Inexperienced Nurses Research Articles

The Glasgow Coma Scale: How Do You Rate?

Nursing instructors, aware of the problems in describing levels of consciousness, know how difficult this process can be for inexperienced nurses and nursing students. The authors discuss the Glasgow Coma Scale, a simple, objective, clinical tool for assessing levels of consciousness in head-injured patients. Using this scale should increase the accuracy of neurologic assessments and provide useful clinical information.

Nurse Turnover in the Newborn Intensive Care Unit

Nurse retention has become a significant issue in the newborn intensive care units for two main reasons: 1) the quality of care declines as it is delivered by inexperienced nurses, and 2) the cost of orienting new nurses is exorbitant. "Stress" has been implicated as one of the important factors in nurse retention; it appears that a paradox exists in that the stress/excitement that attracts a nurse to the newborn ICU in the first place may ultimately drive her away. We attempted to define stress factors in the Turner Newborn Intensive Care Unit at Hermann Hospital in Houston, Texas, and to develop management methods to decrease stress. Over a three-year period, during the implementing of new programs, nurse termination rates decreased significantly, as did turnover.

Errors in Drug Computations During Newborn Intensive Care

Medical personnel in a pediatric center were tested for their ability to correctly compute drug doses for sick newborns. One of every 12 doses computed by 95 registered nurses contained an error that would result in the administration of an amount that was ten times higher or lower than the dose ordered. The error rate was no different for experienced or inexperienced nurses. The test also included an evaluation of the nurse's ability to judge the appropriateness of the drug dose ordered for a specified infant. Experienced nurses tended to be more certain, although wrong, in their judgment when compared to inexperienced nurses. Eleven pediatricians, when given the same test, scored higher than the nurses but still made errors at the rate of one of every 26 computations attempted. Five registered pharmacists who were tested demonstrated far better computational skills than either the nursing or physician group.

The nurse's role in immediate postoperative care.

From the time that a patient leaves the care of the anaesthetist after an operation until he wakes in the ward his physiological state should be continuously and expertly supervised. Postoperative nurses are provided only when the operating theatre has a recovery room. A survey among consultants and nurses in one region showed that many surgical units did not have recovery rooms and that inexperienced ward nurses were often sent to collect patients. The survey showed that most nurses were competent to care for unconscious patients so long as an emergency did not arise. In many hospitals the facilities for the safe nursing of postoperative patients were totally inadequate. The very least that is needed is good communications with the anaesthetist, adequate lighting, and a source of oxygen and suction. Because of the shortage of nurses likely to have to care for postanaesthetic patients early on and to train them accordingly. Nevertheless, recovery nurses, whose sole responsibility is to care for a patient until be has recovered from anaesthesia, should be appointed for all busy surgical units.

DRUG ADMINISTRATION ERRORS IN NURSERIES

Ninety-five nurses were tested for their ability to correctly fulfill 10 physicians' orders that included a drug name, amount, route of administration and the patient's weight. Each nurse was asked to calculate the precise amount of a specified concentration of a stock solution of the drug ordered. For purposes of analysis, errors were declared only when the nurse's computation resulted in an administered dose 10 times greater or less than the ordered dose. The nurse was also asked to indicate whether the dose ordered was appropriate for the infant specified in the problem. Of the 95 nurses, 31 had more than 1 year's professional experience; 64 were inexperienced nurses who were tested less than 1 year after their graduation from nursing school. The mean computational test score of the 31 experienced nurses was 88.1 ± (SE)1.7%. This was not significantly different from the 85.1 ± (SE)1.4% score of the 64 inexperienced nurses. Experienced nurses incorrectly judged the appropriateness of ordered doses in 17% of the problems; this is a significantly higher error rate (p<.05) than the 14% wrong judgements made by the inexperienced nurses. From this study we conclude that infant care may be maladministered because of the computational and judgmental errors that occur when drug doses are prepared for administration to high risk newborns. There are sufficient anecdotal experiences also to conclude that this is a serious and real problem impeding the delivery of intended care to sick newborn babies.