Question

Tony is a newly hired RN whose first assignment after graduation is the recovery room of a hospital that specializes in cardiovascular procedures. He has learned the recovery room procedures quickly and has further developed his nursing skill set to meet the demands of the position. After working there for two weeks, he is assigned one-on-one to Minta, a 58-year-old woman who coded during valve replacement surgery and is not doing well in the recovery room. Nurses are only assigned one-on-one to the most unstable and critical patients. Several hours after surgery, Minta finally recovers consciousness, although the endotracheal tube remains in place and she is still connected to a ventilator. The surgeons speak to Minta about the severity of her condition and the likelihood that she may die, then they leave the recovery room.

Minta indicates to Tony that she wants a pen and a pad of paper to write on since she is unable to speak with the endotrcheal tube in place. After Tony gives her the pen and paper, she writes about a half page note, folds it and writes an address on it. She also writes on the pad asking if Tony will send it out for her after he gets home. Tony gladly agrees.

As Tony folds the note and places it in his pocket, he notices that the recovery room supervisor has been watching the whole scenario from across the room. The supervisor motions

Tony over to her and asks about what he was doing with the patient.

Tony replies: “I’m just helping the patient write a note to her daughter.”  

The supervisor responds: "Recovery room policies don’t allow it and anyway, it is not part of your job to do such things. You’re here to keep the patients alive after surgery."

Tony answers: “I was only trying to help the patient mail the note to her daughter since the physicians told her she might die soon.”

The supervisor replied with: "We are not running a post office here!"

Tony angrily responds: “Well, what do you want me to do with this note now?”

The supervisor turned her back and walked back into her office. Several days later, the supervisor filed an incident report on Tony stating that he was violating recovery room procedures and was insubordinate because he argued with her. Because Tony was still in his six month probationary period, he was reprimanded and then fired from the hospital.

Questions

• How might have Tony handled the situation differently? What communication skills could he have used dealing with this difficult person?
• Does Tony have any recourse to get his job back since he was on probation? What should he do first in determining if he was wrongfully terminated?
• What other elements might be factors in the supervisor’s severe response to Tony’s actions?
• Was Tony violation any ethical principles? What ethical principles are involved in this case study?
• What should Tony do with the note?

Answer 1

- Tony handled the situation in a different way because the patient was unable to respond due to her health problem. He used a non-verbal communication with the patient to communicate as the patient, writes about her health issue and want the nurse to give it to her house. Here, tony notonly considers patient physical problems but also the emotional needs of the patient.

- No, tony doesn't have recourse to get his job back ,because during probation period the employees are under the supervision of the superiors. So he should be more careful while handling any situation during his job. If he does any mistake the superior authorities have the right to take action against the employee. He can report the issue to his superior once as the patient needs a help from nurse. As a nurse,he should care the patient both physically and mentally, but should not take anything personally. When the patient asks help from nurse ,first nurse should report the incidence to the supervisor and should seek help from them, if tony had do this may be he won't be terminated from job.

- Due to probation period ,the head nurse keenly watch tony while caring the patient. If she notify any mistake first she will be giving warning, and the probation period may be extended or the nurse may be terminated from his job.

- According to the ethics in nursing, during decision-making nurse leaders must be able to help staff nurses to handle the implications that arise from poor ethical chaoices.Nurse leader should create work environments that impact employee choices,behaviours and values.

First of all tony should report the client's need to his superior and ask what should do during this situation ,the head nurse will be guiding the nurse what to do .Nurses should follow the ethical principles while caring a patient, it consists of autonomy, nonmaleficence,beneficence and justice.