Question

We have you covered:

Justin Tyme - a registered nurse - joins the unit after successfully completing new employee and unit orientation. He had worked for 10 years in a similar unit at St. Elsewhere but grew tired of the 2 hour daily commute. He is thrilled to be working closer to home. The staff is ecstatic as the unit has been short-handed and the census high.

The staff likes working with Justin. He is a friendly fellow and frequently brings hot donuts and a huge thermos of Peets coffee for the staff. He is always willing to help with lifting and turning patients and often is the first one to respond to patient lights.

Justin does not always follow through on his observations and physician orders; he often misses giving routine meds. The staff has taken to routinely double-checking Justin's orders and the following shift often dispenses the missed meds.

One morning, Dr. Tauk comes in to review the speech consult he ordered the day before on his patient, Mrs. Dee Phagia, prior to ordering her a diet. Dr. Tauk cannot find the consult asks Charity N. Able, RN, to locate it and call him. Charity discovers that the order had never been placed. On follow-up, Charity discovers - not to her surprise - that Justin was the nurse who noted the order. Charity does not talk to the manager but does point out the error to Justin who feels terrible about it.

Over the next month, Justin continues to make intermittent "small" mistakes which cause no harm to patients; and the staff continues to cover.

Today, Dr. L. Ovin comes in and notices that her patient, Mr. Hart, is in atrial fibrillation. She orders stat IV digoxin and cancels scheduled diagnostic procedures. Mr. Hart remains in atrial fib and, as you review his chart, you discover that Justin missed the last two routine digoxin doses.

Respond to each question with an answer of 75-150 words:

1. List two alternative actions and identify the best and worst case scenario for each alternative, anyone who would be harmed by this choice (and how), any values that would be compromised by selecting this alternative, and any automatic reasons why this alternative should not be selected (legal issues, rules, etc…)?

Answer 1

In this case, Justin is an experienced nurse but the 10 year of experience doesn't always mean the person is perfect in his job. He is nice to his colleagues and always ready to give a helping hand. He brings food for them which creates a healthy environment. But when it comes to his duty for his patients he is behaving carelessly or neglecting the orders.

The last case stated is about a patient who is having sudden cardiac problem, the action needs to be taken immediately in order to prevent it from worsening. Justin has been doing intermittent "small" mistakes , but missing a dose of stat injection can not be considered a small mistake because stat orders are to be followed immediately. Now the nursing incharge should be informed about Justin's behaviour of small mistakes. He should be asked for an explaination letter for his wrong doing. Also his colleagues should also stop covering his mistakes in near future and this should be strictly explained to every nursing staff. If he repeatedly (3 times) does the same behaviour then he should be taken to the nursing superintendent (NS). The NS should further emphasize on how to be careful in following orders, should help him out how he can improve; by cross checking his treatment chart whenever he leaves his shift, go through all the doctor's order and likewise he can be more careful.

The best case scenario will be that Justin will reduce the number of mistakes or be careful and on doing mistake will himself try to correct them before other colleagues finds out. He will gradually improve and stop doing mistakes.

Worst case scenario will be that he will not improve and continue skipping the medication or keep doing small mistakes. All this will ultimately affect the patients condition and it may lead to deterioration of the patient condition.

The responsibility and accountability is one of the values which will be affected as the registered nurse Justin will be accountablenin future for his mistakes. He needs to state the reason why he is not following doctor orders on time. Neglected behaviour is never acceptable and always questioned.

I hope it helps if it does don't forget to upvote.

Thank you!