NRS 415 Topic 2 DQ 2

NRS 415 Topic 2 DQ 2

Assessment Description

Read the scenario and address the discussion question:

Scenario

Nurse Lope is starting a busy shift in which she was finishing report on Mr. Johnson. During report, Nurse Jim who was finishing his shift also gave Nurse Lope a medicine cup containing three of Mr. Johnson’s unopened medications that he reported were recently retrieved from the medication dispenser. Nurse Lope was told that these were supposed to have been given 30 minutes ago and asked if she could give them during bedside hand-off. As Nurse Lope planned to stay in Mr. Johnson’s room to complete his vital signs and assessment, she agreed with this plan. 

When she opened Mr. Johnson’s electronic medical record to administer these medications, she noticed that these medications were scheduled to be given 3 hours ago. Additionally, one of the medications had a barcode that was not scanning to Mr. Johnson’s chart. Nurse Lope proceeded to administer these medications so that she would not be late on the next round of medications, which included some of the same ones. It was later discovered that the medication that was not scanning was for another patient and should not have been given to Mr. Johnson. 

Discussion Question

Outline the concept of professional accountability as it pertains to nursing. Examine the actions of Nurse Jim and Nurse Lope. Discuss how you would approach this scenario if you were in Jim’s and Lope’s position. Based on your analysis of how nurses demonstrate accountability in clinical practice, the nursing process, and evidence-based practice, explain how you would handle this situation if you were the nurse manager overseeing Jim and Lope. 

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 2.2, 2.5, 2.6, 9.4.

Nursing continues to be one of the most trusted professions. In order to maintain this level of trust, it is vital to be accountable and responsible for one’s actions to oneself and others. Despite challenges such as time constraints and demands of the job, nurses must avoid shortcuts, follow protocols, and collaborate to ensure safe, high-quality patient care (Davis, 2017). According to the American Nurses Association (2015), the code of ethics states that nurses are responsible for their decisions and actions throughout their careers. It outlines ethical obligations to the public and oneself, emphasizing accountability and responsibility in nursing.

If I were in Nurse Jim’s position and was 3 hours late in administering Mr. Johnson’s medications, I would take accountability for the error and follow appropriate hospital protocol regarding missed medications. I would not involve another coworker into my mistake as that could potentially result in them being reprimanded for my actions.

If I were in Nurse Lope’s position, the first action I would have taken was to check Mr. Johnson’s chart and labs and verify that it was safe to administer his prescribed medications. Then I would have followed the seven rights of medication administration: right medication, right dose, right patient, right route, right time, right documentation, and right indication (Perry et al., 2022). Had Nurse Lope followed the rights, she could have avoided the medication error.

As a nurse manager, I would handle this situation by holding both Jim and Lope accountable for their actions. I would sit down with Jim and determine what caused the delay in medication administration. Depending on whether it was related to time management or patient ratios, I would address the issue and find solutions to prevent a future occurrence. As for Lope, I would encourage her to stand up for herself if fellow nurses try to place the burden of their responsibility onto her, and to speak with the charge nurse or nurse manager if she receives any push back as a result.

References

American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statementshttps://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

Davis, C. (2017). The importance of professional accountability. Nursing Made Incredibly Easy!, 15(6):p 4, November/December 2017. https://doi.org/10.1097/01.NME.0000525557.44656.04

Perry, A. G., Potter, P. A., Ostendorf, W., & Laplante, N. (2022). Clinical Nursing Skills & Techniques. Elsevier, https://pageburstls.elsevier.com/books/9780323796545

Professional accountability within nursing means taking responsibility for your actions, even if deviations from care standards occur (Davis, 2017). As nurses, we must “hold high clinical practice and ethical standards”, thus, holding professional accountability is imperative to providing safe and quality patient care (Chesterton et al., 2020). However, professional accountability can be compromised by “a lack of resources and poor managerial support”, and often goes unaddressed until consequences arise (Chesterton et al., 2020).

I understand that a busy shift can be off-putting and stressful, however, this is not an excuse for Nurse Jim to not administer the patient’s medications, given they were 3 hours late. This is a direct violation of the 5 Rs of medication administration, specifically the right time, as this can have consequences within the body. In addition, telling Nurse Lope that the medications were supposed to be administered 30 minutes ago, when they were instead due 3 hours ago, negatively reflects his integrity and character. If I was in Nurse Lope’s position, I would immediately be apprehensive about Nurse Jim asking for assistance with medications at shift change. Upon seeing the medications were scheduled to be given 3 hours ago and not 30 minutes, I would have stopped. With the patient’s best interest and nursing integrity in mind, I would report to the responsible nurse manager and explain to them the situation (American Nurses Association, 2015). Nurse Lope violated the 5 Rs of medication administration, specifically the right patient and the right drug, when Nurse Lope administered the medications without using 3 identifiers and when they did not check the medications orders to determine if these medications were for the correct patient.

If I was the nurse manager overseeing Jim and Lope, I would allow them to explain their side of the scenario individually. It is important to gather all the details and see where each nurse failed to be accountable for their actions. It is important to enforce disciplinary actions on the nurses, but also understand the reasoning behind their actions and refer them to help if there are personal affairs that hinder their work performance. It is also important to be aware of the environment the nurses work in. Nursing environments should “ensure ongoing safe, quality patient care and professional satisfaction for nurses and to minimize and address moral distress, strain, and dissonance” (American Nurses Association, 2015). Modifications to the environment could include the nursing unit’s knowledge of safe practices, culture among nurses, nurse to patient ratio, and level of support the nurses feel from their superiors.

American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statementshttps://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

Chesterton, L., Tetley, J., Cox, N., & Jack, K. (2020). A hermeneutical study of professional accountability in nursing. Journal of Clinical Nursing30(1–2), 188–199. https://doi.org/10.1111/jocn.15539

Davis, C. (2017). The importance of professional accountability. Nursing Made Incredibly Easy!15(6), 4–4. https://doi.org/10.1097/01.nme.0000525557.44656.04