NUR346 Transition To Practice 2
Question:
Case study
Shannon Doe is a third year undergraduate nurse on clinical placement at Charles Darwin University Hospital Emergency Department (ED).
Day 1. Mon 24/09/2018. Shannon’s preceptor, Jennifer Lee, says “Hi. You are with me. We are short staffed and there is a poor skill mix on today. I will introduce you around and then I will get you to start your orientation to ED by doing this ‘search and find’. Once you have done that, if you sit in the tea room here and log into this computer with these generic log in details (hands you piece of paper with log on and password), you can work through the self-directed learning modules on WHS, infection control, mandatory reporting and aggression management. That should fill in your first shift. OK?” Shannon replies “OK then.” Shannon’s preceptor then walks away. She did not approach Shannon for the rest of the shift.
Day 2. Tues 25/09/2018. Jennifer greets Shannon before handover and says “How did you go yesterday?” Shannon replies “I got through it all. I would like to discuss the placement, my scope of practice and placement objectives”. Jennifer replies “I am aware of your scope of practice but we will find time today to discuss your placement and your objectives” Then she adds “Much to learn you have young padawan” and smiles. Shannon thinks that Jennifer’s comment is ageist and stereotyping.
After handover Jennifer advises Shannon that she will be looking after two patients. Bed 1 has an 11 year old girl with Leukemia. Jennifer asks Shannon “Where should you look for bleeding?” Wanting to demonstrate her knowledge Shannon describes the coagulation cascade and states that “If the girl has low platelets she may bleed and one of the first places to look for signs of bleeding is the gums and mucous membranes”. Jennifer replies with an ambiguous compliment “Wow, you’re a walking text book” and smiles. “Well done” she adds. Shannon thinks Jennifer is being sarcastic.
Bed 2 has a two year old boy with croup. Shannon can hear his barky cough and inspiratory stridor. Jennifer says “Can you tell me what you know about croup?” Just as Shannon was about to respond, Jennifer says “Nah, don’t worry about that, just go in and make sure the parents have some breakfast. Hear that? (pauses to listen) We need to get the family up to Paeds as soon as possible”. Shannon feels a bit dismissed but understands that the clinical need is a priority over her clinical education at that time.
Day 3. Wed 26/09/2018. Shannon and Jennifer are allocated to cubicles 1 to 4. After handover Shannon walks into cubicle 1 to do a set of vital signs on a male patient admitted with pneumonia. He is non-responsive. Shannon pushes the emergency call bell, checks his airway for blockage, checks his breathing using ‘look, listen, feel’. He is not breathing. Shannon commences CPR. Jennifer arrives at the same time as Dr Tim Coloton and RN Anna Roberts. Jennifer asks ” What have you done?” Just as Shannon is about to respond Jennifer says “Finish that cycle of compressions then step back, we’ll handle this”. Shannon completes the cycle of compressions and stands back and observes the resuscitation. Later in the day Jennifer goes to the clinical debrief. Shannon notes that Jennifer did not invite her.
Day 4. Thurs 27/09/2018 . Shannon calls the Nursing Unit Manager, John Matthew, and advises “I am not coming in today. I feel like I am being bullied”.
Task
- Complete the incident report in the template provided as the worker (Shannon) in the case study provided.
- Discuss informal and formal procedures for dealing with conflict; link to case study.
- Criticallyanalyse what has occurred in the case study.
- Draw on the literature to provide recommendations to foster Shannon’s resilience in future placements; link to NMBA standards.
Answer
Introduction
Healthcare practitioners like any other professionals are likely to undergo negative workplace health and safety concerns that in turn posit adverse effects on their well-being, personal and professional relationships and their workplace productivity (Haramati, & Weissinger, 2015). Workplace adversities such as trauma, workload, intimidation, harassment, bullying, and discrimination may lead to burnouts and are a major cause of employee absenteeism. Moreover, workplace conflicts if unchecked can lead to these same results and therefore health care organizations ought to come up with amicable conflict resolution mechanisms. This paper is a reflection of a workplace harassment case study involving a young nursing student; Shannon who faces the same during her clinical placement at Charles Darwin University Hospital Emergency Department (ED) as partly detailed in her workplace incident report. The paper will endeavor to suggest informal and formal conflict resolution mechanism to assist her deal with the workplace harassment she faces. Moreover, drawing from a literature review and NMBA standards, the paper will provide recommendations to foster Shannon’s resilience in future placements.
