Surgical Nursing Interview Questions and Answers (NHS)

1. Tell us a bit about yourself and why you want to come to work with our Hospital

Thank you for this opportunity. My journey in nursing began with a profound desire to contribute directly to patient well-being, and this aspiration led me to specialize in surgical nursing. For the past seven years, I have been working as a registered nurse in the surgical department at City General Hospital, where I have gained comprehensive experience in pre-operative, intra-operative, and post-operative care across a diverse range of surgical specialties, including general surgery and neurosurgery. My responsibilities have encompassed patient assessment, medication administration, wound management, and critical patient monitoring in the perioperative setting. I am particularly adept at anticipating the needs of the surgical team and maintaining a calm and efficient operating room environment, especially during complex procedures.

Beyond my technical skills, I am deeply committed to providing holistic and patient-centered care, recognizing the unique anxieties and vulnerabilities patients experience throughout the surgical process. It’s this commitment that motivates me to seek a position at University Medical Center. I have been consistently impressed by University Medical Center’s reputation as a leader in robotic-assisted surgery and enhanced recovery protocols and its clear dedication to providing compassionate, evidence-based care to all patients within a technologically advanced setting. I am particularly drawn to the hospital’s pioneering work in minimally invasive cardiac surgery and its strong emphasis on interprofessional collaboration within the surgical teams, and I believe my skills and experience align perfectly with your hospital’s commitment to excellence. I am eager to contribute to a team that is so clearly dedicated to advancing surgical care and improving patient outcomes, and I am confident that working at University Medical Center would provide me with the ideal environment to further develop my skills and make a meaningful contribution.

2. What key attributes (characteristics) do you think make a good nurse?

In my view, several key attributes are essential for a nurse to excel and provide truly exceptional patient care. Firstly, a strong foundation of clinical competence is paramount. This encompasses not only possessing the necessary technical skills and knowledge to perform nursing procedures safely and effectively but also demonstrating sound clinical judgment in assessing patients’ conditions and making informed decisions.

Beyond technical proficiency, compassionate communication stands out as a critical attribute. A good nurse can effectively communicate with patients and their families, listening attentively to their concerns, explaining complex medical information in an understandable way, and offering reassurance and emotional support during often vulnerable times. This ability to build rapport and trust is invaluable.

Furthermore, empathy and compassion are at the heart of nursing. A truly good nurse can connect with patients on a human level, understanding their experiences, showing genuine care, and advocating for their needs with sensitivity. This emotional intelligence allows nurses to provide holistic care that goes beyond just the physical aspects of illness.

Professionalism and responsibility are also indispensable. This includes maintaining ethical standards, adhering to confidentiality, being accountable for one’s actions, and demonstrating a commitment to continuous professional development. Nurses operate within a complex and demanding environment, and these qualities ensure they are reliable and trustworthy members of the healthcare team.

Finally, adaptability and resilience are increasingly important in today’s healthcare landscape. Nurses must be able to manage multiple priorities, respond calmly and efficiently to unexpected situations, and cope with the emotional and physical demands of the profession. The ability to learn quickly, adapt to changing circumstances, and maintain composure under pressure are vital for navigating the challenges of modern nursing and providing consistently high-quality care. In essence, a combination of clinical skill, compassionate communication, empathy, professionalism, and adaptability defines a truly excellent nurse.

3. What skills do you have to contribute to this post?

I believe I possess a range of skills that would allow me to make a valuable contribution to this post. Firstly, my clinical skills, honed over six years working as a registered nurse, are directly transferable and relevant. I have extensive experience in complex wound management and post-operative patient monitoring, and I am proficient in intravenous cannulation, wound VAC therapy, and utilizing electronic health record systems like Epic. I am confident in my ability to quickly become competent and contribute effectively to the daily clinical demands of this role.

Beyond technical expertise, I bring strong communication and interpersonal skills. I have consistently demonstrated the ability to build rapport with patients from diverse backgrounds, effectively communicate complex medical information in an understandable manner, and collaborate seamlessly with interdisciplinary teams, particularly in the surgical setting. I understand that clear and compassionate communication is vital for patient safety and well-being, and I am dedicated to fostering a positive and collaborative working environment within the surgical unit.

