Chapter 17: Ensuring quality and effective management of risk

Case study: Jenna

 

Starting a new placement is both exciting and terrifying – meeting my mentor and the staff and getting to grips with new terminology and practices. Some placements provide an induction pack with key terms and pointers to useful reading, but unfortunately not all. In the first couple of weeks I often feel really stupid because I don’t know what certain words mean, and it is even worse when abbreviations are used! To help me settle in and build my confidence, I keep a notebook with me at all times and write down words and abbreviations I don’t know, and then either ask a nurse, if they’re approachable, or wait until I get home to look them up. I’ve also found it really helpful to visit a couple of weeks before and find out what types of patients are being cared for and common conditions – I read around some of them in advance, then at handover I don’t look a complete idiot when I am asked any questions, nor do I feel like I am constantly bothering my mentor. Last week one of the patients, who had a learning disability, was behaving in an odd manner and started to become quite aggressive. The staff said this was just how people with a learning disability behave sometimes but I had been reading around diabetes and realised that she might be having a hypo. So I told my mentor, who checked her blood sugar – which was really low – and she congratulated me on picking up the signs. If I hadn’t done the pre-reading I would probably have just accepted what the staff said. I felt really proud of myself that day!

  1. Which of the strategies Jenna identifies do you think might be useful for you to apply during your next placement?

› Solution

Act with integrity. Every organisation you have a placement with will have a large number of rules, regulations, policies and procedures in place which staff are required to follow. While, as a student new to an organisation, you cannot be expected to know all of these, it is essential that you make yourself familiar with key ones and follow them. Many of these will have been written in response to adverse events; others will arise out of clinical guidelines for best practice. When you are introduced to a new skill in practice, ask whether there is a local policy for it, read it, and always ask questions if you are unsure. In addition, as part of collecting evidence to support the achievement of your practice outcomes, you could write a precis of the policy.

Protect people from harm. Unfortunately there may be occasions on which you believe patients you have come into contact with may be at risk of harm, or when patients for whom you are caring or their carers indicate to you that they are unhappy about the care they are receiving. These situations can be incredibly difficult to manage, but failure to act can have serious consequences, as the findings from the Francis Report (Francis, 2013) demonstrate. If you have concerns, your first action should be to discuss them with your mentor or another member of staff (see Will’s Case Study). Sometimes it may be that you have insufficient knowledge or understanding of the issue and, once explained, you will realise that your concern is not justified, but by talking it through you will have a better understanding for the future. If you feel your concerns are not being heard then talk to the member of staff from your university who links to your placement or personal advisor. The NMC provides clear guidance on raising and escalating concerns (NMC, 2013) which is available on its website, and with which all students should be familiar.

 

Additional case study: Will

Will has been on placement in a hospital with patients who have mental distress for three weeks. During this time he has noticed that some staff do not always record their name on the medication chart, leaving it until later in the shift or sometimes not doing it until reminded. Will had looked at the hospital’s CQC report before starting his placement and knew that this had been an area identified for improvement. As one of the staff who failed to always sign was his mentor, Will was nervous about reporting it to anyone, and another student on the ward with whom he discussed it told him ‘not to rock the boat’. However, when he noticed several patients’ charts were unsigned at the end of a shift, he summoned up his courage and asked to speak to the ward manager. She praised him for coming forward, saying that he was just the type of nurse she wished to employ on her ward.

  1. Who else could Will have discussed his concerns with?

  2. Why was the ward manager so pleased with Will’s behaviour?

› Solution

Authors response: ‘There are no selected answers for this as the student should be using their skills of professional judgement and clinical decision making in relation to raising concerns.