The critical incident that I have chosen to discuss is one that I encountered recently on clinical placement.

It is one that highlights a very important aspect of nursing, communication. This reflection will discuss my role in the situation, why this was an issue was so significant and what I can take away and adapt to future nursing practice. Attached to this reflection is Appendix A which includes a thorough explanation of the incident that occurred. The significant factor underlying my critical incident was a breakdown of communication within the nursing team. Firstly my buddy nurse and I should have confirmed the patient by name before collecting the MSU that way I would have collected it from the right patient. There was poor communication between the unit manager and discharge planner in regards to the patient in 4D who was going to be discharged home. Effective communication is an essential element that assists the multidisciplinary team providing the appropriate care for patients and a breakdown in communication affects patient care and increases stress levels in nursing staff (Xie, Ding, Wang and Liu, 2013). I was aware that my patient in room 4D was going to be discharged that day. However there was a lack of communication between the unit manager, the discharge planner and myself. Ultimately the discharge planner (in this particular setting) makes the decision to send the patient home. As far as I was aware there were still assessments and services to be put into place before the patient was going to be discharged hence why the discharge planner said that she will probably remain in the hospital one more night. I had spoken to my buddy nurse who had also confirmed this was true. When I had returned from my lunch break to find my patient packing her things to go home I was terribly confused. The decision to speak to the unit manager about what was happening was made to clear up any miscommunications between us. The unit manager was quite abrupt in his response. The fact that he was this way made me feel a little hopeless frustrated and as though he did not think I was competent enough. The problem here was the discharge planner and unit manager were communicating with me and not each other. The Victorian Government Department of Health (2010) discusses that in order for effective care to be given appropriate and timely information must be given in order to perform their role correctly. I feel that this statement adequately explains the reasoning behind the occurrence of this critical incident. I think I made a wise decision to speak to the unit manager after the patient was discharged as I wanted to explain my side of the story I think this particular day taught me a lot about the importance of communication in a constantly changing situation. I think the fact that I did not feel as though the unit manager was approachable made it difficult for me as a student to communicate well. To me a unit manager is recognised as a leader and approachability is an attribute that they should embody. Stanley (2005) identifies a clinical nurse leader as one that possesses openness and empowerment. If these aspects are absent then so is trust which leads to a breakdown of communication and subsequently appropriate patient care. I believe that if the unit manager represented these characteristics, communication between staff would improve. In saying this you are not going to get along with everyone everyday throughout life. This is something that I need to overcome and next time I will not be hesitant to push for answers from the other staff members to deal with the situation and come to an agreement that everyone is clear on before it escalates. I found debriefing with my buddy nurse about the stressful day and it was very beneficial to hear her feedback as I felt I had lost confidence in myself. She reassured me that sometimes situations are wishy washy and they can constantly change. At

this point I thought this is the exact reason why effective communication is important. It could have been so easily avoided and this is why this incident became a critical incident.

References Xie, J., Ding, S., Wang, C., & Liu, A. (2013). An evaluation of nursing students' communication ability during practical clinical training. Nurse Education Today, 33(8), 823-827. doi:10.1016/j.nedt.2012.02.011 Stanley, D. (2005). Recognising and defining clinical leaders. Retrieved September 2, 2013, from http://www.uwa.edu.au/__data/assets/pdf_file/0004/1879465/Recognising-and-defining-clinicalnurse-leaders.pdf The Victorian Government Department of Health (2010). Promoting effective communication amongst healthcare professionals to improve patient safety and quality of care. Retrieved September, 2, 2013, from http://www.health.vic.gov.au/qualitycouncil/downloads/communication_paper_120710.pdf

Appendix A I had recently had a shift where I took on a patient load of 4 patients under the supervision of my buddy nurse. I had two patients that were remaining in hospital for a long period of time (4A and 4B), one who was to be discharged indefinitely (4C) and one who was a new overnight admission with throat pain post tonsillectomy (4D). The start of the shift began really well however mid morning it began to get complicated. My buddy nurse had asked me to collect an MSU from the patient in room four, the same patient that I had just done a full ward test (FWT) on as she stated they will probably want one for her. The only problem was this was the newly admitted patient in 4C she was the only patient I had done the FWT on. My buddy nurse had meant the patient in 4D who was going to be discharged. The MSU was correctly labelled and sent to ED for analysis and the results were sent back to the ward. However we discovered that there was a miscommunication between my buddy nurse and I in regards to which patient needed the MSU. The unit manager had stated that 4D was going home that day; however the discharge planner had come around at 11.30 am and did not want to send her home until she had been sure that this patient would not require services when she goes home. The discharge planner said that she will not be going home today. The discharge planner wanted me to supervise her in the shower too assess her need for home help. After having this conversation with the discharge planner my buddy nurse said to ask her to have a shower after lunch as she probably wont be going home. I came back from my lunch break and the patient was getting dressed, I had spoken to the unit manager who said she was going home. I had told him that she needed a shower assessment and he abruptly stated you need to be firm with your patients and tell them no! It needs to be done now because I have time. I didnt know how to feel about this or respond to this situation. At first I was annoyed because I was following instructions from the discharge planner and my buddy nurse. I completed the shower assessment and collected a urine specimen for a FWT and handed the information over to the appropriate staff. After the patient was discharged I apologised to the unit manager for making a mess of the situation and that I had received conflicting opinions about the patients discharge. He had also expressed that theatre was on his back about needing that bed for a surgical patient which was why he was so worked up about the situation. I had also decided to debrief with my buddy nurse at the end of the shift.