Faculty Guide Case 7 (Near Miss Error, Lateral Violence)

Faculty Guide Case 7 (near miss error, lateral violence)

Objectives:  Recognize lateral violence in the workplace.  Discuss at least one strategy for intervention for lateral violence.  Discuss near miss incidents and their significance in a just culture environment.

Room Set Up: The rash images doc is a copy of the images that will be laid out on a table to represent the patient. (We have them enlarged and laminated)

Props: syringes, vial of drug, long lab coat (faculty brings own), IV drug book and regular drug book, patient chart, doctor order sheet, white board for discussion notes , name badges Players: 2 nurses, 1 doctor (this role played by faculty), 1 patient, + 1 other nurse, 1 nurse manager

Discussion Questions:

1. What issues can you identify with this case?  Near miss error (wrong dose medication)  Lateral violence (derogatory remarks by physician and charge nurse, breakroom “put downs”)

2. Should the issues be reported? How so?  Near miss should be reported via incident report-discuss importance of reporting to help with future prevention and analysis of system issues versus personnel issues  Lateral violence should be reported using agency procedures **Remove the person from the room, diffuse the situation, make sure the patient is taken care of first priority, possible disciplinary action

3. What actions could the preceptor have taken when the bedside nurse told her about the dosage problem?  Discuss options and allow the new nurse to question the order using CUS words (C- I am concerned U-I am uncomfortable S-This is a safety issue) [see pdf for more review information if you need to refresh your info on feedback and CUS before the simulation]

4. When the bedside nurse was told to go ahead and administer the dosage without questioning the order, what are some appropriate responses by the bedside nurse?  Discuss with students what they think would be a good response (place themselves in that situation)  Discuss the two challenge rule if no one brings it up (Assertively voice your concern at least two times to ensure it has been heard-- Then if the outcome is still not acceptable, take stronger action and/or use supervisor chain of command) [see pdf for more review information if you need to refresh before the simulation]

5. Were there instances of lateral violence? Describe/discuss.  When the charge nurse told the bedside nurse to shut her mouth at the pt bedside. (When the nurses in the breakroom were talking about the charge nurse.)

1  Can bring up DESC-It (see pdf file for review) either in #3 o4 #4 question-depends on the student discussion flow. (DESC-It: D-describe the specific situation, E-express your concerns about the action, S-suggest alternatives, C-consequences should be stated)  Open discussion about how this often happens and is acceptable because of work culture. As nurses we often are very hard on each other and it is allowed-ever heard of “nurses eating their young” and is often laughed about and acceptable behavior. *ask them if they have heard of this and give more examples of inappropriate behavior that is simply accepted-discuss what actions they could take

6. When the Nurse Manager overhears the conversation between the nurses in the break room, how would you recommend she respond?  nurse manager should have intervened- open discussion of leadership role when observing non-professional behaviors and/or lateral violence *this flows from the previous discussion point and may overlap-you might not need to do this question if it is covered in the above discussions

7. What actions should the Nurse manager take regarding the near-miss incident? *ask should there be any disciplinary actions-opportunity to bring up “just culture” and how near miss incidents are often not reported. *review reasons why near misses should be reported (see above)

Be sure to finish the session with a recap of the scenario using CUS and 2 challenge rule so they see how the situation could have been a positive interaction