CASE STUDY 9-1 Healthy Work EnvironmentsSample Page

                Sergül Duygulu

Pelin worked in a private eye hospital following her graduation from a bachelor’s degree program in nursing. Since leaving that hospital 4 years ago, Pelin has been working in the Emergency Unit of a university hospital. With her energy and desire to exercise her profession, Pelin attends the surgical nursing doctoral program in the nursing school of another university in addition to working. Since she is attending doctoral courses during the day, she works night shifts during the week and on weekends. The charge nurse of the Emergency Unit continually supports Pelin’s development and considers her needs when preparing the work schedules. The Emergency Unit has a resuscitation room with 7 beds, an examination room with 12 beds, and a trauma room with 4 beds. Patient interventions are also performed on 10 stretchers in the corridors. There is a total of 23 nurses and 14 physicians, and there are 12 auxiliary staff members (janitors). Nurses work two shifts: 8:00 a.m.–4:00 p.m. (day shift) and 4:00 p.m.–8:00 a.m. (night shift). There are four nurses with the unit charge nurse during the day shift, and there are generally three nurses during the night shift. Sometimes there are three senior nurses working the night shifts. Some nurses work 24-hour shifts on the weekends due to family demands. Also, there are trainee nurses and doctors continuing their education. In the Emergency Unit there is a locked medicine cabinet, a locked emergency cart, and four cabinets in which disposable supplies are stored. Although there is no written protocol, the key to the locked medicine cabinet is with the unit charge nurse and another nurse during the day shift. It is handed over to a qualified nurse during the night shift. The key is handed over to the next nurse during the shift change. Nurses attend to patients under the supervision of a senior shift nurse. One day, when Pelin takes over the night shift with two other nurses, she, being the most senior nurse on the shift, has organized the patient care duties and assigned them to other nurses. About 4 hours after she took over the shift, the phone rings, and Pelin talks to a police officer who is calling from the police station. The officer says that the police station received a warning about a bomb left in the Emergency Unit and that a team, including bomb disposal experts, is on their way and will arrive at the hospital soon. The officer says that steps should be taken in the Emergency Unit and hangs up. Despite being an experienced nurse, Pelin realizes that she doesn’t know what to do in this situation and immediately calls hospital security to report the situation. There are 3 patients in the resuscitation room, 12 patients in the examination room, and 3 patients in the trauma room. A patient is receiving an active intervention in the resuscitation room. Pelin immediately calls the hospital duty administrative director and the duty physician to report the situation. Meanwhile, in the absence of instructions for what to do in case of a bomb threat, Pelin, three duty doctors, and two other nurses decide to send the patients to other clinics or home, depending on their conditions. They call the hospital supervisor to ask for support, and three nurses, three physicians, and three janitors are sent to the Emergency Unit to transfer patients to the clinics. Meanwhile, the police come to the Emergency Unit to start searching the entire department for a bomb. Five patients in the examination room are in good condition, so they are sent home. The other seven patients in the examination room and the patients in the trauma room are transferred to other clinics. The three intubated patients in the resuscitation room are left in the Emergency Unit to continue receiving care. Two hours after the bomb threat, the search in the Emergency Unit has been completed and the threat was found to be a hoax. During the rest of the shift, Pelin and the Emergency Unit team ensure that the unit resumes services and continues to care for patients. There is a good chance that during the ordeal, the conditions of the patients in the Emergency Unit did not deteriorate. During the shift change, the patients are handed over to the newly arrived nurses who work the 8:00 a.m.–4:00 p.m. shift. During the shift change, it is discovered that a box of 10 dolantines, as well as 5 dolantines from another box, are missing from the locked medicine cabinet. Dolantine is a synthetic opioid analgesic belonging to the phenylpiperidine class. The Emergency Unit charge nurse speaks with the nurses and other team members who worked the night shift. Everyone says that they know nothing about the issue. According to what one nurse remembers, the most recent time dolantine was dispensed was in the resuscitation room during an intervention, and the medicine cabinet was not locked due to the panic and rush caused by the bomb threat. The hospital management reports the situation to the police, and the entire Emergency Unit team who worked the night shift is under suspicion. The investigators inspect the hospital security records for the night of the event, but they find that there is no record of what happened during the bomb threat. The investigation remains inconclusive, and it cannot be determined who took the dolantine. Fifteen days after the incident, Pelin and the other Emergency Unit team members receive an admonition and are warned to be more careful. A procedural change was made on the Emergency Unit so the key to the locked medicine cabinet, which was previously given to a qualified nurse during the night shift, will now be given to the most experienced nurse.

Case Study Questions

1. Considering the principles of healthy work environments (effective leadership, staffing, human resources planning, risk planning, communication, interpersonal relations, decision making, etc.), describe the various issues that complicate the case. 2. What factors caused the problems? 3. How are these problems interrelated? 4. If you were Pelin, how would you have handled the situation?