Furthermore, my experience in a fast-paced, high-volume surgical unit managing a caseload that frequently included critical post-operative patients has instilled in me excellent organizational and prioritization skills. I am adept at managing multiple tasks simultaneously, responding effectively under pressure during surgical emergencies, and maintaining meticulous attention to detail, which I believe are crucial for ensuring efficient and safe patient care in a demanding surgical healthcare setting.

Finally, I am a proactive and solutions-oriented individual. I am not only comfortable following established surgical protocols but also possess the initiative to identify areas for improvement within the unit’s workflow and contribute to problem-solving within the surgical team. I am eager to learn new surgical techniques, adapt to evolving best practices, and consistently strive to enhance the quality of care I provide to surgical patients. In summary, I believe my blend of clinical proficiency, strong communication abilities, organizational skills, and proactive approach would allow me to integrate quickly into your surgical team and make a meaningful contribution to this post and to the patients under our care.

4. How has your training and experience helped to develop these?

My nursing training and professional experiences have been instrumental in developing the skills I previously outlined. Regarding clinical skills, my foundational nursing degree at the University of Toronto provided the essential theoretical knowledge and initial practical training through clinical placements in various healthcare settings. These placements, particularly in demanding surgical and medical units at Toronto General Hospital, allowed me to practice core nursing procedures under supervision, such as medication administration, wound care, and patient assessments, gradually building competence and confidence. Furthermore, my five years working at Mount Sinai Hospital provided continuous on-the-job training, exposing me to a wide range of clinical scenarios and complex patient cases, which significantly refined my clinical judgment and technical proficiency. For example, regularly participating in advanced cardiac life support courses and specialized workshops on complex wound management and negative pressure wound therapy demonstrably enhanced my skills in these critical areas.

In terms of communication and interpersonal skills, my training at the University of Toronto emphasized therapeutic communication techniques and patient-centered care. Practicing communication skills in simulated scenarios during my degree and then applying these in real-world patient interactions at Mount Sinai was crucial. Working within multidisciplinary teams in my previous role further developed my ability to communicate effectively with colleagues, physicians, and allied health professionals, learning to convey information concisely and respectfully in a high-pressure environment. Moreover, consistently engaging with patients and families from diverse backgrounds at Mount Sinai Hospital, a very diverse patient population, strengthened my empathy and ability to tailor my communication approach to individual needs and preferences, building trust and rapport even in challenging situations.

My organizational and prioritization skills were honed by the demanding nature of the nursing practice itself. Managing a heavy patient workload in Mount Sinai Hospital’s busy General Surgery Unit, where efficient time management and task delegation were paramount, forced me to develop systematic approaches to prioritizing care and organizing my workflow. My experience in managing emergency post-operative admissions directly from the operating room and coordinating complex discharge plans for patients requiring extensive home healthcare arrangements taught me to remain calm under pressure, anticipate potential issues, and proactively manage my time to ensure patient safety and optimal care delivery. The fast-paced environment inherently demanded strong organizational skills, which I actively cultivated and refined.

Finally, my proactive and solutions-oriented approach has been fostered through both formal training and experiential learning. My nursing curriculum at the University of Toronto encouraged critical thinking and problem-solving, and I actively sought opportunities to engage in quality improvement initiatives in my previous role. For instance, I was involved in a unit-based project to improve medication reconciliation processes upon patient admission, which significantly reduced medication errors, and a separate initiative to streamline patient handover processes between shifts using a standardized SBAR communication tool, which required me to identify areas for improvement, propose solutions, and collaborate with colleagues to implement changes. This experience, along with encountering and resolving numerous unexpected clinical challenges on a daily basis, has cultivated my proactive mindset and strengthened my ability to contribute constructively to problem-solving and continuous improvement within a healthcare team.

5. What support do you think you will need in your first 3 to 6 months?

In my first 3 to 6 months, I anticipate needing primarily orientation and support to integrate quickly into your specific surgical environment. While I bring a solid foundation of surgical nursing skills and experience, every hospital and surgical unit operates with its own unique workflows, protocols, and team dynamics. Therefore, initially, a structured orientation to your hospital’s electronic health record system, surgical protocols, and specific unit routines would be invaluable. This would allow me to efficiently navigate the practical aspects of my daily tasks and ensure I am fully aligned with your established best practices for patient care and safety.

