RUNNING head: CLINICAL EXEMPLAR 1

Clinical Exemplar

Nefertari I. Knight

University of South Florida

College of Nursing
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Clinical Exemplar

Introduction

Nursing is unquestionably a profession that can lead to an extensive amount of stories

after a long shift has concluded. Clinical exemplars are first-person stories written by nurses in

order to illustrate their practice during a particular situation. These stories have been defined as

the quintessence of nursing. By sharing clinical exemplars, they aid in capturing the true nature

of nursing and help to more clearly identify the richness of caring (Harvey & Tveit, 1994). A

clinical scenario that was vital and important to me occurred during my preceptorship on an

orthopedic unit. This situation could have escalated tremendously but thankfully I was able to

apply critical thinking skills and learned how to act fast to address a patients inappropriate

actions.

Clinical Experience

The patient, G.P. a 37-year-old male, presented to the hospital in early January 2017

complaining of back pain. The patient has a medical history of intravenous (IV) drug abuse,

chronic back pain, and smoking. G.P. shared a room with a fellow male patient with a history of

IV drug abuse, therefore per hospital protocol, sharp containers were not to be placed inside their

room. The patient had scheduled medications that included oral hydromorphone (Dilaudid)

every 4 hours. Whenever, the patient was asked their pain score, it was repeatedly an 8 out of

10. He exhibited a very aloof persona and frequently appeared drowsy or was sleeping. In

addition, he always requested that the room be dimly lit and the door closed.
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For this particular scenario, I knew there was a problem instantly. I had just awakened

G.P. in order to provide his next scheduled dose of hydromorphone. I left the room for about 10

minutes to have a discussion with my preceptor. I was walking back to the shared room because

I needed to check the IV pump of the other male patient. I knocked while simultaneously

opening the door to see to my right G.P. sitting upright in bed with a Walmart bag in his lap and a

saline syringe in his right hand. I continued to complete the task with the IV pump and exited

the room immediately afterwards to notify my preceptor of the incident.

This incident happened during my third shift of preceptorship so I did not feel comfortable

directly addressing the patient. So, I immediately notified my preceptor who quickly rushed to

the room as I followed behind to witness outside of the room door. My preceptor asked G.P. if

he had a syringe and if there were any more in his possession. She confiscated the syringe and

told me we needed to notify the charge nurse and the doctor. My preceptor explained to the

charge nurse that while examining the syringe there was a yellow residue on the tip and inside.

Now, this situation had escalated tremendously. The oral hydromorphone G.P. had been taking

was yellow which led the nurses to believe he had pocketed the recent dose of medicine and was

trying to crush it in order to connect it to the IV line. The patients doctor was notified and gave

orders to crush all oral medications in applesauce.

I recognized any delay in reporting the incident could have led to substantial problems

associated with this patients state of well-being and plan of care. So, by promptly notifying

nurses, it aided in this situation being resolved in a timely manner. According to recent research,

although medication errors can originate at the prescribing, transcribing, dispensing, or

administration stage, research has demonstrated that it is registered nurses (RNs) who are most

likely to identify and intercept inpatient medication errors, regardless of source, before the errors
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reach the patient (Flynn et al., 2012). By observing my preceptor interact with G.P. and

confiscate the syringe, I know the proper actions to take should a situation of this nature arise

again during preceptorship. Additionally, I was able to observe and provide detailed input with

my preceptor as she filed an incident report.

Conclusion

I believe avoiding direct contact with the patient was the overall best decision. My major

concern with directly addressing this particular patient was the potential for him to become

belligerent or violent thus making it an unsafe situation. Moreover, I achieved the desired

outcome of patient safety and absence of patient harm through the collaboration of healthcare

professionals. The charge nurses for day and night shift applauded my finding and good eyes

which made me feel as a nursing student that I acted and handled the situation appropriately. My

strengths regarding this situation were assessment, rapid response, and outcome identification;

whereas my weakness was avoiding patient interaction while my preceptor was in the room.

Overall, this was my first exposure of a high-risk medical error and incident so I will use this as a

learning experience to improve my problem-solving skills.

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References

Flynn, L., Liang, Y., Dickson, G. L., Xie, M. and Suh, D.-C. (2012), Nurses Practice

Environments, Error Interception Practices, and Inpatient Medication Errors. Journal of

Nursing Scholarship, 44: 180186. doi:10.1111/j.1547-5069.2012.01443.x

Harvey, C., & Tveit, L. (1994). Clinical Exemplars to Recognize Excellence in Nursing Practice.

Orthopedic Nursing, 13(4), 45-53.