Assignment task: You are a nursing supervisor summoned to assist with a situation on a medical unit. A new staff nurse in her second week as a nurse is refusing to provide requested pain medication to an elderly patient admitted after a fall at home.
The patient has significant hip and abdominal bruising from the fall. There are no fractures, but there is a considerable and painful soft tissue injury. Accompanying the patient is a niece who produces legal and authentic documentation that she is the patient's only surviving relative and has been named in the patient's advance directive to oversee the patient's care. The written advance directive declines all pain management therapy and other measures, permitting only food and hydration. The patient is now verbally requesting pain medication. The niece is demanding that the advance directive be followed. Additionally, the hospital recently started a new process initiative where admissions department staff gathers information on advanced directives at the time of patient admission to increase the appropriate use of the directives.
The new nurse is refusing to acknowledge the patient's verbal request for pain medication in order to uphold the written advance directive.
In your initial post, address the following:
1. As the nursing supervisor, what do you do? How do you engage with the patient, the niece, and the new nurse?
2. Would you classify the refusal to provide pain medication as appropriate, a near miss, or a full-blown error? Would your answer change if the patient never receives pain medication as was orally requested? Why?
3. How might liability extend to the organization in this scenario?
4. Why is "novice nurse" not a valid legal defense under licensure? What standard of practice is expected? What are the negative repercussions to patients and family members if a novice nurse standard were recognized under the law?
In response to two of your peers' initial posts, answer the following:
5. What does a just culture climate demand for the new staff nurse?
6. What is needed regarding organizational policies and staff education on appropriately and consistently enforcing advance directives in the organization? What is needed regarding organizational policies and staff education related to potential violations of safety and healthcare standards?