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CASE STUDY

Introduction

Xander is a graduate registered nurse (GRN) who is eight weeks into his first graduate rotation at a large regional hospital. In this essay, the transition from a student nurse to a graduate registered nurse will be thoroughly explored, with a focus on strategies to support Xander during this critical phase of his professional development. Firstly, the essay will shed light on a personal resilience-focused strategy for Xander. The justification for this approach will highlight its efficacy in reducing stress, improving emotional well-being, and enhancing resilience among healthcare professionals. Secondly, the organizational aspect of Xander's transition will be addressed. An organizational/workplace strategy will be proposed. Lastly, the essay will explore opportunities for clinical competence and leadership in Xander's role as a graduate registered nurse. Instances where senior registered nurses could have demonstrated clinical leadership during Xander's shift will be identified and analysed. The aim of this comprehensive analysis is to provide valuable insights and recommendations, benefiting not only Xander but also contributing to the improvement of nursing practice and patient care in healthcare settings.

A highly effective personal resilience-focused strategy for Xander is the integration of mindfulness and stress reduction practices into his daily routine. Developing present-moment awareness and accepting one's thoughts, emotions, and experiences without passing judgment on them are key components of mindfulness. A sizable corpus of research substantiating this approach's efficacy in lowering stress, promoting emotional well-being, and boosting resilience among healthcare professionals is available (Chang & Daly, 2020). For Xander, this would entail using a brief period of his shift to engage in mindfulness exercises like deep breathing, body scans, or brief meditation. Consistently, studies have demonstrated that mindfulness practices dramatically lower stress levels in healthcare workers.

As an illustration, a study by Kriakous et al. (2021) indicated that healthcare professionals who participated in a mindfulness-based stress reduction program reported decreased stress levels and higher emotional well-being. Xander can handle the emotional hurdles of his shift better by including mindfulness exercises in his daily routine. This individual approach to mindfulness can be justified due to its uniqueness. Due to Xander's independence, he is able to practice mindfulness and relaxation methods that are convenient for his own schedule and needs (Stacey et al., 2020). Xander can take a few minutes to centre himself, decompress, and restore focus during complex shifts or times of self-doubt. Xander is given the ability to control his emotional health thanks to this self-care technique, which also helps him develop resilience as he faces the difficulties in his new role (Klatt et al., 2020)

To help Xander during his transition from a student nurse to a graduate registered nurse, the hospital should adopt organisational/workplace techniques in addition to personal ones. Establishing frequent check-ins and feedback sessions led by seasoned nurses or nurse educators is a sound strategy. According to studies (Young-Brice et al., 2022), mentoring and feedback have a positive effect on the professional growth and resilience of new nurses. According to a study by Sekhon et al. (2023), structured mentorship programs with regular check-ins and feedback greatly increased the competence and confidence of new nurses. The hospital can establish a structured support system that enables Xander to talk about his progress, difficulties, and successes by assigning him a skilled mentor or educator who conducts regular check-ins. For identifying areas for growth and providing direction on how to solve certain difficulties, regular feedback sessions are crucial (Robeano et al., 2019). Walsh et al.'s research (2020) emphasised the value of constructive criticism in improving nurses' clinical performance and resilience. These sessions enable Xander to receive targeted support and make necessary adjustments to his practice.

One significant area for improvement in Xander's practice is clinical documentation. This deficiency can be addressed in alignment with the National Safety and Quality Health Service (NSQHS) Standard 1 - Clinical Governance, which emphasises the need for effective clinical governance systems to ensure patient safety and quality care (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2017). Firstly, the hospital should invest in training programs that specifically cover Electronic Health Records (EHR) systems and their use to support the training and development of their staff (McCarthy et al., 2019).

These training sessions should focus on proper documentation practices within the EHR system, emphasising the importance of accurate and timely record-keeping, as per NSQHS Standard 1.19, which underlines the significance of patient health information accuracy (ACSQHC, 2017). Additionally, the hospital can streamline documentation processes and templates within the EHR system to facilitate efficient documentation, adhering to NSQHS Standard 1.17, which advocates for the use of standardised tools and templates to enhance patient safety (ACSQHC, 2017). This strategy is in line with Principle 7 of the Nursing and Midwifery Board of Australia (NMBA) Code of Conduct for Nurses, which highlights the significance of maintaining accurate and thorough records (NMBA, 2018).