Beyond the formal orientation, access to a designated mentor or experienced surgical nurse within the team for the first few months would be incredibly beneficial. This would provide a go-to person for clarifying any questions that arise in real time, especially during the initial period of acclimation to new procedures or equipment specific to this hospital. It would also facilitate a smoother integration into the existing team and allow me to learn from the expertise of experienced colleagues in this particular surgical setting.

Furthermore, I believe access to ongoing learning resources and opportunities would be supportive in the long term. Staying current with the latest advancements in surgical nursing is a priority for me, so having access to internal training programs, relevant online resources, or opportunities to attend hospital-sponsored workshops related to surgical specialties or advanced techniques would be highly appreciated. This commitment to continued professional development would not only benefit my individual practice but also allow me to contribute to the team’s overall knowledge base and the quality of care we provide.

In essence, the support I envision needing is focused on efficient onboarding and continuous professional growth within your specific environment. I am a proactive learner and eager to become a fully contributing and effective member of your surgical team as quickly as possible, and I believe these support mechanisms would facilitate that successful integration.

6. Where do you see yourself in 5 years?

Looking ahead five years, I envision myself as a highly skilled and experienced surgical nurse, deeply embedded within your team here at University Medical Center and making a significant contribution to the surgical department. My primary goal is to become a recognized clinical expert in robotic-assisted colorectal surgical procedures and the associated perioperative management. I aim to achieve this through a combination of continued practical experience within your renowned surgical department, actively participating in professional development opportunities offered by University Medical Center’s Center for Surgical Innovation, and potentially pursuing certifications relevant to my chosen specialization. For example, I am very interested in becoming a Certified Robotic Surgical Nurse through the Competency and Credentialing Institute (CCI) and pursuing advanced training in robotic surgical assisting offered here at University Medical Center, and I see University Medical Center, with its strong focus on robotic surgery and advanced surgical technologies, as the ideal environment to achieve this.

Furthermore, I aspire to take on increased leadership responsibilities within the surgical unit, perhaps in a role such as a surgical team leader or preceptor for new graduate nurses joining the OR. This could involve mentoring new nurses in robotic techniques, participating in unit-based quality improvement initiatives focused on enhancing efficiency in the robotic surgery suite, or potentially taking on a charge nurse or preceptor role to guide and support team development. I believe in fostering a collaborative and supportive team environment, which is especially crucial in the demanding OR setting, and I am eager to contribute to the professional growth of my colleagues and the overall efficiency and effectiveness of our surgical services, particularly within the robotic surgery program.

Ultimately, in five years, I see myself not just as an individual nurse progressing in my career, but as a valuable and integral member of the University Medical Center surgical team, consistently providing exceptional patient care in complex robotic procedures, actively contributing to a positive and thriving work environment within the OR, and continuously advancing my skills to meet the evolving needs of our patients and the cutting-edge surgical field. My commitment is not just to personal growth but to leveraging that growth to benefit University Medical Center and the patients we serve through its innovative surgical programs, and I believe this role provides the perfect trajectory to achieve these long-term aspirations within a leading institution like yours.

7. What are the essentials of infection prevention?

The essentials of infection prevention are multifaceted and absolutely critical in any healthcare setting, especially within surgery, where the risk of infection can have serious consequences. At its core, effective infection prevention hinges on breaking the chain of infection at every possible point.

The most fundamental element is meticulous hand hygiene. This means consistent and correct hand washing with soap and water, or the use of alcohol-based hand rub, before and after every patient contact, procedure, and whenever hands become potentially contaminated. This seemingly simple act is the single most effective way to prevent the transmission of pathogens.

Building upon hand hygiene are standard precautions. These are a set of infection control practices used for all patients, regardless of their known or suspected infection status. Standard precautions include the appropriate use of personal protective equipment (PPE) such as gloves, gowns, masks, and eye protection, depending on the anticipated exposure. Safe injection practices and proper respiratory hygiene, like covering coughs and sneezes, are also key components of standard precautions.

