Description The event in question occurred during the handover phase of a nursingexperience. Handovers are a critical element of nursing practice. Ifinformation is missed or transferred incorrectly, the lives of patients can be placedat risk. However, time and space pressures often mean that handovers have to becompleted quickly or in busy environments.
For this reason, routine andprotocol are highly important. In this instance a situation arose where thehandover was completed incorrectly. The ward had long-term clients, themajority of whom had conditions that were unchanged. Nobody had had anyprocedures or surgeries, and there were no changes to medication.
The nurse whowas finishing her shift was in a rush to leave and avoid the heavy traffic onthe roads. Therefore, in order to save time she said “you know everybody here,nothing’s changed since yesterday.” This was her handover, and she leftimmediately afterwards. In response to this, the student nurse carried out hershift as usual, and later spoke with a mentor. The mentor and the studentdiscussed the various options that the student nurse could have taken, andreflected on the experience. Feelings The initial feelings were surprise,shock, embarrassment, and finally insecurity. Student nurses are taught tofollow procedures, and are also taught the high value of those procedures(Chang and Daly, 2012).
Whilst instinct and gut feelings are useful, this is aprofession that requires structure (Daly, Speedy, and Jackson, 2009).Therefore, when somebody with higher levels of experience breaks procedure itcan be a surprising and uncomfortable experience. The feelings of insecuritycame 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 ofinformation to consider. Several of the patients had complex cases thatinvolved comorbidities, and there were lots of risks of sudden changes inpeople’s conditions. In addition to this, two of the clients had allergies thatincreased the complexities of their care.
To be left in a position ofresponsibility without full knowledge of the intricacies of the variouspatients was a particularly vulnerable scenario. After speaking to the mentor,the feeling was one of relief. It was apparent that carrying on with the shiftas if the handover had been successful was not the correct course of action tohave taken. Therefore, there was also the feeling of having learned valuableinformation. Evaluation The experience revealed that a nurse must always beprepared for surprises and departures from the norm. This was both a positiveand a negative experience.
The negativity stemmed from losing confidence in acolleague, and from seeing that procedures that are taught as being immovableare not always followed. This is a normal reaction, according to Rn (2001). Onthe other hand, the positivity stemmed from being able to learn from a newexperience and to meet new challenges. The reality is that not all nurses willfollow procedure correctly (Gerrish, 2000; Duchscher, 2009; and Funnell and Koutoukidis,2008).
This is something for which there are formal responses that can be madeby superiors and other colleagues, and which a new nurse needs to become usedto. In this instance, the mentor explained that there were several courses ofaction that could have been taken. The student nurse could have continued withthe shift without making any comment. Alternatively, the student nurse couldhave stopped the colleague before she departed and asked for a more thoroughhandover. After the colleague had left, the best course of action would havebeen to have alerted a superior to the situation.
This would have ensured thatfull support was given. Learning this was a positive experience. Analysis Thereis much to be made of this experience beyond the basic acquisition ofprocedural information. Involved in this situation were physical and emotionalresponses, and all are an important part of the learning process (Zielinski, 2012).As a student nurse, repeating procedures accurately is very important. Duringthe training phase there is a large amount of information to gather, process,and learn (Zielinski, 2012).
This information can have serious implications fora client’s health, so the stakes are very high in comparison to some otherprofessions. For this reason, a considerable portion of the nursing trainingprocess is practical (Duchscher, 2009). By doing tasks practically, a nurselearns in several different ways, particularly engaging visual and kineticlearning practices (Gerrish, 2000; Chang and Daly, 2012). For this reason, itis particularly important that the training phase of nursing is a period whereaccurate procedure is followed. On the other hand, not all practicalexperiences in the nursing profession are carried out perfectly. Some peopleare unprofessional about their work, and some unexpected experiences arise evenwhen everyone works to the best of their ability.
In the nursing environmentthis can be very unsettling (Gerrish, 2000), but nevertheless requires ananalytical and measured response (Chang and Daly, 2012). Being able to think onones feet is a necessary part of the nursing experience. This handover provideda very good example of a situation where there were multiple courses of actionto be considered and chosen. Therefore, it provided a good example of the needfor 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 threatenedto distract from other professional duties. It was interesting to note that itwas hard to concentrate on other nursing functions, such as taking bloodpressure readings, due to worrying about whether anything important had beenmissed. Knowing that insecurity is the expected personal response in thissituation is an important lesson to learn, as there are various exercises thatcan be carried out to overcome that potential problem. Finally, the importanceof having the support of a mentor was revealed during this experience.
Untilthis time, the mentor had seemed like someone who was there to help withpractical problems such as worrying about carrying out some of the morecomplicated procedures. This was the first situation that had arisen where theprofessionalism of a colleague was called into question, and where the potentialcourses of action were slightly embarrassing to undertake. Recognising that amentor is able to give advice about how to respond emotionally to moralsituations was a valuable lesson. Conclusion It is clear that the course ofaction that was selected was not the best one. Seeking help immediately wouldhave been more appropriate. It was fortunate that on this occasion there wereno problems; however, the situation could have been very different and therecould have been serious consequences.
Therefore, the student nurse should haveeither prevented the colleague from leaving, or should have sought advice.However, the choice to have a meeting with the mentor was the correct one. Thishighlighted the importance of meeting with the mentor more frequently, andbeing more communicative with people in general. If one feels comfortabletalking to colleagues and asking advice, one is more likely to learn from otherpeople’s experiences.
Action Plan An action plan is designed to answer thequestion: if the situation rose again, what would you do? The answer to thisis quite clear. Firstly, it is important to have the confidence to say to acolleague that you do not have enough information. In this instance, saying”please stay and repeat the handover” would have saved many problems and wouldhave reduced the risks considerably. Therefore, if this situation happenedagain the first course of action would be for the student nurse to outline theproblem to the colleague clearly in the hope of repeating the procedurecorrectly. If this failed, the next course of action would be to contact asuperior and explain the situation. If a colleague is satisfied withundertaking a handover in this manner on one occasion, it is possible that itis a frequent occurrence. This potentially puts lives at risk. Therefore, it isimportant that a manager is made aware.
By alerting a superior, a more juniornurse will also be able to have the support that he or she needs to work safely