RN Needs Specific Training for the Best Patient Outcomes Chapter

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¶ … vitally important responsibilities that a supervising registered nurse assumes when it comes to providing leadership and training for student nurses. I was of course well aware of this prior to filling in as a preceptor for a nursing student. I had not been planning to become a preceptor at all, but when the originally assigned preceptor had been sent to another ward, the duty was passed to me and I readily accepted it and did the best I could possibly do. In hindsight, I recall doing researching the literature during my own training as to the importance of mentoring nursing students in the proper way when it comes to the very critical task of administering medications. An example of the literature that is pertinent to the RN involved in providing training for a nursing student is an article in the Journal of Clinical Nursing. I reference it as background into the experience I am presenting in this reflective paper.

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According to the peer-reviewed article mentioned in the first paragraph, registered nurses have a history of contributing to serious problems when it comes to administering medications to patients. Indeed, "…registered nurses are considered as major contributors" to the problem of errors during the process of administering medications (Reid-Searl, et al., 2012). The author goes on to say that in Australia errors committed by registered nurses are known to occur in approximately 2% of all hospital admissions. But that may be a conservative estimate because as Reid-Searl writes on page 1998, professional healthcare workers are often reluctant to report errors in the administering of medications. It would be embarrassing to make such an admission, and if no patient died or was seriously harmed, the person making the mistake may decide to keep the information close to the vest.

Chapter on RN Needs Specific Training for the Best Patient Outcomes Assignment

Moreover, Reid-Searl explains that it is not "uncommon" for student nurses to make errors when administering medications to patients (1999). The reasons for these mistakes include: a) "interruptions" during making rounds giving medications to patients; b) "dosage calculation errors"; c) failure to follow "relevant protocols"; and d) lack of "professional development" and shortages of staff on duty (Reid-Searl, 1999). This aspect of the Reid-Searl article (mistakes made while administering medications) will come into play in my reflective narrative and it relates as well to my own learning curve as well.

My experience when asked to be a preceptor for student nurse

"Percepting is vital to promoting the competence, familiarity, confidence and security of new nurses in a new environment…" (American Association of Critical Care Nurses).

Meanwhile, given the background presented in the introduction, there I was, in a position to be helping a nursing student in the second year of her training. And yet I was only in my first full year of my professional nursing career, so I will admit that I initially doubted my competence at mentoring. Why did I have initial doubts? This assignment had been thrust upon me unexpectedly, and it in fact surprised me, which is why I doubted my ability. But because I am a responsible and alert professional, I didn't let my initial doubts influence my approach. I will say my competency at time management wasn't as good as it should have been at this point in my new career, but nevertheless I believed deep down that I was going to be able to handle this assignment.

Recalling my personal experience as a nursing student I remembered that my own teaching preceptors motivated me as well as taught me the right way to administer medications and conduct other procedures. That gave me some confidence and assurance because all student nurses need opportunities to experience what licensed nursed do and how they do it.

At first she told me that she had experience in administered medications (including subcutaneous injections) under direct supervision of other trainers. My job as preceptor was to try to include her in every aspect of patient care that I was involved with that day. We basically did everything together because when a student is simply watching another person conduct certain procedures that is never as effective in terms of learning as when the student actually carries out the procedure herself. Around 6:00 P.M. It was time to do our medication round and one of the patients on my round was due for a Heparain 5000 shot. Heparain is a prescription drug that prevents clots in blood vessels after surgery and before surgery; it also treats patients who have had heart attacks.

The nursing student told me she had experience giving injections on mannequins, but never on humans. This fact worried me, and I know now why I was unsure of her competency in this area. Part of me fully understood her need to learn by doing, but another part of me was not sure that this was the right time for her to learn this particular procedure.

The fact that she had only given shots to a mannequin explained why she seemed reluctant at first, and she went on to explain that she had watched other nurses giving injections so she was willing to go ahead and give a shot to this patient. As mentioned previously in this paper seeing someone give a shot to a patient is not at all the same as giving the shot yourself, so I agreed to let her give the shot. We reviewed how to give the shot, the site and the angle of the shot, and we received consent from the patient, and went into the drug room to prepare the Heparin injection.

The medication comes in small glass vials, and probably due to her nervousness, she broke the top of the vial and cut herself in the process. Neither of us were aware right away that she had cut herself, but I witnessed her shaky hands and her face was very red. She had protective gloves on of course so we couldn't tell immediately that she was bleeding. But when we arrived at the patient's room, and we went through the 6 rights of medication administration, I did notice that there was bleeding in her glove. I didn't know at that time whether she had accidently injected herself with Heparin, or if she had simply cut herself in the process of accessing the vial.

At this point I asked her to go back into the drug room and see if I had left my glasses there. She looked at me with a perplexed expression but she went into the drug room as I had requested. The patient of course was wondering what was going on, so I apologized to that person and said the nurse would be back shortly.

The student was in the drug room washing her hands and trying to stop the bleeding. But her nervousness did not help her as she attempted to stop the bleeding and the finger had been cut in a way that was quite noticeable. I was quite worried that she had injected herself with this powerful medication but she assured me that wasn't the case. I showed her how we file an incident report, we filed it, and went back to the patient's room.

While administering the shot, the student's hands were shaking. I watched closely of course and let her know the fault in her technique was the way in which she lifted the skin between two fingers and the thumb. She got the injection done, and after she confessed to me that she was terrified due to her lack of experience, I assured her that in time she would be able to master this technique. It was at this point that she confessed that she was in fact terrified because of her inexperience; she also said she had serious doubts as to whether or not she would be able to complete the task of providing medication to a patient through injection.

In asking myself why I did what I did -- allowing a very nervous student to give a shot -- I know I just wanted to be supportive and give the student the chance to practice her nursing skills. In hindsight, I know my main concern was the safety of the patient, but I tried hard to bring some experience to the training of the student. That said, I will reference a peer-reviewed research article in Contemporary Nurse. In this article the authors conducted a qualitative study of how nursing students perceived the preceptors that helped them in their practice. The majority of the nurses that participated in this survey said that confidence was the most significant result of their interactions with preceptors; either the preceptor built up the student's confidence or "shattered it" (Kelly, et al., 2013). I believe that I built up the confidence of the student by allowing her to administer the shot.

The student nurse thanked me very sincerely for including her in every aspect of patient care, and she was grateful that I interacted verbally with her, asking… [END OF PREVIEW] . . . READ MORE

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