In addition to standard precautions, transmission-based precautions are essential. These are implemented based on the suspected or confirmed mode of transmission of specific pathogens. They include contact precautions for infections spread by direct or indirect contact, droplet precautions for infections spread via respiratory droplets, and airborne precautions for infections spread through the air. Understanding and correctly applying these precautions is vital to containing the spread of specific infections within the surgical environment.

Beyond direct patient care practices, environmental hygiene plays a crucial role. Regular cleaning and disinfection of frequently touched surfaces, patient rooms, and the operating room environment itself are essential to minimize the presence of pathogens. Adherence to strict cleaning protocols and the appropriate use of disinfectants are key components of this.

Another critical aspect, especially in surgery, is device and equipment sterilization and disinfection. Surgical instruments and medical devices must be rigorously sterilized or appropriately disinfected according to established guidelines to eliminate microorganisms and prevent surgical site infections. Proper processing, storage, and handling of these items are paramount.

Furthermore, antimicrobial stewardship is increasingly recognized as an essential element of infection prevention. This focuses on using antimicrobial medications judiciously and only when necessary to prevent the development of antimicrobial resistance. Appropriate antibiotic prophylaxis in surgery, guided by evidence-based guidelines, is a critical aspect of this.

Surveillance and monitoring for infections are also vital to identify trends, detect outbreaks early, and evaluate the effectiveness of infection prevention strategies. Regular audits of infection control practices and data collection on infection rates allow for continuous improvement and targeted interventions.

Finally, education and training are essential for all healthcare staff, patients, and visitors. Ensuring that everyone understands infection prevention principles and their role in preventing transmission and receives ongoing education reinforces a culture of safety and promotes consistent adherence to best practices.

In summary, effective infection prevention in surgery relies on a comprehensive and consistent approach encompassing meticulous hand hygiene, adherence to standard and transmission-based precautions, robust environmental hygiene, proper equipment processing, antimicrobial stewardship, surveillance, and ongoing education. These elements, working in concert, are the cornerstones of a safe surgical environment and are fundamental to protecting patients from healthcare-associated infections.

8. How would you support a new member of staff that you can see as struggling to cope but is too shy to ask questions?

If I noticed a new staff member appearing to struggle but seeming hesitant to ask for help, my first step would be to proactively approach them in a supportive and non-intimidating manner. I would start by observing their behaviour carefully for consistent signs of difficulty, such as looking overwhelmed when charting on Epic, taking longer than expected to complete medication passes, or exhibiting signs of stress like repeatedly sighing, while being mindful that everyone adjusts differently. Instead of directly asking Are you struggling?, which might feel confrontational, I would opt for a more casual and supportive opening. For example, if I saw a new nurse, say Sarah, looking hesitant near the medication cart, I might approach her during a quieter moment and say something like, Hi Sarah, how are you finding things on the surgical unit? Is there anything I can help with or clarify as you get settled in? This opens the door for them to share any concerns without feeling directly called out or pressured.

If she still seemed hesitant, I would try to offer concrete, practical assistance rather than just a general offer of help. I might say, I remember when I first started on this unit, the wound VAC dressing changes took me a little while to get the hang of. Would it be helpful if we quickly reviewed the hospital’s protocol for wound VAC application together? I just want to ensure we are both on the same page with how things are done here. Offering specific assistance related to a task normalizes the experience of needing help and makes it easier for her to accept support without feeling inadequate.

Furthermore, I would emphasize that asking questions is not only acceptable but actively encouraged within our surgical team. I would want to reinforce our unit’s culture of open communication. I could reassure her by saying something like, Please know that everyone here on the surgical team is really supportive, and we all understand there’s a learning curve when starting a new role, especially in the OR. There are no silly questions, and we’d much rather you ask for clarification on something like setting up the robotic surgical equipment than feel unsure or struggle in silence. We’re all here to support each other, especially in high-pressure situations.

