NARRATOR

Alex is a newly-licensed nurse and thrilled to have recently landed his first nursing position. He is working at a local hospital on a Med-Surg unit, where he’s still getting used to being nurse and working on a large team. That is been especially hard because his charge nurse Rio, tends to take a “tough love” approach with new nurses and he is still figuring out how to communicate with her and how to convey urgency in a way she can hear, especially when patient safety issues are at stake. Alex recently noticed his client Ms. Patricia Meade wasn’t on the glucose testing list, even though she could have been since he was scheduled to give her insulin that morning. He needed to talk to Rio about getting her on the list. Alex was worried about Ms. Patricia Meade receiving a safe dose of insulin and he didn’t approach Rio in the best way.

ALEX: Rio we really need to talk

RIO: Uh oh…what did you do?

ALEX: Nothing-look, this is about Ms. Meade. I’m supposed to give her insulin, but you didn’t get an order for glucose testing.

RIO: So what? Carol was supposed to get the order. It’s not my fault if she didn’t do it, and frankly, I’m still checking orders.

ALEX: Yeah, well, are you going to make the change or not? There’s not much time before she’s scheduled to get insulin.

RIO: Why are you just coming to me with this now? You must have realized it a while ago.

ALEX: Cause- I was in the middle of stuff…

RIO: We’re all in the middle of stuff, Alex… (angry sigh) But we have to know what stuff really matters. So… I’ll make time to get her on the list, I guess.

NARRATOR:

Rio and Alex were clearly not communicating in the best way for the client, or the team.

Alex did a lot of thinking that night about the interaction with Rio, and their working relationship overall. When he got into work today, he asked her if they could talk.

ALEX: Hey, thanks for, uh, sitting down to chat. I know there’s a lot going on with it.

RIO: I guess is about yesterday.

ALEX: Yes, it is.

RIO: So, what more do I have to say.

ALEX: I wanted to get your perspective on yesterday, as in… when I came to you about Ms. Meade, and we talked. From your point of view… what happened?

RIO: I don’t know… I was just heading to check on Ms. Crane when you barged in- like…was a life-or-death situation, and it was my fault? So, when that wasn’t the case… it threw me.

ALEX: I didn’t mean to come off like that.

RIO: Well… that’s good to hear. So… I guess that’s something to keep in mind moving forward.

ALEX: Help me understand, how could I have done it differently.

RIO: I mean, you could have spoken up without the extra drama. More… calm, you know?

ALEX: I didn’t mean to be unprofessional. I was worried about Ms. Meade. I’ll try to do better next time.

RIO: (Sigh) Yeah. I get that. And I’m glad you see room to improve yourself, there are certainly lesson to take away here. I mean… I think you get that you could have done better here. But this isn’t a one-time thing. From what I’ve seen, you tend to try and do everything by yourself, instead of coming to me and the rest of the team. And by the time you do come, you’re pretty stressed out. That concerns me.

ALEX: I guess I tend to rely on myself too much. It’s seemed like a good approach before.

RIO: That’s true, but… like, when you tried to lift Mr. Robinson by yourself… that doesn’t help anyone. Gotta know how to use the team to help you.

ALEX: It probably took you a while to figure things out with your charge nurse when you first started. How did you bring important stuff up?

RIO: Well, if I knew things were getting complicated with a client, I’d find someone to help me, and ask them in a calm, professional way. You should probably work on doing the same. Look… I don’t mean to sound like a broken record, but just to make sure we’re on the same page… You are part of a team here, and when you try to do everything alone, it doesn’t always end well. Clients may be at risk if you don’t ask for help when you need it. I’d like to talk a little more about how we can make that better.

ALEX: So, you said I could work on communicating better with the team. Can you tell me more about that?

RIO: Huh… I guess if you are concerned about patient safety, check with one of us. And if you talk to us like colleagues and not people to… blame, then we can work together on solutions. You know?

ALEX: Okay, I’ll try. That would be easier for me to do if you and some of the other nurses could try to be a little less… intense toward me.

RIO: I hear you. If you are willing to come to us more, I can try to watch my tone. But, just saying, if you don’t change, I’m probably not going to either. The CUS model helps approach, especially when I’m listening as well as I should.

The CUS model from TeamSTEPPS is a good way to think about how to frame concerns patient safety. C- CONCERN (share your observation), U- UNCOMFORTABLE (describe client’s condition, and S- SAFETY (suggest a response to address safety concern).

Part 2: Reflective Questions

Create a Microsoft Word document and respond to the following questions:

How was patient safety compromised in the scenario?
How successful was the CUS model in addressing the patient safety issue? How would you describe the experience? What went well?
What would you do again? What would you do differently?
How might you apply what you have learned in your clinical practice?