assignment

Running head: TERCAP PROPOSAL

TERCAP PROPOSAL 6

TERCAP Proposal

Student’s Name

Institutional Affiliation

Date:

TERCAP Proposal

Part One-Review Summary

The case is a about a 54 year old patient admitted for back surgery secondary to compressed vertebrae and intense pain. The injury was serious and needed two days of hospitalization and six more days of therapy. The nurse assigned to the patient was a pregnant RN with nine months experience. Unfortunately, certain aspects of practice went wrong, exacerbating the patient’s pain. The patient could not get the assistance she needed from the nurse. The nurse was found to have breached nursing policy by not taking responsibility and not assessing the patient well. The nurse was also expected to undertake hourly checks, which did not happen.

Part Two: Factors That Contributed To the Event and How They Can Be Addressed

In light of situational factors, it is important to mention that the RN nurse overworked and exhausted as she was on her third 12-hour successive shift. It was inappropriate to make her work overtime for she was pregnant. Hospitals can minimize legal risk in future by giving pregnant staff shorter shift hours. Even though the scenario regards a 54-year old post-surgery patients, the pregnant RN would exercise her legal rights to sue the facility in case she suffered from an injury in the course of working overtime. Pregnancy is the nurse’s situational factor that make her unsuitable for longer shift hours. The patient would have been given a bedpan to address the need of going to the restroom. According to Eltaybani, Mohamed, and Abdelwareth (2019), post-surgery patients are always weak and cannot perform basic physical activities such as visiting a restroom. The Lack of a bedpan is a situational factor in the patient’s environment, which the management can address by having an effective nurse call system for comfortable recovery and patient length of stay.

When it comes to nursing factors, hospitals should provide high-quality care for post-surgery patients. Providing high-quality care reduces patient length of stay following admission. O’Brien, Thompson, and Hagler (2019) argues that subjecting patients to risks leads to slower recovery and readmission. For instance, the 54-year old post-surgery patient would have been discharged earlier if not for her fall while going to the restroom. The nursing issue here is that the hospital has not maintained the right nurse-patient ration, leading to exhaustion. Hiring more nurses to maintain the right nurse-patient ratio will avoid lawsuit. Interpersonal, organizational, and individual and nurse issues characterize the case (O’Brien, Thompson & Hagler, 2019). Organizational issues such as nursing leadership, context of care provision, and working schedule are evident in the case. The individual and nurse issues are the needs of the pregnant nurse and the patient. Interpersonal issues include ineffective communication, lack of patient care priorities, and the relationship between the patient and nurses.

The human factors emanating from the case are associated with bad HRM practices. Having 28 occupied beds with just two RNs and a single patient technician constitute an impending catastrophe for any health care facility. The shortage of RNs in the facility is an urgent matter that the management should address by hiring more nurses because overworking the available nurses is unrealistic. As Similey and McCarthy (2016) rightfully reported, the hospital should not hide behind one vacancy and call-n for lateness when they recording dismal performance in taking care of patients. The patient would not have experienced a fall if there were enough nurses for they would have responded when the patient pressed the nurse call button for help (Papinaho et al., 2019). Besides, it is highly likely that ergonomics was overlooked in the treatment of the patient. For example, the bedside call bell was distally located, making it difficult for the patient to access. Worse still, nurses did not attend to the patient yet she managed to access the bell and push it many times.

The hospital’s organizational structure – the organizational factor evident in the case – is questionable. Implementing an affective structure with few workers is difficult. TERCAP identifies labor shortage as a major cause of poor performance in hospitals (National Council of State Boards of Nursing, 2018). The pregnant RN should have been given paid-leave to avoid risking the lives of patients. The hospital was poorly organized and lacked an effective strategy for managing many patients. Managing patient traffic through the right nurse-patient ration would ensure the best treatment for reduced readmission.

Whether the Nurse Was Negligent or Her Actions Reached the Level of Malpractice

The nurse was negligent to some level, but her actions do not amount to malpractice. She failed to perform hourly checks on the patient as post-surgery care demands. However, this negligence does not constitute a malpractice as she administered the right pain medicine (morphine) to the patient (Papinaho et al., 2019). Besides, the nurse administered the right dosage of the right medicine to the patient, adhering to the five rights of medical administration. Being absent when the patient required someone to take her to the restroom was the nurse’s main wrongdoing (Eltaybani et al., 2019). Additional mistakes involve failing to reassess the patient after giving medication and accepting a workload when she was aware of her condition. Hence, the nurse was negligent due to the failure to take care of the patient in the presence of few nurses, but that did not reach the level of a malpractice.

Options at the Disposal of the Nursing Board

The nursing board had the alternative of revoking her license if at all the case was tantamount to a malpractice. But because her negligence is somehow connected to understaffing in the hospital, the board can only subject her to a two-week or one-month probation (NCSBN, 2018). Another consideration is that the nurse was on her third 12-hour shift in addition to being 29 weeks pregnant.

Justification of the Action I Would Recommend

I would undoubtedly suggest a probation if I were on the disciplinary committee of your Board of Nursing. The Board has the power to place on probation nurses who have either unintentionally or knowingly committed a practice-related violation. The nurse would practise in particular settings or under clearly defined terms such as submitting written reports, being supervised, submitting tests and samples or even licensure surrender (O’Brien et al., 2019). Whereas a revocation of license would be too severe, a warning would be too lenient to the nurse. TERCAP recommends nurse-patient ratio of 1:2 and 1:4 in critical care and emergency units respectively.

How the Level of Nursing Behavior Relate To My Proposed Recommendation on Licensure

The information on the nurse’s level of qualification is lacking, but being an RN proves that she passed a nursing course. Thus, the short experience of nine months cannot be an excuse for her negligence. When the patient fell, understaffing and the nurse’s condition played a role. Being aware that her career is at stake, the nurse should appeal for immunity as she made a first-time mistake (O’Brien et al., 2019). Further, the nurse should cease working or practice under stringent supervision. The Board should order her to report regularly to the probation division.

Part Three-Continuing Education

Based on the summary of the TERCAP report, the following topics should be provided to the education department:

· The nurse-patient ration, which deals with the number of patients a nurse should be assigned to improve care.

· Paid leave option to expectant workers as a way of treating employees well to deliver quality care.

· High-quality health care for reducing patient length of stay

· Strategies for addressing burnout in nurses as overworked employees cannot deliver.

· Creating ergonomically safe care settings to reduce patient falls.

· TERCAP guidelines on hospital protocol

· Nursing policy for guiding practice

· Missing nurse rounds as a topic for improving patient monitoring

· Failing to reassess patients after administering medication should be included in education to promote continuous patient assessment.

References

Eltaybani, S., Mohamed, N., & Abdelwareth, M. (2019). Nature of nursing errors and their contributing factors in intensive care units. Nursing in Critical Care, 24(1), 47-54.

National Council of State Boards of Nursing (NCSBN). (2018). the nursing regulatory environment in 2018: Issues and challenges. Journal of Nursing Regulation, 9(1), 52-67.

O’Brien, J., Thompson, M. S., & Hagler, D. (2019). Using generalizability theory to inform optimal design for a nursing performance assessment. Evaluation & the Health Professions, 42(3), 297-327.

Papinaho, O., Häggman‐Laitila, A., Liedenpohja, A. M., & Kangasniemi, M. (2019). Integrative review of studies about nurses who have been disciplined by their professional regulatory bodies. Journal of Nursing Management, 27(8), 1588-1603.

Smiley, R. A., & McCarthy, C. (2016). A mixed-methods study of gender differences in nurse reporting and nurse discipline. Journal of Nursing Regulation, 7(3), 33-40.