Beyond immediate assistance, I would make a conscious effort to check in with her regularly, especially in the initial few weeks, perhaps during handover or during lunch breaks, just to see how she is progressing and to reiterate my open-door approach for any questions or concerns. This ongoing support and gentle encouragement can help build her confidence over time, demonstrating that help is readily available and that her well-being and success within our team are valued. Ultimately, my goal would be to create a safe and supportive environment where she feels comfortable enough to eventually voice her needs independently, knowing she is surrounded by a team willing to assist her in providing excellent surgical nursing care.

9. You are doing your drugs round when you realize you did a drug error. What do you do? What actions can be taken to prevent mistakes from happening?

Discovering a medication error during a drug round immediately triggers a very specific and crucial set of actions, with patient safety being the absolute priority. Firstly, my immediate action would be to stop the drug round completely and ensure the patient’s immediate safety. This means assessing the patient for any immediate adverse effects from the medication error, such as allergic reactions, changes in vital signs, or any new symptoms. This assessment would be thorough and focused on the potential harms associated with the specific medication and error type.

Secondly, I would immediately inform the appropriate senior staff member, typically the nurse in charge or the shift coordinator, and also the prescribing physician. Providing a clear and concise report of the error – including the drug name, dose, route, time, patient details, and the nature of the error – is essential for prompt medical review and further orders. Transparency and speed are critical at this stage to ensure timely interventions and mitigate any potential harm to the patient.

Following these immediate patient safety steps and notifications, the next action is to adhere strictly to hospital policy regarding medication errors and incident reporting. This invariably involves completing a detailed incident report, documenting the error thoroughly and factually. This documentation includes not only the details of the error itself but also the patient assessment findings, the interventions taken, and the notifications made to senior staff and the physician. Accurate and comprehensive documentation is vital for patient safety, legal purposes, and for organizational learning and improvement.

Regarding actions to prevent future medication errors, a multi-faceted approach is necessary. Reinforcing and consistently practicing the ‘rights’ of medication administration is fundamental. This involves meticulously checking the right patient, right drug, right dose, right route, right time, and right documentation every single time, without fail. This practice, though seemingly basic, is the cornerstone of safe medication administration.

Furthermore, implementing double-checking systems, particularly for high-risk medications, provides a critical safety net. Having a second qualified nurse independently verify the medication order, drug preparation, and dosage can significantly reduce the likelihood of errors, especially in busy or demanding situations.

Minimizing distractions and interruptions during medication rounds is also crucial. Creating a dedicated and quiet environment for drug administration allows nurses to focus solely on this complex and critical task, reducing the potential for errors due to lapses in concentration. This may involve strategies like using ‘do not interrupt’ vests or designated medication administration times.

Improving communication and clarity in medication orders and prescriptions is another key preventative measure. Ensuring legible handwriting in paper-based systems or clear and standardized electronic prescribing systems minimizes misinterpretations of drug names, dosages, or routes. Furthermore, robust handover processes and clear communication during shift changes about medication orders are vital for the continuity of safe medication management.

Leveraging technology, where available, can also significantly enhance medication safety. This includes utilizing barcode scanning systems to verify medication against patient identity, automated dispensing cabinets to reduce manual handling errors, and clinical decision support systems within electronic health records to flag potential drug interactions or dosage concerns.

Finally, fostering a culture of open reporting and learning from errors, rather than blame, is paramount. Encouraging staff to report errors without fear of reprisal allows for the analysis of system weaknesses and the implementation of proactive strategies to prevent recurrence. Regular medication safety audits, root cause analysis of errors, and ongoing education and training for staff on medication safety best practices are all essential components of a comprehensive infection prevention strategy. In summary, a combination of individual vigilance, robust systems, clear communication, technological aids, and a blame-free learning environment are all crucial to minimizing medication errors and ensuring patient safety.

10. You are witnessing an angry patient shouting at another patient. What would you do?

Witnessing a patient becoming verbally aggressive towards another patient immediately requires a calm, measured, and patient-centered response. My first priority would be to ensure the immediate safety and well-being of both patients involved, as well as any other patients or visitors in the surgical waiting area. This means quickly but calmly approaching the situation to assess the immediate risk and prevent any potential physical escalation, especially in a potentially crowded waiting space.

