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Case Study: Nursing on a Medical Floor - Dealing with Culture Shock and Heavy Patient Load

Challenges Faced

Case Study
You are a nurse on a Medical Floor and have just started working there a few weeks ago. Most of the staff have worked there for years, most of their career.
Although the patients are well cared for, there is an underlying hierarchy of expectation amongst the nurses. The newer you are, the heavier your patient load. The old phrase “Nurses eat their young” is a very relevant culture.
You are expected to show up for your 12 hour night shift, 45 minutes early to make sure the floor is ready to start the next shift. If there is a new patient coming up to the floor around shift change, you are expected to start the admission process. You are to complete the narcotic count with a nurse from the day shift and make sure all of the orders are completed and processed. This is all completed before you actually start your shift.
You get the assignment of 8 patients at the end of the longest hall and most of these patients are very complex.
After report, you assess each of your patients, hand out the HS meds, and make sure they are ready for bed. Around 2300, you sit down to chart and Nancy, one of the seasoned nurses sits down beside you. Nancy looks you in the eye and states, “I am going into the lounge to have a nap. I didn’t sleep well. I need you to watch my patients. They are in rooms 1-8.” At that she got up and left the nurses station. You got up from the desk and walked down the hall towards Nancy’s patients when you realized they are located at the opposite end of the unit from your patients. You walk over to Susan and tell her how upset you are that Nancy just dumped her patient load on you. “Suck it up. We have all been through this. You need to just have to deal with it” is the response you get.
After a very long 5 hours of caring for 16 patients without even a bathroom break, you finally sit down for a quick snack. Karen, another seasoned nurse drops the medication records beside you and states that they all need to be double checked before the end of shift. You look through the pile and realize it is for the whole floor. You are only expected to do your own on your shift but the other nurses are playing computer games and sleeping so there appears to be no one else to do them.
You pull your patient medication sheets out of the pile, and proceed to complete them. By this time it is 0530 and you need to start to hand out your AM meds. You have not seen Nancy all night, so you go into the lounge where she is still sleeping, and awaken her. When you tell her what time it is, she starts to yell at you that you should have woken her before this as she needs to get her stuff done before she leaves. Nancy leaves the lounge to do her work.
At 0700, when the next shift started, all of the night nurses went home and left you to cover the floor during the morning report.
At 0745, you see the Charge nurse walk into her office. You knock on the door and ask her if you can speak to her. Through your frustration and exhaustion you tell her about your experience last night.
1.How do you explain to the Charge nurse what you experienced last night without judgment of the other nurses?
2.How do you think Nancy, Susan and Karen will feel if you tell the Charge Nurse what happened?
3.In hindsight, what do you think you could have done differently to make this shift a better experience?
4.According to the CNO, who do you think would be responsible for Nancy’s patients if something had happened to one of them during the night?
5.What might you do differently tonight, if you walked into the same scenario?

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