Question: Decision Making and Risk Taking You are a new graduate nurse just fi nishing your 3-month probation period at your first job in acute care nursing. You have been working closely with a preceptor; however, he has been gradually transitioning you to more independent practice. You now have your own patient care assignment and have been giving medications independently for several weeks. Today, your assignment included an elderly confused patient with severe coronary disease. Her medications include antihypertensives, antiarrhythmics, and beta blockers. It was a very busy morning, and you have barely had a moment to reorganize and collect your thoughts. It is now 2:30 PM, and you are preparing your end-of-shift report. When you review the patient's 2:00 PM vital signs, you note a signifi cant rise in this patient's blood pressure and heart rate. The patient, however, reports no distress. You remember that when you passed the morning medications, the patient was in the middle of her bath and asked that you just set the medications on the bedside table and that she would take them in a few minutes. You meant to return to see that she did but were sidetracked by a problem with another patient. You now go to the patient's room to see if she indeed did take the pills.

The pill cup and pills are not where you left them, and a search of the wastebasket, patient bed, and bedside table yields nothing. The patient is too confused to be an accurate historian regarding whether she took the pills. No one on your patient care team noticed the pills. At this point, you are not sure what you should do next. You are frustrated that you did not wait to give the medications in person but cannot change this now. You charted the medications as being given this morning when you left them at the bedside. You are reluctant to report this as a medication error since you are still on probation and you are not sure that the patient did not take the pills as she said she would. Your probation period has not gone as smoothly as you would have liked anyway, and you are aware that reporting this incident will likely prolong your probation and that a copy of the error report will be placed in your personnel fi le. The patient's physician is also frequently short tempered and will likely be agitated when you report your uncertainty about whether the patient received her prescribed medications. The reality is that if you do nothing, it is likely that no one will ever know about the problem. You do feel responsible, however, for the patient's welfare. The physician might want to give additional doses of the medication if indeed the patient did not take the pills. In addition, the rise in heart rate and blood pressure has only just become apparent, and you realize that her heart rate and blood pressure could continue to deteriorate over the next shift. The patient is not due to receive the medications again until 9 PM tonight (b.i.d. every 12 hours).

ASSIGNMENT: Decide how you will proceed. Determine whether you will use a systematic problem-solving model, intuition, or both in making your choices. How did your values, preferences, life experiences, willingness to take risks, and individual ways of thinking influence your decision?