Contemporary Professional and Clinical Nursing Issues

Introduction
The standards set by the National Safety and Quality Health Service (NSQHS) are meant to ensure that health service consumers get the same quality of care when served in any health care facility across the nation (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2016). The main objective of the NSQHS standards is to protect users of health services from harm and to enhance the quality of care provided countrywide. The standards are essentially mechanisms meant to monitor the quality of health services provided (ACSQHC, 2019). However, despite the existence of these standards and several other measures, clinical and professional issues still occur in the nursing world resulting in health service consumers being harmed or negatively impacting the quality of health care services being offered (Government of Western Australia, 2017).
One of the key standards, Standard IV, sets standards to ensure medication safety (ACSQHC, 2019). It essentially deals with drug prescription, administration, and monitoring. Part of the guidelines contained in the standard recommend explaining to patients the use and the risk associated with certain medication before prescribing or administering the medication to them (Davies, Coombes, Keogh, & Whitfield, 2019). The objective of this essay is to outline an issue that touches on medication safety and to subsequently analyse its legal, ethical, delegation, teamwork, conflict management, and clinical leadership contexts.
The Issue
In a simulation class, a student and a registered nurse were providing care to a patient that was in severe pain and had asked for pain drugs. When asked what her pain level out of ten was, the patient said it was eight. She also stated that her leg felt uncomfortable and tight in the cast that had been placed on it. However, the registered nurse happened to be distracted when taking the woman’s vital signs that she failed to take notice of her level of pain. Whilst the registered nurse measured the vital signs, the student nurse recorded them. Before the end of the measurement session, the student nurse brought the attention of the registered nurse to the pain the patient was suffered and together they opted to give Tramadol for the pain. While the student nurse was quite concerned regarding the woman’s pain, the registered nurse was in quite a hurry to complete certain tasks so she rushed to administer the pain medication (Endacott, et al., 2015). In her rush, she did not adequately follow the standards and rights for medication administration. The medication, being a Schedule IV medication, ought to be checked first, and then counted, and then signed by 2 registered nurses at the treatment room and prior to administration (Government of New South Wales, 2013; Government of Western Australia, 2013). This did not happen because the student was not a registered nurse and was, therefore, outside their scope of practice, and the nurse failed to point out what is normally done. The medication administered ended up being wasted and the whole administration process had to be re-initiated when a second registered nurse came in.
Several factors can compromise medication safety. In this particular case, the main factors were lack of delegation and clinical leadership (Claffey, 2018). The case also reveals that there are some ethical and legal questions that need to be answered regarding what happened (Ben Natan, Sharon, Mahajna, & Mahajna, 2017). Lack of consistency in medication administration can negatively impact both the patient and the nursing team (Davies et al., 2019).
Impact of the issue on the nursing team.
Quite a number of factors can compromise medication safety and negatively impact the nursing team. In this case, the nursing team could end have having negative feelings such as doubt, guilt, and shame (Yung, Yu, Chu, Hou, & Tang, 2016). The nursing student was operating out of their normal scope of practice and the registered nurse allowed it occur to help the student learn (Bucknall, et al., 2016). Sometimes, embarrassment from making such errors can lead to the involved member or members of the nursing team not admitting to what they did wrong (Yung et al., 2016). Such persons may also fear consequences such as loss of work or suspension of their professional license leading to stress and lower performance (Al-Ghareeb & Cooper, 2016). Nurses lead from the front in the provision of care and in the administration of drugs, therefore, lack of confidence following an error can significantly impact their work (Jember, Hailu, Messele, Demeke, & Hassen, 2018). Nursing students also ought to know their normal scope of practice and to restrict their duties and actions accordingly (Reid-Searl, Happell, Burke, & Gaskin, 2013).
Impact of the issue on the patient.
The patient, in this scenario, had to wait for medication, for longer than she needed to while in sever discomfort. Her experience was unpleasant and could definitely affect her satisfaction levels (Claffey, 2018). Her situation could also lead to her and people who know her distrusting medical professionals and the health system they operate in (Claffey, 2018). The lack of trust could further negatively impact the patient and the care providers. Furthermore, the scenario could have resulted in adverse events that could increase the mortality rate for her (Jember et al., 2018).
Literature review
Clinical leadership is necessary for the improvement of the quality and safety of care provided. Without strong leadership, quality and safety of care cannot be guaranteed. There is a need for leaders to get sufficient training for them to be able to provide the right leadership (ACSQHC, 2019). Nursing practitioners play a key role in the administration of medication, which is a complex process that has to be handled carefully (Roughead, Semple, & Rosenfeld, 2016). The training of nursing students in real hospital environments is usually encumbered by factors such as lack of sufficient time especially in busy hospitals leading to emotional stress and pressure (Jarvelainen, Cooper, & Jones, 2018). It is exactly because of lack of time that the above error occurred (Vaismoradi, Griffiths, Turunen, & Jordan, 2016).The registered nurse could have used delegation to create time for training the student (Yoon, Kim, & Shin, 2016). Delegation is important in the nursing world because of the many tasks involved in patient care (Nursing and Midwifery Board of Australia [NMBA], 2016).
The nurse in this case did not show strong preceptorship or teamwork (Vaismoradi, Jordan, Turunen, & Bondas, 2014). By working with others as a team, the registered nurse could have ensured patient safety (Davies et al., 2019). Effective teamwork strategies can reduce or eliminate medication safety issues (Latimer, Hewitt, Stanbrough, & McAndrew, 2017). It should be remembered that the safe administration of drugs is an ethical and legal requirement of all medical professionals (Hall, 2017). Registered nurses have multiple legal responsibilities during the entire process of medication administration (Kadivar et al., 2017). Considering the non-maleficence cornerstone of medical ethics, registered nurses and other medical professionals ought to emphasize and protect patient safety in all their actions and conduct (Ben Natan et al., 2017).
The reporting of errors and issues related to patient safety is often avoided because of fear of repercussions even though would be reporters know that such reporting could reduce the future occurrence of such errors. The individuals who make errors also fear consequences hence do not report since they believe administrators would focus on them rather than to investigate the root cause of the errors (Kadivar et al., 2017). Medication safety issues can lead to adverse events or even death (ACSQHC, 2019; Davies et al., 2019).
Recommendations
Teaching of student nurses in hospital environments is necessary to prepare them for the life ahead as it improves their decision-making and problem-solving skills (Bogossian et al., 2018). To ensure registered nurses provide such students with the right training, there is a need to train them effectively on nurse leadership (Saqer & Abu Al Rub, 2018). Thus, in this particular case, new clinical leadership training programs will need to be instituted. There is also a need to review the policies and define the scope for student nurses in the hospital environment so as to ensure the students know their duties and stick to them (Green, 2018).
The Learning Experience
The student nurse learned an important lesson about restricting their activities to their scope of conduct. The nurse was busy and distracted when interacting with the patient. The student should have made them aware of their concern and should have subsequently informed the preceptor that the task they were assigned was outside the boundary of their scope of practice. This is what all student nurses should do in all cases. In the case of the actions of the registered nurse, the learning experience was that there is always a need to follow standards and protocols to protect patient safety. Delegation and teamwork are also important for the protection of patient safety. The main learning experience is that patient safety should always remain the priority in the field of nursing.
Conclusion
The administration of medication is a complex process with registered nurses at the forefront of it. If done incorrectly and if standards are not adhered to, errors can occur. The errors can lead to adverse events for the patients and consequences for the nursing staff. Nursing students need the right preceptorship. They also need to only handle duties within the borders of their scope of practice. Evaluation of medication administration procedures and regular investigation of errors can reduce them in the future.
References
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