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nurses

Gone bad?

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© 2024 by Amy, Josh, Kailey, and Yena

These are not stories of heroism, but of those who betrayed the foundation of NURSING. Patients hurt. Policies broken. Trust shattered. Your job is to STOP history from repeating itself. As you navigate through each room, you must use your knowledge of the Professional Standards of Nursing to solve the questions. Choose the right path or risk losing everything. Your career, your license, your integrity.

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LEVEL 4 - FIRE GEM

ROOM 1

The BCCNM defines a professional standard as, “an expected and achievable level of performance against which actual performance can be compared. It is the minimum level of acceptable performance”. There are 4 standards created to ensure that nurses are competent and professional in their practice. Now let’s explore these standards and test your knowledge.

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Standard 2: Knowledge-based practice

Standard 4: Ethical practice

Standard 1: Professional Responsibility and Accountability

Standard 3: Client focused provision of service

Q1: Which of the 4 standards would the following statement fall under? “Functions within own level of competence, within the legally recognized scope of practice and within all relevant legislation”

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Standard 2: Knowledge-based practice

Standard 4: Ethical practice

Standard 1: Professional Responsibility and Accountability

Standard 3: Client focused provision of service

Q2: Which of the 4 standards would the following statement fall under? “Collects information on client status from a variety of sources using assessment skills, including observation, communication, physical assessment and a review of pertinent clinical Data.”

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Consistently applies knowledge, skills and judgment in nursing practice

Provides nursing services and works with others to provide health care services in the best interest of clients

Understands, upholds and promotes the ethical standards of the nursing profession

Maintains standards of nursing practice and professional conduct determined by BCCNM

Q3: Which of the following options best defines the BCCNM Professional Standard 3: Client-Focused Provision of Service?

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All of the above

Protects client privacy and confidentiality

Makes equitable decisions about the allocation of resources under one’s control based on the needs of clients

Clearly and accurately represents self with respect to name, title and role

Initiates, maintains and terminates nurse-client relationships in an appropriate manner

Q4: Which of the following options fall under the BCCNM Professional Standard 4: Ethical Practice?

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That’s Correct! As nurses, we are authorized to perform tasks and make decisions based on our skill set and knowledge base. “Standard 1: Professional Responsibility and Accountability” refers to the laws and policies from a legal standpoint of nursing practice. In other words, nurses must act within their scope of practice but also within the boundaries of legal guidelines and regulations.

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Good Job! This statement demonstrates the ability to perform patient research and collect relevant information from different sources (ie lab results, health records, family, etc.) required for developing nursing care plans. Gathering comprehensive data and applying previous knowledge to determine patient status and outcomes are examples of knowledge-based practice.

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That’s Correct! "Client-Focused Provision of Service” refers to the care that nurses provide to better the well-being of our patients. Care plans are individualized according to patient-specific cases by communicating and collaborating with the clients themselves.

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You’re rocking it! Ethics plays a very large role in the nursing profession. There are many different layers we must consider in terms of ethical practice including, client privacy, confidentiality, mutual respect and caring. It is also important to recognize that there will be potential conflicts which require the use of critical thinking skills and equitable decision making.

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Congratulations, you answered all the questions! Let's move on to the next room!

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ROOM 2

Now that you've completed your Nursing Standards review, it's time to assess cases where some were broken. You'll have a nurse presenting each case to you, so make sure you can answer each of their questions to move on to the next one!

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Q3

Q2

Q1

CASE 1: Sarah Hennings, a 34 year old Registered Nurse with a history of dedicated patient care, finds herself stuck in a situation that results in unprofessional decisions that led to serious consequences for her career. Sarah started prescribing medications to eight of her friends/family members. She also prescribed 14 medications to a neighbor in a non-clinical setting and accessed the health records of 179 individuals outside of her practice.

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Professional Responsibility and Accountability

Client focused provision of service

Knowledge-based practice

Ethical practice

Q1: As an RN, prescribing medications to clients in a non-clinical setting is considered as “out of scope” practice. Which BCCNM Professional Standard is Sarah violating in this situation?

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Professional Responsibility and Accountability

Client focused provision of service

Knowledge-based practice

Ethical practice

Q2: In addition to accessing health records from 179 individuals outside of her workplace, Sarah also failed to protect confidentiality by carelessly leaving empty medication containers and documentation in public places. Which of the four BCCNM Professional Standards recognizes patient privacy and confidentiality?

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Provide training on the legal and ethical boundaries of their roles.

Encourage nurses to prescribe medications to their loved ones if they are "trusted."

Q3: As a result of her actions, Sarah now requires supervision during practice for the next 2 years and must pay a fine of $5000 to the BCCNM. Failure to do so will result in suspension. Sarah is also prohibited to supervise students or other health professionals while she is practicing under supervision. What should Sarah do to prevent similar situations from occurring with other healthcare professionals?

Encourage nurses to be flexible with their scope of practice.

Do nothing, assuming most healthcare workers will follow the rules on their own.

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Congratulations, you answered all the questions! Let's move on to our second case.

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Good Job! In this case, Sarah is not performing within her legally recognized scope of practice and failing to follow protocols and standards. As an RN, Sarah was not allowed to prescribe medications to patients and the fact that she did so in a non-clinical setting is considered a violation of professional responsibility and accountability.

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That’s Correct! "Standard 4: Ethical Practice” recognizes not only client privacy and confidentiality but also honesty and integrity as well which Sarah failed to uphold in this case. As nurses, if we fail to follow these ethical standards, we begin to lose patient trust and respect when it comes to professional interactions with our clients and other health care providers.

