The following assignment from NURS 308 maps onto several program outcomes for VCU’s School of Nursing. Program outcome 5 addresses knowledge of health care, financial and regulatory policies that influence the nature and functioning of the health care system. This paper digs into details about laws and regulations that impact safe nursing practice, as well as the involvement of the Board of Nursing. Furthermore, it addresses program outcome 6, effective communication and collaboration skills with the interprofessional team to deliver high quality and safe patient care. The scenario analyzed for this paper involved communication between doctors, nurses, and managers, as well as with BON members. Excellent communication during this scenario helped resolve the issue for Nurse Troy in this scenario.
High Tide Health System Scenario: Board of Nursing Complaint
School of Nursing, Virginia Commonwealth University
NURS 308: Foundations of Professional Nursing II
Mrs. Fabiana Bowles
June 21, 2021
Health care providers and nurses always strive to help their patients become healthier. However, sometimes choices or errors made by these same health care workers can actually harm the patient. When a patient experiences an adverse outcome as a part of their hospital stay, it is sometimes necessary for the state’s Board of Nursing to investigate. This is the main purpose of nursing regulation: “nursing regulation exists to protect the health, safety, and welfare of the public in the receipt of their nursing services” (National Council of State Boards of Nursing, 2021a). In the scenario at High Tide Health System, a patient received propofol given by nurse Troy during a conscious sedation procedure. The patient’s kidneys did not clear the propofol well and as a result, his length of stay in the hospital was longer. One of the patient’s doctors filed a complaint to the Board of Nursing against Troy, resulting in an investigation. The investigation is being handled by Misty Marsh, the chief quality officer for the Seashore Hospital.
Several important factors played into nurse Troy’s decision to administer propofol during the conscious sedation, and should be taken into account by the state Board of Nursing as a part of this investigation. The first thing to consider is Troy’s actions. As determined by a previous investigation by Misty Marsh and the Seashore Hospital, Troy was well within his scope of practice to proceed with the conscious sedation, given his training and experience as well as the policies of the larger High Tide Health System. After reviewing Troy’s actions through the lens of the National Council of State Boards of Nursing’s Decision Making Framework tool, there was no violation of the nursing scope of practice (2021b).
Additionally, Troy was following orders given by another physician during an emergency. The patient was in hemodynamically unstable supraventricular tachycardia. Had Troy not given the propofol necessary for the conscious sedation, the patient could have had an acute cardiac event associated with his tachycardic dysrhythmia. It is not within Troy’s scope of practice to decide which sedation medications are most appropriate for the patient—that responsibility falls on the cardiologist who prescribed the medication (American Nurses Association, 2015, p. 62). However, based on interviews conducted during the investigation, it has been determined that hospital staff were not aware of the patient’s kidney problems. The intake nurse did not chart any nephrological issues upon the patient’s admission, because the situation was emergent and no family members were at bedside. The family members themselves admitted that they failed to notify hospital personnel of the patient’s low urinary output for several days prior to admission.
As a result, no action should be taken against nurse Troy. The investigation has revealed a flaw in the admission process at High Tide Health System that will be addressed immediately. Admission history should be reviewed after the admission process is complete, to ensure that the record identifies all of the patient’s medical history. When a patient is admitted emergently, and no family is at the bedside to provide information, it is difficult for a nurse to be able to identify all of the details of a patient’s history. High Tide Health System will be changing their policies such that nurses will review the intake information with the patient and the patient’s family a few days after the admission. This will likely help avoid further incidents of this nature at High Tide Health System.
American Nurses Association. (2015). Nursing: Scope and standards of practice. American Nurses
National Council of State Boards of Nursing. (2021a). Guiding principles.
National Council of State Boards of Nursing. (2021b). Scope of practice decision-making framework.