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INTERACTIVE SCENARIOS - PART 2
In this section of the module you can access multiple Interactive Scenarios. Test yourself by scrolling through the scenarios and questions followed by the responses of a supervisor from that health care specialty. There are links to relevant professional regulators for further information. You can also use the examples as the basis for discussion with colleagues at a multi-disciplinary team meeting or development event.
This is PART 2 of 3. Click the 'Next Section' button at the top of this page to progress to PART 3 once you have completed the Scenarios below:
Over the last couple of weeks, you have noticed one of the radiographers in your team rarely seems to talk to her patients or any of her colleagues in the team. This is a change from her usual manner.
Do you have any concerns about this radiographer’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 7 response
Supervisor answer:
Do you have any concerns? Yes
Supervisor comments: All professionals should be able to communicate effectively and work appropriately with others (Standard 8 & 9 SOP for Radiographers see below). The main concern is that there is an underlying cause for this change, either personal or work-related, which would need to be investigated further. The radiographer should be able to recognise that he needs to seek the assistance of his line manager to manage the situation effectively, if required. In general, and where possible, personal issues should not interfere with performance in the workplace but it may be that this radiographer requires some additional support from his/her GP and or occupational health. A professional should be able to know when to seek help or advice from a line manager, particularly if this affects his/her ability to communicate with patients and colleagues. Inability to communicate effectively with colleagues and patients is a performance issue and impacts negatively on teamwork and patient care.
Guidance from the regulator
See the standards of proficiency from the Health and care professions council: https://www.hcpc-uk.org/standards/standards-of-proficiency/
Points for reflection
Think about how you would approach the conversation with this radiographer.
- What support services are available to assist?
- What reason might here be for his change in behaviour?
Nurses on the ward bleep the dietician many times for assistance with a disabled child’s nasogastric feed but she does not answer. By chance, you happen to see her chatting to a colleague in the hospital coffee shop at 3pm. When challenged she says, ‘I’ll be there soon’.
Do you have any concerns about this dietician’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 8 response
Supervisor answer:
Do you have any concerns? Yes
Supervisor comments: Pagers provide the ward with rapid access to the multi-disciplinary team and should be answered as soon as reasonably possible. If she has other priorities to attend to, the dietician should still respond to the bleep quickly, informing the ward of her planned arrival time or direct them to a colleague who is able to assist if she is unable to do so. One would have to look at this scenario in context – she may just be chatting to the colleague in passing or quickly buying something, which is not ideal, but most managers would understand and exercise some discretion. A situation like this would need consideration before concluding. Is this behaviour part of a pattern? It is possible that the presence of the dietician in the shop at 3pm raises the question of why she is not working during paid working hours and this may be construed as a probity matter. Further investigation is indicated.
Guidance from the regulator
Health and care professions council standards: https://www.hcpc-uk.org/standards/standards-of-conduct-performance-and-ethics/
Points for reflection
- Have you ever ignored a bleep/pager/phone at work?
- How does it make you feel when you are persistently bleeped by the ward for the same thing?
- Who else could the nurses discuss their concerns about the child with?
A nurse arrives at 07.30 to join you on the ward round and asks you to go easy on him as he was out at a party till 4 am and ‘drank for England’.
Do you have any concerns about this nurse’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 9 response
Supervisor answer
Do you have any concerns? Yes
Supervisor comments I am initially concerned for both the nurse and the safety of patients, although it is important to establish the facts before deciding on a course of action. An immediate meeting to establish what the nurse means when he says he ‘drank for England’ is advisable to determine whether the nurse was in a fit state to undertake his duties. Jumping to a conclusion which is not justifiable would be unfair and counterproductive. If the nurse is fit for duty a follow up meeting could be arranged for the following day to discuss professional expectations concerning alcohol consumption. However, if it is established that the nurse was drinking excessive amounts of alcohol late into the early hours then the supervisor could not allow the nurse to remain in the workplace. If, at the meeting with the nurse you are concerned about his health and/or the safety of patients then Human Resources (HR) and Occupational Health should be consulted. Your trust will have a local policy advising on alcohol use. Suspension and investigation or sick leave may need consideration. Depending on the outcome referral to the Nursing and Midwifery Council may be indicated. If, for example, the nurse immediately recognises the seriousness of the situation, and the concerns raised and is willing to engage with management of the situation then suspension may not be necessary. A referral to Occupational Health (OH) will need to be discussed. OH, can advise if the nurse is fit to return to work and on any intervention and additional support required. Confidentiality is of the utmost importance as is due consideration of this nurse's health, well-being, and difficulties that he may be experiencing in his personal and/or professional life. It may be that the nurse is feeling consistently stressed at work and more frequent de-briefing and a higher level of supervision is indicated for not only this nurse but the rest of the team.
