Description

The event in question occurred during the handover phase of a nursing
experience. Handovers are a critical element of nursing practice. If
information is missed or transferred incorrectly, the lives of patients can be placed
at risk. However, time and space pressures often mean that handovers have to be
completed quickly or in busy environments. For this reason, routine and
protocol are highly important. In this instance a situation arose where the
handover was completed incorrectly. The ward had long-term clients, the
majority of whom had conditions that were unchanged. Nobody had had any
procedures or surgeries, and there were no changes to medication. The nurse who
was finishing her shift was in a rush to leave and avoid the heavy traffic on
the roads. Therefore, in order to save time she said “you know everybody here,
nothing’s changed since yesterday.” This was her handover, and she left
immediately afterwards. In response to this, the student nurse carried out her
shift as usual, and later spoke with a mentor. The mentor and the student
discussed the various options that the student nurse could have taken, and
reflected on the experience. Feelings The initial feelings were surprise,
shock, embarrassment, and finally insecurity. Student nurses are taught to
follow procedures, and are also taught the high value of those procedures
(Chang and Daly, 2012). Whilst instinct and gut feelings are useful, this is a
profession that requires structure (Daly, Speedy, and Jackson, 2009).
Therefore, when somebody with higher levels of experience breaks procedure it
can be a surprising and uncomfortable experience. The feelings of insecurity
came from being left with patients who had not had a proper handover. Although
“nothing had changed” from the previous day, this was still a large amount of
information to consider. Several of the patients had complex cases that
involved comorbidities, and there were lots of risks of sudden changes in
people’s conditions. In addition to this, two of the clients had allergies that
increased the complexities of their care. To be left in a position of
responsibility without full knowledge of the intricacies of the various
patients was a particularly vulnerable scenario. After speaking to the mentor,
the feeling was one of relief. It was apparent that carrying on with the shift
as if the handover had been successful was not the correct course of action to
have taken. Therefore, there was also the feeling of having learned valuable
information. Evaluation The experience revealed that a nurse must always be
prepared for surprises and departures from the norm. This was both a positive
and a negative experience. The negativity stemmed from losing confidence in a
colleague, and from seeing that procedures that are taught as being immovable
are not always followed. This is a normal reaction, according to Rn (2001). On
the other hand, the positivity stemmed from being able to learn from a new
experience and to meet new challenges. The reality is that not all nurses will
follow procedure correctly (Gerrish, 2000; Duchscher, 2009; and Funnell and Koutoukidis,
2008). This is something for which there are formal responses that can be made
by superiors and other colleagues, and which a new nurse needs to become used
to. In this instance, the mentor explained that there were several courses of
action that could have been taken. The student nurse could have continued with
the shift without making any comment. Alternatively, the student nurse could
have stopped the colleague before she departed and asked for a more thorough
handover. After the colleague had left, the best course of action would have
been to have alerted a superior to the situation. This would have ensured that
full support was given. Learning this was a positive experience. Analysis There
is much to be made of this experience beyond the basic acquisition of
procedural information. Involved in this situation were physical and emotional
responses, and all are an important part of the learning process (Zielinski, 2012).
As a student nurse, repeating procedures accurately is very important. During
the training phase there is a large amount of information to gather, process,
and learn (Zielinski, 2012). This information can have serious implications for
a client’s health, so the stakes are very high in comparison to some other
professions. For this reason, a considerable portion of the nursing training
process is practical (Duchscher, 2009). By doing tasks practically, a nurse
learns in several different ways, particularly engaging visual and kinetic
learning practices (Gerrish, 2000; Chang and Daly, 2012). For this reason, it
is particularly important that the training phase of nursing is a period where
accurate procedure is followed. On the other hand, not all practical
experiences in the nursing profession are carried out perfectly. Some people
are unprofessional about their work, and some unexpected experiences arise even
when everyone works to the best of their ability. In the nursing environment
this can be very unsettling (Gerrish, 2000), but nevertheless requires an
analytical and measured response (Chang and Daly, 2012). Being able to think on
ones feet is a necessary part of the nursing experience. This handover provided
a very good example of a situation where there were multiple courses of action
to be considered and chosen. Therefore, it provided a good example of the need
for critically reflective practice. One of the most valuable aspects, however,
was learning about the personal emotional response to the situation (Zielinski,
2012). The feeling of insecurity was particularly problematic, as it threatened
to distract from other professional duties. It was interesting to note that it
was hard to concentrate on other nursing functions, such as taking blood
pressure readings, due to worrying about whether anything important had been
missed. Knowing that insecurity is the expected personal response in this
situation is an important lesson to learn, as there are various exercises that
can be carried out to overcome that potential problem. Finally, the importance
of having the support of a mentor was revealed during this experience. Until
this time, the mentor had seemed like someone who was there to help with
practical problems such as worrying about carrying out some of the more
complicated procedures. This was the first situation that had arisen where the
professionalism of a colleague was called into question, and where the potential
courses of action were slightly embarrassing to undertake. Recognising that a
mentor is able to give advice about how to respond emotionally to moral
situations was a valuable lesson. Conclusion It is clear that the course of
action that was selected was not the best one. Seeking help immediately would
have been more appropriate. It was fortunate that on this occasion there were
no problems; however, the situation could have been very different and there
could have been serious consequences. Therefore, the student nurse should have
either prevented the colleague from leaving, or should have sought advice.
However, the choice to have a meeting with the mentor was the correct one. This
highlighted the importance of meeting with the mentor more frequently, and
being more communicative with people in general. If one feels comfortable
talking to colleagues and asking advice, one is more likely to learn from other
people’s experiences. Action Plan An action plan is designed to answer the
question: if the situation rose again, what would you do? The answer to this
is quite clear. Firstly, it is important to have the confidence to say to a
colleague that you do not have enough information. In this instance, saying
“please stay and repeat the handover” would have saved many problems and would
have reduced the risks considerably. Therefore, if this situation happened
again the first course of action would be for the student nurse to outline the
problem to the colleague clearly in the hope of repeating the procedure
correctly. If this failed, the next course of action would be to contact a
superior and explain the situation. If a colleague is satisfied with
undertaking a handover in this manner on one occasion, it is possible that it
is a frequent occurrence. This potentially puts lives at risk. Therefore, it is
important that a manager is made aware. By alerting a superior, a more junior
nurse will also be able to have the support that he or she needs to work safely

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