Hesitancy and Miscommunication on the Part of Novice Nurses: An Incident That Chastised Me for Life
During my third year of nursing school, while on a Reproductive Health rotation, I was assigned to the labor room to deal with antenatal clients. Under supervision of the faculty staff, I was introduced to my client who was in induced labor and on cardiotocography (CTG) monitoring. I was briefed me about CTG monitoring and reminded of the normal Fetal Heart Rate (FHR): 120-160 bpm. The faculty staff restated that the client could go into severe complications if the FHR fell below the given range. Once briefed, I was made responsible for the care and continuous monitoring of my client.
While monitoring the CTG, there was a sudden drastic drop in FHR, down to 90 bpm. I at once thought to rush and inform the staff regarding the decline in FHR, but then somehow I stepped back and didn’t inform the staff. I thought the staff would not take it seriously and would see it as an act of overconfidence on my side, it being my first day of RH clinical. After some time, the doctor saw the changes in CTG and everyone rushed into the room. The nurse on duty shouted at me for not doing what I had been appointed to do, i.e. monitor FHR, note changes and promptly inform the staff. I couldn’t say anything at the time, for I knew I was in the wrong. As a result of my preoccupations, lack of confidence and communication, the client suffered acute complications – which fortunately were resolved later on.
Reflecting back and looking past the guilt, I can now see how this incident had been extremely challenging for me. I regret my indecision and failure to take quick action. I felt useless and disappointed; as I had failed to build an effective therapeutic relationship with my client. Though I felt concerned to inform the staff of the findings, I didn’t actually manage to do so. Likewise, I felt embarrassed and ashamed in front of the client when the staff shouted at me. Being a third year nursing student I wasn’t able to communicate the readings; leaving an everlasting negative impression on my client and colleagues.
Giving a thought to this incident, I realize that self-awareness plays a significant role in developing nurse-client relationship. According to Rasheed (2015), “Self-awareness is an important component in the nurse-client relationship, this leads to competency in provision of high quality nursing care”. Keeping this view in mind, I now realize that my fears and anxieties on day 1 of RH had left me in a preoccupied state-of-mind, and making ill judgments regarding staff behavior.
A literature review on this subject also highlights that when preoccupied in thought, one fails to consider the actual explanation of ‘’landmark’’ results, and is predisposed to uncritically accept conclusions that fit our intuition and bias (Newell & Shanks, 2014). In critical care situations, irrelevant preconceptions that can put client at risk for fatal complications. Stepping away from my preconceived biases, I can now objectively weigh the risk versus benefit ratio of not instantly relaying the readings to the staff.
As recapitulated by the recent research of Donna Marie (2013) in which she discusses that situation of patients can change abruptly in the critical care settings, it is the nurse’s responsibility to identify, respond to and report efficiently and immediately those changes. This indicates the importance of interpersonal communication and critical thinking in acute critical care settings. A nurse is expected to remain in contact with the patient 24/7, and is responsible for recognizing subtle and overt cues signifying deterioration in patients’ condition prior to near misses.
Integrating the importance of communication into clinical practice, current research shows that in acute care settings, communication failures among HCPs (health care providers) is one of the leading causes of medical errors (Dingley et al, 2008). Lack of communication often increases the length of stay, resource use and potential harm to patient. The joint commissions’ review of reports claims that over 70% of the near misses are as a result of communication failures (Woods et al., 2008).
In a similar vein, critical thinking in novice nurses is another core competency required of them. Critical thinking as described by LeFevre, is “focused, outcome-oriented directed thinking determined by client’s necessities and principles of scientific method and nursing process”. Ideally, a nurse must apply creativity and analytical capability to implement quality standards while making clinical decisions and judgments in order to ensure professional liability and quality nursing care. As a matter of fact, novice nurses are equipped with excellent theoretical knowledge, yet lack practice in integrating it into their clinical skills. By the same token, I now see that being a novice, I had lacked the element of competency that put me in difficulty in decision-making. Just as no two patient experiences are alike, similarly no two instances of staff behavior can be the same, and so instead of making generalizations, a competent nurse must quickly process the readings, use their knowledge and then integrate into their action.
To sum up, nothing would have gone wrong if only I had communicated clearly with the staff earlier. The situation would have been different, if I could have translated my anxiety into active concern for the patient’s wellbeing. Moreover, that communication would have resulted in a collaborative approach towards patient’s care.
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