Guidance from the regulator
The Nursing and Midwifery Code of Conduct states that, 'You make sure that patient and public safety is not affected. You work within the limits of your competence, exercising your professional ‘duty of candour’ and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate.'
and that you must:
'support any staff you may be responsible for to follow the Code at all times. They must have the knowledge, skills and competence for safe practice; and understand how to raise any concerns linked to any circumstances where the Code has, or could be, broken.' [https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf]
Points for reflection
- Have you ever drunk a large amount of alcohol very late into the night and arrived early in the morning to start work?
- How much alcohol do you consider too much the night before you are due to start an early shift?
- Think about the possible risks to patients, yourself, and colleagues. What do you consider to be a reasonable interval between drinking alcohol and starting work?
You are a Foundation Dentist in a dental practice. You are tasked with conducting an audit on the quality of patient record-keeping in the practice. You notice that the patient records made by a visiting specialist are deficient in many of the domains of patient extra- and intra-oral examination. At a subsequent staff meeting, the specialist explains that he only sees patients referred for a specific treatment and so does not have to undertake a full examination as that will already have been done by the referring dentist.
Do you have any concerns about the dental specialist’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 10 response
Supervisor answer
Do you have any concerns? Yes
Supervisor comments: It is not acceptable to assume that a referring dentist has conducted a full extra- and intra-oral examination of his/her patient. The dentist accepting the referral must carry out a complete examination and record the findings in the patient record.
Guidance from the regulator
GDC Standards for the Dental Team:
4.1 You must make and keep contemporaneous, complete, and accurate patient records
4.1.1 You must make and keep complete and accurate patient records, including an up-to-date medical history, each time that you treat patients. Radiographs, consent forms, photographs, models, audio or visual recordings of consultations, laboratory prescriptions, statements of conformity and referral letters all form part of patients records where they are available.
4.1.2 You should record as much detail as possible about the discussions you have with your patients, including evidence that valid consent has been obtained. You should also include details of any patient’s treatment needs where appropriate.
Points for reflection
- If an audit showed inadequate clinical entries, what would you do?
One of the Core Trainees in your team is always late. He is forever making excuses for not being where he should be. Yesterday, on the ward round he told the consultant that he took some blood from a patient, yet you found no record in the lab. When you challenged him, he said he did not take any blood. Last week he said he was with a patient in A&E, but you saw him in the mess chatting on the phone.
Do you have any concerns about this foundation doctor’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 11 response
Supervisor answer
Do you have any concerns? Yes
Supervisor comments: The core trainee must always abide by the duties of a doctor and be honest in his dealings with patients and colleagues. The trainee may have issues which contribute to this behaviour. A discussion between the consultant supervisor and the core trainee is the first step in approaching this problem. After discussing concerns with the trainee, it should be possible to identify whether there is a pattern of behaviour that needs further investigation or whether having a conversation and outlining concerns may be sufficient to resolve the situation.
Guidance from the regulator
The General Medical Council states that “If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or [the GMC]. If you are still concerned you must report this, in line with [GMC] guidance and your workplace policy and make a record of the steps you have taken. [General Medical Council, Good Medical Practice, 2013, para. 25c]
Points for reflection
- What personal factors might be affecting this trainee’s behaviour?
- If you have ever had concerns about the honesty of a colleague how did you manage the situation?
- What factors might make it easier or more difficult to blow the whistle on a colleague?
One of your practice nurses in Tree Side Surgery is increasingly unkempt looking. Her nails are often dirty and for the last 3 weeks she has had the most overwhelming body odour.
Do you have any concerns about this practice nurse’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 12 response
Supervisor answer
Do you have any concerns? Yes
Supervisor comments: The change in behaviour her appearance could indicate health or personal issues that the nurse may need support with. One area of concern would be about the impression that she will make upon patients if she is not presenting herself professionally. There is also a risk of cross infection due to poor hand hygiene. It is important to decide who would be the most appropriate person could be helpful to offer to arrange to meet with the nurse in a confidential space, to offer support and would sensitively ask questions to try to assess any underlying issues. Suspension should be considered if there is any risk to patients.
Guidance from the regulator
Raising concerns: Guidance for nurses and midwives, NMC 2013 www.nmc-uk.org/Nurses-and-midwives/Raising-and-escalating-concerns
Points for reflection
- Have you ever considered raising concerns about a colleague at work?
- What factors helped you to decide whether to take your concerns further?