1. Drew is a new RN on a busy 42-bed medical-surgical unit. An aspect of Drew’s new graduate
orientation includes training based on the hospital’s policy and procedure and competency check-off
in a variety of skills frequently performed by RNs. Drew did well in school and feels he understands
the rationale for the policies and procedures. Before he can perform the specified skills without the
supervision of his preceptor, he must successfully demonstrate all of his competency check-offs. Drew
has completed 75% of his check-offs with his preceptor before his preceptor goes on vacation.
While his preceptor is on vacation, Drew works with another experienced RN who has been
authorized to check off Drew’s remaining skills. Drew notices that the experienced RNs expectations
are lower than those of his preceptor. The RN completes Drew’s remaining competency check-offs.
Drew notices that the experienced RN does not performing her skills according to the hospital’s
policies and procedures and he notes frequent gaps in required infection-control procedures such as
hand washing and breaks in sterile technique. Drew is concerned that patients may be at risk for
infection and he is concerned that he may be incorrect to judge the experienced RNs technique.
a. What is the significance of gaps between (a) what is taught in a nursing textbook, (b) the hospital’s
policy and procedures, (c) published literature, and (d) actual practice?
b. What is a “culture of safety,” and how would it benefit Drew’s case and the patients’ at his hospital?
c. What are Drew’s options for managing his concerns based on what he witnessed? How can he protect
patients from an unsafe environment?
d. What is Drew’s role in continuous quality improvement?
2-Your best friend, Lindsey, and you are working together in the surgical ICU. Often you cover for her
when she goes to lunch or on breaks. You notice that often her clients complain of being in pain, even
though she has told you that she medicated them right before she left the unit. You also notice that
she appears to be very jumpy and short-tempered and a bit disheveled when she comes to work. You
are suspicious that she is using the medications that she says she is giving to her clients.
a. What should you do first?
b. What might be the consequences if you decide to do nothing?
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