Erin is a new graduate working in a large medical-surgical unit. She wrote the NCLEX exam, passed, and now has a license to practice. While she worked under her temporary license, after graduation, the unit manager ensured that she had lighter assignments and was paired up with a more experienced nurse, in order for Erin to learn the policy and procedures of the unit before getting used to having a full patient load on what it, traditionally, a very heavy unit.
When the unit manager and staff find out that Erin has passed her NCLEX and become an RN, they congratulate her heartily. The next night Erin returns to work to find that she has a very heavy assignment and is not paired up with anyone to help her. Up until now, she has had only four patients on the night shift and has been able to cover for one other nurse while that nurse goes on break. Tonight, Erin finds that she has been assigned nine patients. One patient requires careful monitoring as she becomes disoriented at night and is at risk for falls or wandering. There is no one available to provide constant care for the patient tonight. Another patient requires administration of a chemotherapy drug via a peripherally inserted central catheter (PICC). The report notes that the PICC is not working well and may have to be reinserted.
Erin approaches James, the nurse in charge, to ask for help. She isn’t sure how she can provide constant care for one patient, with eight others. Erin is also very concerned about the patient with the PICC line who requires chemotherapy. The hospital policy states that only nurses who have undergone special certification may administer chemotherapeutic agents. While she has flushed PICC lines, Erin has not been certified to insert one.
James tells her that they are very understaffed tonight, as the nursing supervisor pulled two of the unit nurses to cover in the ICU. He suggests that Erin go first and try to flush the PICC line and if it sticks, just push harder. He quietly adds that he knows the policies state not to do this, but it usually works, if you “do it just right”. If it doesn’t work, he adds he’ll show her how to insert one himself and she can do it. He also tells Erin that he will prepare the chemotherapy drug but Erin will have to give it. Finally he instructs Erin to just try to look in on the patient requiring constant care once in a while, as often as she is able. “If something happens”, he states, while shrugging, “we’ll deal with it”.
Erin is well aware that her provincial regulatory body outlines seven standards of practice and that one of the standards, accountability, is demonstrated by “maintaining competence and refraining from not performing activities for which she/he is not competent”. (College of Nurses of Ontario, 2009).
James sees Erin hesitating. “This happens all the time”, he says to Erin, “Welcome to the real world!”
Questions:
1.What dilemmas does Erin face?
2. What are the alternatives are available to Erin?
3. Can Erin meet the standards and adhere to the policies of the institution?