Emergency response planning is another vital area where Xander's practice needs to be enhanced. In accordance with NSQHS Standard 8 - Recognizing and Responding to Acute Deterioration, the hospital can implement research-based measures to improve Xander's readiness for emergency scenarios. The hospital needs to execute the NSQHS Standard 8.1-recommended regular drills for an emergency response to deal with this problem (ACSQHC, 2017). These exercises are crucial to ensuring that medical personnel are sufficiently ready to handle crises. Xander and his coworkers can hone their response to life-threatening situations by regularly running emergency simulations, which will also help them get familiar with the hospital's emergency procedures and protocols (Merriel et al., 2019).

This is in line with the NMBA Code of Conduct for Nurses' Principle 3, which emphasises the significance of providing safe and effective care (NMBA, 2018). In addition, the hospital can offer specialised instruction on how to use emergency gear and activate rapid response teams, as advised by NSQHS Standard 8.4 (ACSQHC, 2017). This specialised education, coupled with regular drills, enhances Xander's and other nurses' competence and confidence in responding to emergencies, adhering to Principle 6 of the NMBA Code of Conduct, which calls for the maintenance of competence (NMBA, 2018).

A crucial opportunity for a senior registered nurse (RN) to exhibit clinical leadership during Xander's shift was in the realm of clinical decision support and mentorship. Xander encountered a situation where he had not thoroughly investigated the discharge requirements for Ms. Anderson, highlighting a gap in his knowledge and experience. In such instances, a senior RN could have demonstrated clinical leadership by stepping in to offer guidance and mentorship (Lamb et al., 2018). The NMBA's Decision-Making Framework underscores the importance of nurses' responsibility to provide safe and competent care (NMBA, 2023). Guiding and supporting less experienced colleagues aligns with this ethical responsibility. In this context, the senior RN's role would encompass providing Xander with insights into patient discharge processes, emphasizing the significance of accurate documentation, patient education, and effective collaboration with other healthcare professionals (Monroe, 2019).

The NMBA Code of Conduct for Nurses Principle 5, which emphasizes the provision of safe and quality care, underscores the responsibility of senior nurses to support and guide their junior colleagues (NMBA, 2018). By offering mentorship and clinical guidance, the senior RN adheres to this principle, contributing not only to Xander's professional development but also to the improvement of patient care quality (Stanley, 2019). This aligns with the NMBA's expectation that nurses promote and facilitate the professional growth of their peers (NMBA, 2018). Another critical opportunity for a senior RN to display clinical leadership presented itself during the emergency response when Mrs. Williams required an urgent clinical review, and a MET Call was initiated. In high-stress situations like these, effective communication among the healthcare team is paramount for ensuring a coordinated and efficient response (Dolan & Overend, 2019).

The NMBA's Decision-Making Framework emphasises the importance of clear and effective communication in nursing practice, especially during critical events (NMBA, 2023). Clinical leadership entails taking charge of communication and coordination in such situations to optimise patient outcomes (McCormack et al., 2013). In this context, the senior RN could have assumed a leadership role by ensuring that roles and responsibilities were clearly assigned, communication lines remained open, and all team members were well-informed about the evolving situation (Walker et al., 2021). The NMBA Code of Conduct for Nurses Principle 3, which pertains to providing safe and quality care, underscores the significance of effective communication in nursing practice, particularly during critical events (NMBA, 2018). Lastly, by taking a leadership role in communication, the senior RN would align with this principle, ultimately contributing to patient safety and the well-being of the healthcare team (McCormack et al., 2013).

Conclusion

In conclusion, supporting Xander's transition from a student nurse to a graduate registered nurse requires a multifaceted approach that combines personal strategies and organizational support. Incorporating mindfulness and stress reduction practices into his daily routine empowers Xander to manage the emotional challenges of his new role independently, enhancing his resilience. Moreover, the hospital can play a pivotal role by implementing mentorship and feedback programs to guide and support him in his professional development. Addressing specific areas for improvement, such as clinical documentation and emergency response preparedness, aligns with national healthcare standards and ethical principles. Proper training, streamlined processes, and regular drills bolster Xander's competence and confidence in delivering safe, quality care. Additionally, senior registered nurses can demonstrate clinical leadership by offering guidance and mentorship, ensuring that ethical responsibilities and professional growth are upheld.

