Question

A nursing student, Caitlyn, is working with her preceptor, Brenda. Brenda, an experienced nurse, appears to be fumbling with her assessment and acting a bit odd. She then accidentally pulls out the patient’s IV without noticing. When Caitlyn brings it up, Brenda blames Caitlyn for pulling it out. Caitlyn approaches her nursing instructor, Ms. Simpson, with concerns that her preceptor might be impaired.

SCENE 1: A nursing student, Caitlyn, is working with her preceptor, Brenda. Brenda, an experienced nurse, appears to be fumbling with her assessment and acting a bit odd. She then accidentally pulls out the patient’s IV without noticing. When Caitlyn brings it up, Brenda blames Caitlyn for pulling it out. Caitlyn approaches her nursing instructor, Ms. Simpson, with concerns that her preceptor might be impaired.

SCENE 2: Caitlyn and Ms. Simpson are discussing Caitlyn’s concerns in a small conference room. Ms. Simpson asks Caitlyn to provide as much information as possible and then inquires what Caitlyn’s first immediate action should be. Caitlyn agrees to report the nurse to the nurse manager, with Ms. Simpson’s support. However, Caitlyn, who would like to get a job at the hospital after graduation, is concerned about coming off as a tattletale and possibly losing a job opportunity.

5. Caitlyn is worried about reporting because she may want to seek a job at the hospital and does not want to be seen as a “tattletale”. How do you feel about Ms. Simpson’s response? Have you had similar concerns in your clinical setting (when you felt something was incorrect but didn’t want to “rock the boat” due to the possibility of future employment at the facility)?

6. At the end of the scene, Ms. Simpson asks Caitlyn if she is ready to report to the nurse manager. In what other ways could Ms. Simpson have helped Caitlyn prepare for giving the report?

7. How would you report the concerning behaviors to the nurse manager? What specifically would you say?

SCENE 3: The nurse manager enters the room of one of Brenda’s patients to find Brenda draped over the patient and asleep. The nurse manager awakens Brenda and tells her that she will need to be escorted by security down to the Emergency Department.

8. Why do you think the nurse manager stated that security was coming to take Brenda to the Emergency Department? Do you feel that this was appropriate?

9. What are the next steps that the nurse manager and facility will take in regard to Brenda’s chemical impairment?

10. What guidelines do you think maybe put in place when Brenda returns to work? What do you think will happen if Brenda violates those guidelines?

Answer 1

5.Being in the place of an instructor it is a must to teach the right thing to a student .This is an act of negligence or error caused by the experienced nurse and blaming the nursing student or put the fault on the nursing student .This has caused a harmless to the patient which is basically categorized into an incident .In most hospital an incident report has to be filed. So it is best to instruct the student that on the principle of non maleficience ,this has to be reported to the concerned authority .

6.Some of the way Ms Simpson can help Catyln to report are

• Educating about incident report
• Teaching the principle of ethics
• Providing support on behalf of an instructor

7.Report this concern with panache ,and narrate the incident for its truthfulness .Being ready to face the thereafter events and defending that the mistake was not done by the student .

8.This was appropriate because the nurse was little unstable making her fumble during patient care. Apart from this she was found sleeping in the bed of patient in a draped form which indicates she is either physically or mentally not well at this moment ,who needs support to take her to the emergency department.

9.The next step which will be taken immediately are

• Issuing a memo if it is the first time
• Suspension for causing injury to the patient
• Duty of breach for being chemically impaired on duty
• Strict warning

10.The guidelines which can be put are

• No chemical usage before or during duty time
• Will be on observation period
• Violation of the guidelines can lead to suspension or dismissal from the job due to high risk so for causing patient injury .