My initial intervention would be to verbally de-escalate the situation with a calm and empathetic tone. I would approach the angry patient, let’s say Mr. Jones, in a non-confrontational manner, speaking clearly and softly, perhaps saying something like, Mr. Jones, I can see you’re upset. Let’s talk over here for a moment, what’s happening? while gently gesturing to move slightly away from the other patient, Mrs. Davis. The goal here is to interrupt the immediate escalation, acknowledge his emotions without validating aggressive behaviour, and shift his focus from Mrs. Davis to myself as a staff member.

I would then actively listen to Mr. Jones to understand the underlying cause of his distress. Perhaps he’s in severe pain and is frustrated with the wait time for medication, or he’s confused about his discharge instructions. I would allow him to express himself, listening attentively without interruption initially, to try and identify the trigger for his anger. Showing empathy and understanding at this stage is crucial, even if I don’t condone his behaviour. For example, I might say, Mr. Jones, I understand you’re feeling frustrated with the waiting time, or it sounds like something about your medication schedule has really upset you.

Simultaneously, while engaging with Mr. Jones, I would also be attentive to Mrs. Davis, the patient who is being shouted at, ensuring her comfort and safety. I would discreetly check on her, perhaps offering her a chair in a quieter part of the waiting area or a glass of water, with a quiet word of reassurance like, Mrs. Davis, are you alright? I’m here. to let her know she is not alone and that staff are present and responsive. If it seemed appropriate and safe to do so, I might gently guide Mrs. Davis to a slightly different area of the waiting room to create some physical separation and reduce immediate tension while still remaining present with Mr. Jones.

Once I have a better understanding of the situation from Mr. Jones’s perspective, I would then attempt to address the root cause of his agitation in a constructive manner. If his frustration is about pain, I would immediately assess his pain level and expedite pain relief if appropriate, or explain the process and estimated timeframe clearly. If it’s confusion about discharge, I would offer to clarify his instructions and answer his questions. It’s important to address the underlying issue while calmly and firmly setting boundaries regarding acceptable behaviour, explaining that while his feelings are valid, shouting at other patients is not acceptable. For instance, I might say, Mr. Jones, I understand you’re upset about the wait for your pain medication, but it’s not okay to shout at Mrs. Davis or other patients. Let’s see if I can check on the status of your medication for you right now, and then we can talk more calmly about how you’re feeling.

If de-escalation strategies are not effective, or if the situation continues to escalate or becomes unsafe, I would immediately seek assistance from colleagues and potentially hospital security, following the Code Grey protocol for managing escalating patient behaviour. Knowing when to call for help is crucial for patient and staff safety. I would discreetly signal to a nearby colleague or directly contact the Charge Nurse and hospital security to provide backup and support in case verbal de-escalation is insufficient.

Following the immediate situation, it is essential to document the incident thoroughly and accurately in the electronic patient record and also complete a separate incident report. This documentation includes the trigger for Mr. Jones’s agitation, the de-escalation interventions I used, the response of both patients, and the outcome of the situation. This documentation is important for both patient records, for communication with the healthcare team, and for potential review and learning to improve future patient management strategies on the surgical unit.

Finally, in the aftermath, it would be important to check back with both Mr. Jones and Mrs. Davis later in the shift. To ensure Mrs. Davis is feeling safe and supported, perhaps offering a quiet space to decompress if needed, and to follow up with Mr. Jones, once he is calmer, to reflect on the incident, offer any necessary support, and potentially involve social work or patient advocacy if the underlying issues are more complex or require further intervention. This demonstrates a commitment to holistic patient care and to fostering a safe and respectful environment for everyone in our care on the surgical unit.

11. Describe a situation where you had to deal with an angry patient or colleague.

In my nursing career, I’ve encountered situations requiring skillful management of anger, both from patients and colleagues. One instance that stands out involved a post-operative patient, Mrs. Eleanor Vance, who became increasingly agitated and verbally aggressive towards nursing staff due to uncontrolled pain despite regular analgesia. She was shouting and demanding stronger medication, disrupting the ward environment on the orthopedic post-operative ward and causing distress to other patients, particularly in the four-bed bay. My initial response was to approach Mrs. Vance calmly and privately, removing her from the busier ward area to a quieter patient room designated for consultations. I actively listened to her concerns, allowing her to express her frustration about the ongoing pain in her hip post-arthroplasty without interruption, acknowledging her pain and validating her feelings that her current pain level was unacceptable.

