Effective nursing requires strong communication, collaboration, and self-care. In this assignment, you’ll reflect on a realistic practice-based scenario that brings together key topics from Weeks 4–6: delegation, teamwork, patient rights, professional communication, and managing stress in clinical environments.
Scenario:
You are a student nurse working on a busy medical-surgical floor. The RN you’re shadowing asks you to assist with patient rounds, including reviewing vitals, helping with hygiene, and preparing one patient for discharge. You overhear a tense conversation between a nurse and a patient’s family member about discharge plans. Later, a nursing assistant expresses frustration about being asked to do something outside of their scope. By the end of the shift, you're feeling overwhelmed, unsure whether you handled everything correctly, and you’re reflecting on how to manage similar situations in the future.
Your Task:
Write a 750–1000 word reflection addressing the following prompts:
Part 1: Delegation, Collaboration, and Patient Rights
How would you determine what tasks can be delegated and to whom?
What strategies would you use to support collaboration with the RN and the nursing assistant?
How would you ensure patient rights are protected in this scenario (e.g., informed consent, privacy, respect)?
Part 2: Communication and Conflict
How would you respond to the communication breakdown between the nurse and family member?
What structured communication tools (e.g., SBAR, closed-loop) would help in this situation?
How would you apply active listening and professionalism in peer communication?
Part 3: Stress and Self-Care
What signs of stress or early burnout might you be experiencing in this scenario?
Which self-care or emotional regulation strategies would you use to reflect and recover after the shift?
How might you prepare for similar challenges in the future?
Assess the Delegatee (Right Person): Verify the competency, scope of practice, and facility policy for the person I am delegating to (in this case, the nursing assistant). The nursing assistant's expression of frustration about being asked to do something outside their scope is a critical cue, indicating a potential violation of the Right Person or Right Task. I would immediately stop and clarify the request with the RN or the assistant to ensure the task is within their authorized scope.
Strategies for Collaboration
Collaboration is key to safe and efficient patient care.
With the RN: I would use a proactive, inquisitive approach. Instead of waiting for directions, I would ask the RN, "How can I best support you with these rounds? I can handle the hygiene and initial vitals review for the discharge patient, but I'd appreciate you clarifying the specific teaching points you want me to review." This demonstrates initiative and respects the RN's accountability. I would also provide timely updates on patient status (closed-loop communication).
With the Nursing Assistant (NA): I would approach the NA privately and with empathy. "I heard you sounded frustrated about a task. Can you tell me what the request was, and if it was something you felt was outside your scope? I want to make sure we're all working within our roles and supporting each other safely." This non-judgmental approach validates their feelings, clarifies the issue, and reinforces mutual respect and teamwork.
Ensuring Patient Rights Protection
Patient rights are paramount and must be protected across all interactions:
Privacy: If I overhear a tense conversation, I would ensure it is moved to a private location (e.g., a conference room or an empty office) to protect the patient's and family's confidentiality and privacy (a core component of HIPAA). When reviewing vitals, I would always close the door/curtains.
Sample Answer
This reflection addresses the complexities of a busy medical-surgical floor scenario, focusing on principles of delegation, collaboration, patient rights, professional communication, and stress management essential for effective nursing practice.
Part 1: Delegation, Collaboration, and Patient Rights
Determining Delegation
As a student nurse, understanding the principles of delegation is crucial, especially the Five Rights of Delegation (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation).
In this scenario, to determine what tasks can be delegated and to whom, I would follow these steps:
Assess the Task: Evaluate the complexity, required skill level, potential for harm, and legal/regulatory restrictions. Tasks involving assessment, nursing judgment, teaching, or evaluation cannot be delegated to assistive personnel (like the nursing assistant). Reviewing vitals and helping with hygiene are generally appropriate for a licensed practical nurse (LPN) or, under RN supervision, a qualified unlicensed assistive personnel (UAP) like a nursing assistant. Preparing a patient for discharge (e.g., packing belongings, gathering forms) can be delegated, but the discharge teaching and final assessment must be done by the RN.