Shannon Workplace Incident Report
Nature/Type of Incident/Event: Day 1. Mon 24/09/2018: Induction and orientation Day 2. Tues 25/09/2018: Patient clinical procedures Day 3. Wed 26/09/2018: Patient clinical procedures; attended the clinical debrief |
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Description of the incident: Induction and orientation: On the first day of my clinical placement, I got inducted and oriented to the health facility and particularly the emergency department (ED). I then worked on the self-directed learning modules on various health facility policies and procedures. Patient clinical procedures: I took care of two patients; an 11-year-old girl with Leukemia and a two-year-old boy with croup in bed 1 and 2 respectively. Patient clinical procedures: I took care of patients in cubicle 1-4. In cubicle 1, I took care of a male patient admitted with pneumonia. After checking on the vital signs, I noticed that he was non-responsive and not breathing. I pressed the emergency call bell to alert my fellow colleagues but in the meantime commenced CPR |
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Brief description of injury/illness: On day 3, a patient admitted of pneumonia showcased non-responsive presentations and after checks of his breathing, I realized that he had a blocked airway likely to lead to suffocation. |
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Did the person receive treatment following the injury/illness: Yes; I instituted CPR as I waited for my colleagues to respond to the emergency call bell for further clinical care. After completing my compressions, the man was resuscitated |
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Person(s) who saw the incident or first came to the scene: I was the first to see this incident but after pressing the emergency bell, Jennifer, Dr. Tim Coloton and RN Anna Roberts were the first to come to the scene. |
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Action taken/intended, if any, to prevent recurrence of the incident:
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Describe any longer-term action proposed to prevent a recurrence: Deploy more nurses for continuous checking of patients’ healthcare conditions; Put in place emergency oxygen delivery systems to facilitate quick resuscitations.
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Contributing factors: |
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Were issues related to patient ID or patient factors |
The issues were related to the patient factors and not the patient’s ID. The patients breathing system had collapsed. |
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Were issues related to staffing levels, training or competency? |
Staffing levels and competency might have contributed to this patient’s health situation. There is poor skill mix in the emergency department |
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Was equipment (or use/lack of use) a factor? |
Equipment were not a factor since the emergency call bell worked to alert the other healthcare practitioners of an emergency situation |
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Was the environment a factor? |
No; there were no environmental factors in this incident hindering or that might have contributed to the patients’ condition. |
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Were appropriate policies or procedures or lack thereof a factor? |
No; Healthcare practitioners followed all due policies and procedures to check vital signs and resuscitate the patient |
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Was the failure of a safety mechanism or barrier designed to protect the patient/staff a factor? |
No; there was no such a factor |
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Was communication a factor? |
Free and open communication was a factor because the clinical trainee was not given time to explain what had happen by one of the staff; Jennifer |
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Signed: Shannon Doe |
Date:
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Signed: John Matthew |
Date:
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Work Health & Safety: Shannon Case
In this case study, Shannon feels bullied by her preceptor Jennifer Lee as evidenced from their interaction within the last three days of her clinical placement. From the very first day, Jennifer strikes Shannon emotionally by indicating heavy workload ahead since the facility is short staffed. Jennifer hurriedly orients Shannon in the facility and leaves her to conduct the self-directed learning modules on WHS by herself. The following day, Jennifer sneers on her that she is well aware of her scope of practice but promises. Jennifer then makes a comment “Much to learn you have young padawan” leaving Shannon to perceive Jennifer as one person full of intimidation, ageist and stereotyping. Later in the day, Shannon feels that Jennifer is being sarcastic and dismissive when she (Shannon) meticulously explains clinical presentations and nursing procedures for various healthcare conditions.
Jennifer’s compliment “Wow, you’re a walking textbook” and “Well done” accompanied by unnecessary smiling makes Shannon feel intimidated and psychologically bullied. Shannon feels dismissed when she is not allowed to respond to a question core at demonstrating her clinical education. On day three, Shannon experiences the full wrath of Jennifer’s intimidation and bully behaviour when Jenifer again dismisses Shannon’s explanation of what had occurred to a patient admitted of pneumonia. This psychological torture is vividly revealed when Shannon realizes that Jennifer had not invited her for a clinical debrief.
