty motivated by professional and moral ideals for the utmost good. Errors are, however, common in practice and ought to be looked into to improve patient care. The supervisor in this report carried out an objective analysis of the situation and developed a comprehensive list of deficiencies and suggestions for improvement.
I believe the most egregious flaw was the casual response to a patient's change of condition. This deficiency dictated the staff's actions, such as failure to investigate, document, and inform the resident's physician. Some of the additional changes I would suggest would be quarterly refresher courses that provide transparent duty allocation and introduce official handovers where everyone is briefed about every resident. This report teaches me to communicate and consult both horizontally and vertically and to engage in constant learning to update knowledge on practice and policy.
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Nursing care is a critical determinant of patient outcomes. Nurses are expected to be skillful and knowledgeable in their line of work. According to research, most nurses are motivated by the need to do good. For this reason, medical errors due to negligence are less than 30% (Sohn, 2013). Nurses are expected to carry out duties within their stipulated scope of practice to avoid medical errors. While nurses ought to help patients, some errors of commission or omission in the workplace could prove fatal for some patients (Croke, 2003). This is what happened in the case of resident #402 where several nurses committed errors of commission and omission. While every error is unforgivable given the implications, I think the most egregious deficiency, in this case, was the casual response to the patient’s change in condition. A change in patient’s condition could be a matter of life and death, and healthcare professionals ought to respond using the channels laid down. LPN 4 was the supervisor at the facility on the day the resident’s condition changed. She was notified of the change by other members of staff. On notification of a change in condition, she ought to have taken the information seriously, undertaken an assessment, and inform the resident's physician through the right channels. Her actions indicate a severe lack of concern for the changing situation of the patient. The constant interventions made without the physician's knowledge are also negligent. The most severe deficiency, I think, is the inability to assess a patient's situation in the presence of a complaint.
If I were a manager at the unit, my actions would be guided by the determination as to whether the deficiencies were a result of negligence or medical error. Deficiencies out of medical mistakes can be rectified through training and monitoring. If I were the unit manager, I would ensure the staff has continuous refresher training courses, locally organized, to remind them of their duties and the policies they ought to follow. Another way of reminding staff would be to put posters at duty stations, summarizing steps to be followed in certain circumstances. To increase accountability, I will make clear the division of roles clear for every shift. This prevents a situation where roles are blurred, and actions are not taken in a timely fashion. In addition to the division in labor, I would introduce entry and exit official handover for staff to ensure that everyone is aware of every resident's situation and progress. This provides an opportunity where staff can discuss a resident's condition and will guide more prompt action.
The supervisor was fair in writing the deficiencies cited as per the evidence collected from the staff. First, the surveyor carried out a detailed investigation into the case, taking note of the fateful day's events. The investigation uncovered any deficiency that was committed. With every statement given by staff, the surveyor was able to build a list of gaps. I believe all the deficiencies were exhausted, from those by staff to those by the management. I was particularly keen on noting how the deficiency in LPN 4 and management were tied together. This is because, from the statements, LPN 4 has a habit of working independent of physicians and senior staff, in full knowledge of the hospital. Therefore, I believe that by tying unearthing deficiencies and tying them together, the surveyor provided an objective assessment.
Reading this survey report has taught me that as a nurse, I cannot work in isolation. This, therefore, means that I have to consult both vertically and horizontally. According to the report, the nurses at work on that day failed to report to the RN and the resident's physician. Besides, CNA #18 knew the resident's behavior and noted a significant change in condition. However, she did not transparently pass the same information to the LPNs on duty. The missing communication and consultation led to the patient not receiving prompt and adequate care. As a nurse, I have learned that I ought to have open communication channels as this may provide a lot of information on patients. Discussion between colleagues is essential since most decisions were made independent of any consultation with colleagues (Sohn, 2013).
This assignment also teaches me that despite years of experience, I cannot have a monopoly of information. Medical practice is about constant learning to improve one's knowledge and skills (Wilson, 2018). While education is essential, it does not mean carrying out duties outside my scope of practice. Out-stepping one’s scope of practice, as in the case of LPN 4 and 5 who carried out interventions without the physician’s knowledge, could be fatal for a patient. I believe that I ought to regularly update myself on knowledge and policy so I can professionally carry my duties.
References
Croke, E. M. (2003). Nurses, Negligence, and Malpractice: An analysis based on more than 250 cases against nurses. AJN The American Journal of Nursing , 103 (9), 54-63.
Sohn D. H. (2013). Negligence, genuine error, and litigation. International journal of general medicine , 6 , 49–56. https://doi.org/10.2147/IJGM.S24256
Wilson, W. C. (2018). Inadequate Nurse’s Notes Lead to Lawsuit. Caring for the Ages , 19 (3), 14-15.
