Case study

Chief complaint: Joan is a perky, 21 year old nursing student in your clinical group. Joan is funny and likeable but a bit disorganized. During the first two weeks of clinical, you have to remind her frequently about tasks to be done (medications, signing off on the MAR). Her computer documentation also is frequently incomplete. When reminded of these lapses, Joan cheerfully complies with your request.

During the second week, Joan is caring for a patient who is on a sliding scale insulin protocol. As before, you have had to remind Joan of the 11:30a blood sugar. About 15 minutes later, you check back with Joan. She cheerfully announces that the blood sugar was 245. You begin to discuss the sliding scale with her and she states, “Oh, I’ve already given him the insulin.” You calmly ask her which nurse checked the insulin for her, to which she replies, “No one. I couldn’t find you, so I just went ahead and gave it.” (students had been given strict instructions that no medications were to be given without supervision of the instructor or staff nurse).


1. What problems do you identify?

2. What actions would you take?

Follow up: You are into the fourth week of the eight week clinical. Joan has not given any more medications without supervision. When checking her patient’s MAR, you note that she has not signed off on the medications she gave three hours ago, nor had she remembered an 11:00am medication. When you find her, she is chatting with her patient while he is eating lunch. You remind her about signing the MAR, the 11:00am medication and also inquire about the patient’s 11:30am blood sugar. She stated: “Oh, I forgot all about that. I’ll check it right now.”


1. What would you do?

Your answer should be in APA format with references.


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