These altercations between Shannon and Jenifer are a clear sign of workplace health and safety concerns that are embedded at the Charles Darwin University Hospital and in this case the Emergency Department (ED). According to the Australian Work Health and Safety Act 2011 (WHS Act), a person conducting a business or undertaking including employers and their supervisors or team leaders have a duty to protect employees and other people from workplace health and safety concerns [Australian Government 2018]. This includes protection from workplace harassment, bullying, intimidation, and discrimination. This is aimed at elevating the employees’ resilience and wellbeing while in the course of their duty (Sivris, & Leka, 2015).
In this case study, Shannon undergoes psychological harassment, intimidation and overly feels being bullied by her preceptor Jennifer primarily because of her age and position. This is evidenced by the Jennifer’s malicious actions towards Shannon and her clinical placement endeavors. Psychological stressors such as the ones Shannon is undergoing through on the very eve of her clinical placement adversely impacts on workplace productivity by discouraging and demotivating employees to work wholeheartedly (Cooper, Liu, & Tarba, 2014).
Conflict Management: Informal and Formal Procedures
At any one point in time, different healthcare practitioners will be involved in conflicts emanating either from personal differences or professional conduct differences just like in the case of Shannon and Jennifer. Conflicts and disputes not only destroy peaceful interpersonal relationships and but also significantly impairs workplace integration, teamwork, and productivity (Saundry, & Wibberley, 2014). Having formidable conflict resolution mechanisms and procedures in place can go a long way in helping a healthcare organization easily achieve its goals and objectives. This constitutes of both informal and formal conflict resolution approaches.
Conflicts ought to be solved as soon as they emerge and a stepwise approach is ideal where informal approaches of solving the same are applied. This starts by assessing the source of the conflict and moving ahead to consider possible solutions. Informal approaches advocate for early dialogue and resolution where the people in conflict amicably solve their concern in private. Minor disputes are the order of the day in workplaces and therefore basic problem-solving skills can help suffice such situations. Moreover, informal complaint, negotiation, and mediation can come at play if basic dialogue fails to bear fruits. This ought to culminate at fully sharing information to unearth the conflict and coming up with an amicable long-lasting solution (Saundry, et al., 2014).
In this case, Shannon feels bullied and intimidated by Jennifer when Jenifer sneers and dismisses her severally. However, this withstanding, Shannon and Jennifer can solve this stalemate by Shannon freely and clearly expressing her displeasure on how Jennifer is treating her only at the very start of her clinical placement. Jennifer, on the other hand, ought to heed the complaint and promise not to repeat. Keeping quiet and jumping to report the concern like Shannon did has the effect of escalating the conflict yet small disputes only emerge from simple misunderstandings, incorrect assumptions, and misinterpretations that can easily be solved through simple dialogue.
When informal conflict solving approaches fail, parties to the conflict can engage more formal approaches whereby the complainant can file the complaint with higher authorities. This then calls for investigations and when the matters in the complaints are fully unearthed, formal mediation can be affected or depending with the weight of the case in hand then more stern actions can be resorted to (Brubaker, et al., 2014). Healthcare organizations must have a formal procedure of handling complaints from healthcare practitioners and other stakeholders. This include having adequate conflict resolution policies and procedures in place such as fair and clear warnings, appropriate time limits, clear communication, and democratic decision-making criteria. In the case of Shannon, she ought to have filled a formal complaint for investigation to be done and a resolution reached by the health facility’s management instead of simply failing to report to duty and calling the Nursing Unit Manager, John Matthew on the same.
Recommendations for Building Resilience
The American Psychological Association (2018) terms resilience as the abilities of individuals to adapt and cope successfully in the advancement of adversity, threats, changes, stress, and life challenges. Indeed, Aburn, Gott, & Hoare, (2016) refers to resilience as simply the abilities of “bouncing back” from troubling problems and challenges. To this end, Aburn, Gott, and Hoare (2016) perceive resilient people as individuals with the ability of maintaining their social and emotional wellbeing in the face of adversities. Resilience fosters the virtue of wellbeing in which case people are rendered in a state of wellness, are able to enjoy life and have capabilities of connecting and dealing with adversities (Hart, Brannan, & Chesnay, 2014).
