Integrate nursing professional values, responsibilities and accountability during clinical decision making with colleagues and to support individuals’ autonomy and dignity
Analyse safe care in relation to moral, ethical, legal, policies and professional standards using current evidence in CYP nursing practice
Demonstrate the knowledge, skills and attitudes required to support/lead others confidently and articulate nursing issues within the MDT and the public
Analyse how existing health and social policies influence resources that impact delivery of patient care to CYPs and their families
Compare and contrast how legal frameworks, local and national policies identify vulnerable CYPs within health and social care environments to prevent risks of harm to safeguard them
Analyse models designed to identify and support staff develop self-awareness, resilience, self-well-being and management in their role
Case scenario
Staff Nurse (SN) Dave has been a qualified children’s nurse for three years and due to personal interests in world travel Dave made the decision to work as an agency nurse. He has worked in several UK and international general paediatric wards. He has been working as an agency nurse on the present general paediatric ward for the past 16 months. SN Dave is also a Practice Assessor (PA) to student nurses.
On this particular shift SN Dave is the PA of year 2 student nurse (STDN) Nicola. Junior Sister Kay is in charge of the shift. The shift is particularly busy because they are short staffed. Ward manager Senior Sister (SR) Latta did not get around to booking any agency or bank staff to fill the shift shortages as she had to complete an e-module for a course she was attending. It took longer than expected and she completely forgot to cover the shifts. On SR Latta’s professional development study day she pops onto the ward during the morning to see how the ward is but did not inform the hospital site manager that the ward was very short staffed and no patient safety incident report been completed to record the unsafe staffing levels.
During the busy shift SN Dave is looking after far more patients than normal and they are broadly geographically dispersed across the ward, to include patients on different bays and also those residing in cubicles. STDN Nicola measures baby Suzi’s vital signs and documents them on the PEWS chart. The baby is pyrexial. The baby Suzi has a nasogastric tube in place and also an intravenous cannula in her right arm. STDN Nicola shows SN Dave the PEWS. SN Dave is in the process of taking some medication to another patient on the bay when STDN Nicola shows him the baby Suzi’s PEWS. SN Dave is concerned by Suzi’s very high temperature and quickly asks the parent to identify their son and SN Dave politely asks the parent to give their son the oral antibiotic liquid that Dave was about to administer to the child on the drug round. He leaves the antibiotic with the parent.
SN Dave walks with STDN Nicola to the drug treatment room and as he is walks Dave signs for the drugs that he left with the parent to administer; as given.
STDN Nicola hands SN Dave the drug chart of the baby with the very high temperature. He draws up some prescribed paracetamol in an oral syringe and hands it to STDN Nicola to give to the baby Suzi in the cubicle. STDN Nicola observes in the background SN Dave check the paracetamol with SR Kay and Nicola is happy that the drug dose is correct. SN Dave tells STDN Nicola to check baby Suzi’s identity bracelet, check the tube and flush the paracetamol down the tube. He then continues with the drug round and goes to another patient in the opposite direction.
STDN Nicola checks the baby’s identity bracelet against the drug chart, checks the time for administration and flushes the liquid paracetamol into the intravenous cannula instead of the nasogastric tube. Within minutes the baby’s appearance changes and the baby looks unwell and mottled. STDN Nicola shouts for help and explains to SN Dave what she has done. A medical emergency begins.
After emergency medical intervention the hospital site manager is bleeped and informed. The baby is stable. A patient safety incident report is completed. The baby’s parents return from their lunch break in the hospital canteen and are informed about the incident by the site manager and SR Kay. They are furious and wish to make a formal complaint. They cannot understand why they were not called on their mobile phones to come to the ward and also they cannot understand why and how the drug error could have happened.
Essay questions
Question 1: Consider the current NMC Code, relevant legislation, policies, guidelines, ethical principles. Identify, discuss and analyse the appropriateness of behaviours of the nurses involved in the scenario.
