Pauline has just graduated from her nursing course. She recently secured a position in a large public hospital in a new graduate program. She is a mother to a 3-year-old boy and a 6-month-old girl. Her husband also works shift work so that they can accommodate the childcare responsibilities together.

However, they are both exhausted and do not have time to spend with each other very often due to their conflicting shift work. Pauline is currently working her first-night duty rotation. She has recently worked several double shifts as the hospital has been short-staffed and she is trying to pay off her student loans.

SCENARIO

On a particularly busy night, Pauline accidentally administers a second dose of an anti-hypertensive medication to one of her elderly patients, Olive, who has mild dementia. The medication error occurred as Pauline did not check to see if the drug had already been signed as given on the medication chart. She reviews Olive’s medical history and notes that her blood pressure is usually quite high.

Pauline then decides not to inform anyone about the error as she is concerned that it might reflect poor performance in her new role. She does not inform Olive as she feels it might cause Olive to be anxious if she tells her that she has made a mistake. However, Pauline is worried Olive may get dizzy from the second dose of the medication. She goes to Olive and states firmly she must stay in bed for the next 6 hours.