In the healthcare profession, many are the times that healthcare providers undergo stressors while in the course of their duty extensively impairing on their wellbeing besides impacting on their productivity. Edmonson and Asturi, (2015) perceive workload, time pressures and activity deadlines, multiple roles, and emotional concerns emanating from workplace bullying, discrimination, and intimidation as the major stressors in the healthcare profession. These adversely impact on the wellbeing of healthcare providers and may lead to fatigue, psychological trauma, and burnout.
Being resilient at the workplace does not mean evading or avoiding difficulties and adversities altogether. However, it means having abilities of living with troubling emotions, adversities, and challenges by engaging or doing what is necessary to minimize them (Frey, Robinson, Wong, & Gott, 2018). In this case, being a healthcare practitioner, Shannon can develop resilience to overcome Jennifer’s intimidation and bully behavior by elevating her self-awareness levels by evaluating her values, strengths, and weaknesses. This is especially the case if Shannon can refer back to the standards of practice informing the nursing profession as advanced by the Nursing and Midwifery Board of Australia (NMBA) and the Australian Health Practitioner Regulation Agency (AHPRA). NMBA’s standard number two encourages nurses to engage in in therapeutic and professional relationships in which case nurses are expected to approach their practice on grounds of mutual trust and respect for purposes of forging professional relationships [AHPRA, 2018].
Shannon is best suited to contrast her space when dealing with Jennifer by striving to establish and sustain a professional relationship that vividly distances personal intrigues. In doing so, Shannon ought to vividly and openly communicate all clinical observations in her practice which by extension promotes a culture of safety and learning. As per the standards number one; thinks critically and analyses nursing practice, Shannon is obliged to use her nursing skills and education to advance holistic care to patients under the confines of ethical frameworks. However, for purposes of forging adequate professional relationships, this ought to be in consultation with the other healthcare practitioners where necessary. Standard number three calls upon nurses to maintain the capability for practice by engaging in continuous self-management while responding to the concerns of other healthcare providers on the same. This opens an opportunity for Shannon to build workplace resilience by responding in a timely manner to her health and wellbeing [AHPRA, 2018].
Moreover, positive psychology has showcased that maintaining positive emotions and attitudes towards work in the face of workplace adversities not only promotes flexibility in thinking but also enhances decision making, problem solving, conflict resolution capabilities besides counteracting psychological impacts of negative emotions (Bond, Flaxman, & Bunce, 2013). To this end, Shannon is best suited to maintain positive emotions and attitudes besides focussing on what she deem to be the right things to do. In future, Shannon ought to forge effective workplace relationships; develop realistic and achievable personal and career goals; develop decision making, problem solving, and conflict resolution capabilities and work planning capabilities to boast her resilience levels (Winwood, Colon, & McEwen, 2013).
Conclusion
Indeed, devising amicable personal and workplace strategies of dealing with stressful and adverse workplace adversities can go a long way in assisting healthcare practitioners gain the resilience they need to survive in such environments. The healthcare industry is undeniable a very stressful industry and therefore resilience is very vital (McDonald, Jackson, Wilkes, & Vickers, 2013). Since some of these adversities emanate from internal conflicts, healthcare organizations ought to come up with amicable conflict resolution mechanisms to cope with the same. In this case study, Shannon has been exposed to several conflict resolution approaches as well as ways in which she can improve her workplace resilience as she further transfers deeper in the nursing profession.
References
Australian Government (2018). Federal Register of Legislation. Work Health and Safety Act 2011. Accessed from https://www.legislation.gov.au/Details/C2018C00293.
Retrieved 9/22/2018
American Psychological Association (2018). The Road to Resilience [Retrieved from]
https://www.apa.org/helpcenter/road-resilience.aspx. Accessed 1/9/2018
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AHPRA (2018). Registered nurse standards for practice [Retrieved from]
https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD16%2f19524&dbid=AP&chksum=R5Pkrn8yVpb9bJvtpTRe8w%3d%3d. Assessed 31/8/2018
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