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You got this! Understanding the legal and ethical boundaries of the nursing profession should be the foundation to our practice. Remember, nurses are only capable of functioning within their legally recognized scope of practice as outlined in the BCCNM Standard 1: Professional responsibility and Accountability. Therefore, one of the best ways that Sarah can ensure these situations do not occur is to educate her fellow colleagues.

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Q3

Q2

Q1

CASE 2: Jennifer Kanoga has worked at the Chilliwack General Hospital as an RPN for the last 5 years. On her busy unit one day, she failed to follow an independent double check and discrepancy for high-alert medication but was so distracted that she never caught her mistake. She failed to do so on another occasion which resulted in serious consequences.

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Obtain consent from the patient prior to assessment

Know how and where to access information such as medication labels to support safe, competent and ethical client care

Set priorities when developing a nursing care plan for her patient

Q1: In this scenario, Jennifer violated the BCCNM Professional Standard #2: Knowledge-based practice. Which of the following statements best describes what she failed to do when preparing high-alert medication for her patient?

Provide patient confidentiality when documenting medication administration on the MAR

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Updating her education on high-alert medications, ethics and professional responsibility in addition to providing a learning plan to her employer

Require her to take the NCLEX Exam again

Complete a special training program on the 7 medication administration rights and 3 checks

Go back to nursing school

Q2: As a result of her actions, Jennifer was suspended of her nursing registration for three weeks, prohibited to independently handle, administer and waste high-alert medications for six months. Which of the following do you think is an appropriate term for her punishment as a result of her actions?

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Perform the 7 medication administration rights and 3 checks in a timely manner

Do all 3 checks prior to seeing the patient to save time as she needs to provide equal care to all her patients

Q3: What do you think Jennifer should have done to prevent errors during medication administration?

Collaborative work with a buddy nurse

Call the pharmacist to double check the patient’s medications after administering them

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Great job! It is very important, especially with high-alert medications, to perform the 7 medication rights and 3 checks during medication administration. Knowing how to recognize high-alert warnings and where to find them demonstrates competent knowledge, skills and judgment needed for nursing practice.

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Nice work! Although her actions demonstrate a lack of knowledge and attention to detail regarding high-alert medications, she would not be required to retake the NCLEX exam or restart her nursing education. Instead, an appropriate requirement would be for Jennifer to update her knowledge on high-alert medications and maintain an education plan with her employer to show consistent learning.

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You got it! When administering any medication, especially with high-alert warnings, nurses must ensure that each right and check is completed so that we can minimize medication errors. As outlined in the “BCCNM Standard 2: Knowledge-based Practice”, nurses must continue to apply knowledge, skills and critical judgment including at times of medication administration.

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Congratulations, you answered all the questions! Let's move on to our third case.

Q3

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Q2

Q1

CASE 3: Shannon Whieldon works in the pediatric unit at BC Children’s Hospital. During her patient rounds one day, she failed to administer and manage infusions of Oxytocin and appropriate doses of Erythromycin. Shannon had gotten an order from the MRP to administer Erythromycin to the patient. However, she got a verbal order from the MRP.

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Professional Responsibility and Accountability

Client focused provision of service

Knowledge-based practice

Ethical practice

Q1: Shannon realizes it’s already 1130 and has to go on break! She gives a handover report to her covering nurse and fails to relay the doctor’s verbal order for administering Erythromycin. Which standard is Shannon failing to uphold in this handover situation?

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That’s Correct! In order to facilitate continuity of client care, it is important to communicate with other members of the health care team about new information or relevant changes and delegate tasks appropriately. Doing so will ensure that nurses deliver health care services thoroughly and in the best interest of the patient.

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Proceed to administer the medication to the patient and document afterwards

Complete an assessment on the patient and determine any changes in vital signs as a result of a late medication administration

Apologize to the covering nurse for failing to relay important information

Decide not to administer the medication and instead document that the parents made an informed refusal for the administration of Erythromycin

Q2: When Shannon comes back from break, she remembers that the Erythromycin order from the doctor was not shared with the covering nurse and therefore, the infant did not receive the medication. Which of the following options do you think Shannon should NOT do in this situation?

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Good work! This would not be an appropriate action that Shannon should take however, this is what she actually did in real life. Instead of documenting her mistake, she decided to hide it by stating that the parents had refused this medication for their child. This act was not only considered unethical but also “disgraceful” as stated by the discipline committee panel for this case.

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Two-week suspension

BCCNM discipline committee will decide on the penalty and settle the issue after the hearing is completed

She should not be penalized

Take the NCLEX again

Q3: At this time, the committee has not yet determined Shannon’s penalty and dues for the acts that she performed. Which of the following options do you think is an appropriate punishment in this case?

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Nice work! A panel of the Discipline Committee will review her actions and determine which standards were violated based on the Health Professions Act, RSBC 1996. They will conduct a hearing where the panel committee will determine the appropriate penalty and costs. The determination will be made available to the public when it is final.

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Break down and cry

Watch Nurse Jackie to destress

Post about your day on social media

Engage in self-reflection and set SMART goals

Q4: After Shannon’s hearing, she returns home and is trying to process her day. What would be an appropriate option that would help mitigate Shannon’s mistakes in the future?

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You got it! To be a responsible nurse it is very important to self-reflect, so we can determine which areas are needed for improvement. This can help us grow into competent nurses by processing our mistakes and emotions into a meaningful asset.

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Congratulations, you answered all the questions and survived your night shift! See you in 30 minutes for your 12 hour day shift...
© 2024 A game of 'NURSES GONE BAD'