NURS 6341 Week 9 Complexity of Nursing Practice Essay Assignment

“… [T]he RN must decide at a given moment between the following: stay with a patient who is alone, distraught, and anxious about a diagnosis; leave this patient to give a pain medication to a patient who called 15 minutes ago; check on the new graduate nurse who seems to be overwhelmed by her assignment; or prepare a room for a patient returning from the operating room…. [T]he patient who is distraught and anxious is threatening to refuse treatment and/or testing that is important for his plan of care; the patient who called for pain medication is scheduled for physical therapy and, if not medicated appropriately before the transporter comes, will not get full benefit of the session, and the nurse may be faulted in the weekly pain management audit; the new graduate is caring for patients who are stable but have the potential to ‘crash,’ and the RN wonders whether [she]…will be able to notice subtle signs of deterioration…; and the elderly patient whose surgery was risky and who has multiple co-morbidities…will need one-on-one monitoring for several hours.”

—From “The Complex Work of RNs: Implications for Healthy Work Environments” (Ebright, 2010)

Does it all sound familiar? Have you experienced or observed these complexities in clinical experiences or in the practicum setting? As a practicing nurse, what would you consider in prioritizing this set of tasks? As a nurse educator, how might you use this example with those you teach to examine the complexity of nursing practice and its impact on patient safety, staff retention, and ultimately, quality of care?

This week you explore the complexities that make nursing a highly demanding profession and consider how experienced nurses, such as the RN in this example, effectively manage the minute-by-minute organizing, prioritizing, and decision-making involved in maintaining patient safety and quality of care.

Learning Objectives

Students will:

Evaluate the principle of stacking as a means to improve quality of care and patient safety
Analyze stacking strategies for managing complex nursing practices
Analyze specialties of interest for evidence of advance knowledge*
Analyze professional standards as a means to develop advanced knowledge in a specialty of interest*
Analyze the practicum experience for application of professional standards*
Evaluate methods for integrating specialty practice standards into a teaching experience*
Evaluate practicum experiences in the context of interprofessional collaboration**
Analyze personal development of interprofessional collaboration competencies**
Evaluate the impact of interprofessional collaboration on nurse educators**
Construct a detailed practicum log***

* You continue working on the Assignment related to this Learning Objective, first introduced in Week 8 and submitted in Week 10.

** You continue working on the Assignment related to this Learning Objective, first introduced in Week 8 and submitted in Week 11.

*** You continue working on the assignment related to this Learning Objective, first introduced in Week 1 and submitted in Week 11.

NURS 6341 Week 9 Discussion: Analyzing Patient Risk

“Through direct observation, interviews, and surveys, [researchers] Tucker and Spear identified a number of major categories of obstacles to nursing care, including physician orders, obtaining equipment and supplies, and staffing. These researchers reported that the average time nurses in this study spent at one task was 3.1 seconds and that nurses were interrupted mid-task eight times per shift.”

—From “The Complex Work of RNs: Implications for Healthy Work Environments” (Ebright, 2010)

What comes to mind as you consider the estimate of 3.1 seconds per task—and the multiple interruptions per shift? Even considering the likelihood of improvements in management of nursing tasks since the study year, how does this statistic speak to the inherent potential for mistakes and misjudgments?

It is recognized that nursing complexity and the stress that it generates can lead to medication errors, mislabeling of specimens, and procedural breakdowns. This week’s readings focus on strategies to address nursing complexity, including stacking, a strategy that nurses with advanced knowledge use to prioritize responsibilities and focus on quality of patient care.

To Prepare

Review this week’s Learning Resources on nursing complexity and stacking.
Review this week’s media, “Complexity of Nursing Practice.” Reflect on the insights and strategies shared by the Dr. Ebright and Dr. Sitterding.
Locate current research articles that discuss complexity of nursing practice and stacking specific to your specialty of interest.
Reflect on your practicum experience. Identify a situation in which the principle of stacking might have prevented an error, helped to decrease stress, or mitigated ambiguity/miscommunication for an individual nurse or group of nurses. If necessary, you may also select a situation from your past or current workplace or the current literature.
Thinking broadly about your specialty area of interest, consider stacking as a means of addressing nursing complexity and improving quality care.

By Day 3

Post a brief description of the situation you selected. Explain how the principle of stacking might have improved the quality of care and/or safety of the patient(s). Then, explain a stacking strategy you might use to manage complexity of nursing practice in your specialty area of interest. Support your response by citing specific references to your practicum experience and current literature.

Note: With the exception of an example from a research article, maintain the privacy of those involved in your sample situation by changing the names of patient(s) and nurse(s).

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Offer and support an additional strategy a colleague might use to integrate the principle of stacking into his or her specialty of interest.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

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