Preserving Safety
‘Preserving Safety’
Scenario
Ani is a registered nurse, has been working in the area for the last 12 months and works regularly with Marie. Marie is a senior nurse who has worked in the same area for 15 years.
Ani has recently noticed that Marie has started to become quite offhand with patients and other members of staff. She is concerned that this may start to impact on the quality of care delivered but is unsure about what she should do.
A few days later Ani hears Marie raising her voice and becoming increasingly verbally aggressive towards a patient. Ani recognises that she must take some action, and approaches the patient and Marie in an attempt to defuse the situation. Through discussion it becomes apparent thatMarie has administered some medication without it being prescribed. Anitakes Marie to one side and speaks to her about how she communicated with the patient and the medication administration. Marie’s only response was that she had spoken to the doctor who would prescribe it soon anyway, she doesn’t even acknowledge that she was shouting at the patient.Ani does not know what to do next as she knows that Marie has worked in the unit for a long time and appears to have a good relationship with the senior charge nurse (SCN).
This situation leaves Anifeeling very uncomfortable, she is aware that she must now do something and decides to reviewthe NMC Code to guide her actions. In particular she looks at the ‘Preserve Safety’ section and recognises that Marie’s behaviour is not meeting the standards required of a registered nurse.
She finds the following two sections of the NMC Code particularly useful:
16 Act without delay if you believe that there is a risk to patient safety or public protection
To achieve this, you must:
16.1 raise and, if necessary, escalate any concerns you may have about patient or public safety, or the level of care people are receiving in your workplace or any other healthcare setting and use the channels available to you in line with our guidance and your local working practices
18 Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations
To achieve this, you must:
18.1 prescribe, advise on, or provide medicines or treatment, including repeat prescriptions (only if you are suitably qualified) if you have enough knowledge of that person’s health and are satisfied that the medicines or treatment serve that person’s health needs(NMC 2015).
Having re-read the NMC Code,Anirealises that she must report her concerns but she is worried, as a newer member of the team, she will not be listened to. Aninow knows she is professionally accountable for escalating concerns and decides to speak with the SCN. Ani’s concerns are taken seriously, and the SCN reassures Ani that she did the right thing and thanks her for raising these issues with her, recognising that it isn’t an easy thing to do.The SCNexplains to Ani that she is also guided by the NMC Code in relation to actions she must take in response to any complaint or concern raised.
She also explores with Ani why she did not raise her concerns with her earlier. Ani discloses to the SCN that she finds it difficult to give difficult feedback to her peers, and feels uncomfortable with challenging colleagues about their practice.Aniand the SCNdecide it would be useful for Anito use this situation to support evidence for her revalidation.
Evidence in support of revalidation
Following further discussion, the SCN and Ani add “facilitating feedback to colleagues” to Ani’s personal development plan (PDP). Ani contacts the Practice and Professional Development unit and books herself onto a workshop on courageous conversations. After attending the workshop, she also shadows a Practice Education Facilitator giving student feedback to the area. Anirecords this learning activity as 4 hours of participatory continuing professional development.
Ani realised that although she had acted in the best interests of her patients, she had felt very apprehensive about raising her concerns directly with Marie and/or reporting her concerns about Marie to the SCN. She had been worried that she would be seen as a trouble maker. However, the feedback Ani received from her senior charge nurse confirmed that she had acted appropriately. However she did tell Ani that she could have spoken with her informally at any time and that she should have come to her sooner if she was concerned about Marie’s practice. Ani has learnt from this and now knows that she musttake action with any concerns immediately. Anidevelops a written reflectionon this situation, which she links to the NMC Code, the feedback she has received from the SCN and CPD undertakenand after re-reading the Escalating Concerns guidance, she now feels more confident to act differently in the future.