NAME: TEREZO, INAH MAY D.

4BSN1A
GROUP: 1 NCM 107

Leadership Simulation Scenario:

Setting:

It is late at night during a particularly hectic shift. A distressed young adult female having an allergic
reaction arrives in the emergency department. She has developed a rash and is beginning to wheeze.
Doctor A is the physician in charge and is new to the emergency department. The bedside nurse is a new
nurse who is in her last week of unit orientation. Physician: Orders: Benadryl 125mg IV STAT.

Bedside Nurse: Prepares the medication for administration.

Preceptor: Has heard about the new admission and comes in—state: “How are you doing, do you need
any help?”
Bedside Nurse: “I’m just about to administer 125mg of Benadryl IV to a new admission who is having an
allergic reaction. “
Bedside Nurse: “This dose seems high do you think that’s too much? Should I ask the doctor to come
back andcheck it?
Preceptor: “Go ahead and follow the doctor’s order, we don’t want to bother him on this busy night.”

Nearby Nurse: Roll eyes and makes a face toward the preceptor but say nothing.

Setting: The patient states “You guys are scaring me, please call someone to help you”

Bedside Nurse: Call for the Charge Nurse on the intercom. When Charge Nurse arrives, the bedside
nurse states: “I don’t feel comfortable giving this amount of Benadryl IV”.

Charge Nurse: Reading the order for Benadryl 125mg IV from the chart- state in a loud, angry voice,
posturing: “I can’t believe you bothered me for this! The doctor has ordered this dose; you
are new so you don’t get to question the doctor. You just keep your mouth shut and do
your work.”

Bedside Nurse: (raised, trembling voice, waving syringe around) “You shouldn’t talk to me like that, I have
rights”.

Preceptor: “Now that I think about it, I’ve never given more than 50mg IV at a time before”.

Charge Nurse: “Since you two are making such a fuss, I’ll guess you should just go ask the doctor about
his order. He might have been confusing the dose with the one for Solu-Medrol”.

Follow up: The bedside nurse questions the order and the physician corrects the medication order. The
medication is administered to the patient correctly.

Setting: The nurses are in the break room and the Nurse Manager can overhear them talking from her
office (the walls are thin).

Bedside Nurse: “I can’t believe that the Charge Nurse talked to me like that.”

Preceptor: “You just have to ignore her, she is mean to everybody. I just hate it when she is in charge.
We ended up giving the patient the right dose so that is all that matters.”

Nearby Nurse: state: “Yeah, she’s said some really nasty things to me before too. I think she is a terrible
nurse and nobody likes her. “
Please answer the following questions after carefully reading and understanding the case scenario.

Discussion Questions:

1. What issues can you identify with this case?

The issue that I can see in this scenario is the potential medical error, the reinforcement of teamwork
skill through peer coaching, especially to the newbie, was not implemented, lacking mutual support
from the senior nurse although the preceptor tried to provide one but was not implanted properly like
she just advises the new nurse to just go ahead and follow Doctors order even though the order was
questionable and might risk the safety of the patient.

2. Should the issues be reported? How so?

The attitude of the charge nurse is not healthy in a working environment and I think this need to be
addressed since other co-workers observe the same the charge nurse attitude towards co-worker the
history will just repeat by itself and what if the bedside nurse will just follow them without thinking twice
due to intimidation then the patient safety will be at risk, For me, if this can still be handle by speaking
first to the involve person like the charge nurse and talk about the matter, and if the charge nurse listen
and accept what is needed to be addressed regarding with the charge nurse attitude is a good step,
but if the charge nurse will not cooperate and still do the same, then I think it’s the right time to talk to
the supervisor in charges because teamwork working harmoniously as a team combined with mutual
support is healthy in the working area.

3. What actions could the preceptor have taken when the bedside nurse told her about the dosage
problem?

As a teacher or clinical instructor, the preceptor is already aware of the underlying problem regarding
the wrong dosage but it was not applied if in the first hand the preceptor advice the bedside nurse to
first clarify the order through the physician, and because the patient can overhear them that makes the
patient uncomfortable and might lead to a trust issue, the preceptor should not advise the bedside
nurse to just follow the doctor’s order since it’s the doctor who issues the order even though the
dosage is questionable. The preceptor can immediately advise the bedside nurse to clarify the dosage
to the physician to avoid a potential medical error.

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?

The appropriate response is not to follow the advice of the preceptor and still insist to look for the
physician to clarify the dosage, with this action it will avoid future problem regarding the administration
of the medicine, and a nurse we should always double-check the dosage and the medication for the
safety of both nurse and the patient.

5. Were there instances of lateral violence? Describe/discuss.

The instances for lateral violence is the potential medical error and safety of the patient, as a medical
care provider, we do not do harm to our patient, being careful and confuse regarding the doctor's order
is ok, as long as it is for the good and safety of our patient it is not wrong to ask a question especially if
the situation might cause harm to our patient, taking orders, double-checking the medicine and the
dosage, and checking the right person to receive the order is very important in taking care of our
patient.

6. When the Nurse Manager overhears the conversation between the nurses in the break
room, how would you recommend she respond? What actions should the Nurse manager
take regarding the near-miss incident?

I believe as a manager it is your responsibilities to monitor the staff and their attitude towards their
work, it is also the manager responsibilities to priorities the safety and the wellness of each patient,
any wrong action or doing of the staff under his or her management that may leads to the risk of the
patient safety is also the managers concern, he/ she have the right to perform appropriate action
regarding with the matter.