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6): Brandon and Marilyn Case Study
Justin Tyme – a registered nurse joins the unit after successfully completing new employee and unit orientation. He had worked for 10 years in a similar unit at St Elsewhere but grew tired of the 2 hour daily commute. He is thrilled to be working closer to home. The staff is ecstatic as the unit has been shorthanded and the census is high. The staff likes working with Justin. He is friendly fellow and frequently brings hot donuts and a huge thermos of Peets coffee for the staff. He is always willing to help with lifting and turning patients and often in the first one to respond to patients lights. Justin does not always follow through on his observations and physician orders; he often misses giving routine meds. The staff has taken to routinely double checking Justin’s orders and the following shift often dispenses the missed meds. One morning, Dr. Tauk comes in to review the speech consult he ordered the day before on his patient, Mrs. Dee Phagia, prior to ordering her a diet. Dr Tauk cannot find the consult and asks Charity N. Able RN to locate it and call him. Charity discovers that the order had never been placed.
On follow up, Charity discovers not to her surprise- that Justin was the nurse who noted the order. Charity does not talk to the manager but does point out the error to Justin who feels terrible about it. Over the next month, Justin continues to make intermittent “small” mistakes which cause no harm to patients and the staff continues to cover. Today, Dr. L. Ovin comes in and notices that her patient, Mr. hart is in atria fibrillation. She orders stat IV digoxin and cancels the scheduled diagnostic procedures. Mr Hart remains in atria fib and as you review his chart, you discover that Justin missed the last two routine digoxin doses.
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