References

Australian Commission on Safety and Quality in Health Care (2017). National safety and quality health service (NSQHS) Standards. https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf Chang, E., & Daly, J. (2020). Transitions in Nursing eBook: Preparing for Professional Practice. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=woKlDwAAQBAJ Dolan, B., & Overend, A. (2019). A nurse’s survival guide to leadership and management on the ward. (3rd ed.). Elsevier. Klatt, M. D., Bawa, R., Gabram, O., Blake, A., Steinberg, B., Westrick, A., & Holliday, S. (2020). Embracing change: A mindful medical center meets COVID-19. Global Advances in Health and Medicine, 9, 2164956120975369. https://doi.org/10.1177/216495612097536 Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic review. Mindfulness, 12, 1-28. https://doi.org/10.1007/s12671-020-01500-9 Lamb, A., Martin‐Misener, R., Bryant‐Lukosius, D., & Latimer, M. (2018). Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. Nursing Open, 5(3), 400-413. https://doi.org/10.1002/nop2.150 McCarthy, B., Fitzgerald, S., O’Shea, M., Condon, C., Hartnett‐Collins, G., Clancy, M., & Savage, E. (2019). Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review. Journal of Nursing Management, 27(3), 491-501. https://doi.org/10.1111/jonm.12727 McCormack, B., Manley, K., & Titchen, A. (Eds.). (2013). Practice development in nursing and healthcare. John Wiley & Sons. https://books.google.co.in/books?hl=en&lr=&id=XkZzzeiVFpIC Merriel, A., Ficquet, J., Barnard, K., Kunutsor, S. K., Soar, J., Lenguerrand, E., & Siassakos, D. (2019). The effects of interactive training of healthcare providers on the management of life‐threatening emergencies in hospital. Cochrane Database of Systematic Reviews, (9). https://doi.org/10.1002/14651858.CD012177.pub2 Monroe, H. A. (2019). Nurses’ professional values: Influences of experience and ethics education. Journal of Clinical Nursing, 28(9-10), 2009-2019. https://doi.org/10.1111/jocn.14806 Nursing and Midwifery Board Aphra (2023). Decision-making framework (DMF). https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/frameworks.aspx Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses. http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements.aspx Robeano, K., Delong, D., & Taylor, H. A. (2019). Optimizing transitional support for novice nurse practitioners. Nurse Leader, 17(4), 303-307. https://doi.org/10.1016/j.mnl.2019.03.020 Sekhon, A. (2023). Mindfulness and its Impact on Mental Health: A Review. Indian Journal of Positive Psychology, 14(2), 252-255. https://www.proquest.com/openview/ Stacey, G., Cook, G., Aubeeluck, A., Stranks, B., Long, L., Krepa, M., & Lucre, K. (2020). The implementation of resilience-based clinical supervision to support transition to practice in newly qualified healthcare professionals. Nurse Education Today, 94, 104564. https://doi.org/10.1016/j.nedt.2020.104564 Stanley, D. (2019). Values-based leadership in healthcare: Congruent leadership explored. SAGE. https://books.google.co.in/books?hl=en&lr=&id=MQKQDwAAQBAJ Walker, F. A., Ball, M., Cleary, S., & Pisani, H. (2021). Transparent teamwork: The practice of supervision and delegation within the multi‐tiered nursing team. Nursing Inquiry, 28(4), e12413. Walsh, P., Owen, P. A., Mustafa, N., & Beech, R. (2020). Learning and teaching approaches promoting resilience in student nurses: An integrated review of the literature. Nurse Education in Practice, 45, 102748. https://doi.org/10.1016/j.nepr.2020.102748 Young-Brice, A., Farrar-Stern, K., & Malin, M. (2022). Comprehensive onboarding and orientation to support newly hired faculty in a nursing program. Nurse Educator, 47(6), 347-351. https://doi.org/10.1097/NNE.0000000000001242

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