While empathizing with her discomfort, I also calmly and clearly explained the current pain management plan, detailing the medications she had received – regular paracetamol and ibuprofen, and PRN oral morphine – and the rationale for the prescribed dosages, emphasizing the importance of multimodal analgesia in post-operative recovery, while assuring her I would advocate for her with the medical team. I then promptly contacted the on-call orthopedic registrar to communicate Mrs. Vance’s escalating pain and distress. Following medical review, an adjusted pain management strategy was implemented, which included the addition of regularly scheduled oxycodone and a PCA pump if needed, and I diligently reassessed Mrs. Vance’s comfort level every hour for the next few hours, communicating the changes in the plan and expected improvements to her directly and frequently, explaining how the PCA pump would allow her more control.

Throughout this process, I maintained a calm and professional demeanor, consistently focusing on understanding and addressing the root cause of her anger – her uncontrolled pain – and working collaboratively with the medical team to find a solution. Ultimately, by actively listening, advocating for the patient, and maintaining open communication, we were able to effectively de-escalate the situation, improve Mrs. Vance’s pain control, and restore a calm environment on the ward, which greatly improved the atmosphere for patients recovering from hip and knee replacements. This experience reinforced for me the importance of empathy, active listening, and proactive problem-solving when managing anger in the healthcare setting.

12. If I walked into a ward where you were working, how would I be able to tell that the patients you were allocated were being cared for?

If you were to walk into a ward where I was working and observe my allocated patients, I believe several indicators would clearly demonstrate that they were receiving diligent and comprehensive care. Firstly, you would observe a calm and organized environment around each patient, which is particularly important on a busy surgical ward like the vascular surgery unit. Their immediate bedside areas would be tidy and clutter-free, with essential equipment like IV pumps and oxygen readily accessible and in good working order, reflecting proactive organization to facilitate efficient care delivery.
Secondly, you would notice patients appearing comfortable and engaged, where appropriate to their post-operative status. This might manifest as patients being positioned comfortably, with pressure-relieving mattresses and pillows in place, with readily accessible call bells and personal items like reading glasses and water jugs within reach. For patients who are alert and communicative, such as those recovering from elective hernia repairs, you might observe nurses engaging in conversations, explaining post-discharge wound care plans, reviewing their mobility goals for the day, or simply offering a reassuring presence, indicating a focus on holistic well-being beyond just task completion. You would also likely see evidence of proactive monitoring and assessment – charts being updated in real-time with regular vital sign recordings, infusion pumps programmed and checked with current infusion rates documented clearly, and nurses attentively observing patient wound sites during dressing changes or assessing peripheral pulses post-vascular bypass surgery, demonstrating vigilance in tracking patient status.

Furthermore, you would hopefully sense a respectful and dignified atmosphere in interactions between myself and patients, particularly important for patients who may be feeling vulnerable post-surgery, perhaps after a bowel resection. Communication would be clear, considerate, and tailored to individual patient needs, respecting their privacy with screens used appropriately during personal care and autonomy throughout all care activities. In essence, you would observe a blend of organized efficiency, proactive monitoring, patient comfort, and respectful communication, collectively indicating a standard of care that prioritizes both clinical excellence and patient well-being on a surgical ward focused on complex post-operative recovery.

13. How can you ensure good practice is maintained on your ward?

Ensuring good practice is consistently maintained on a ward, particularly in a specialized area like the cardiothoracic surgical ward, requires a multifaceted and proactive approach, encompassing both individual accountability and collective responsibility. A cornerstone of maintaining good practice is rigorous adherence to established hospital policies, protocols, and evidence-based guidelines, such as those for post-operative infection prevention and deep vein thrombosis prophylaxis. This involves a personal commitment to staying updated on current best practices, often disseminated through unit-based in-services and hospital-wide clinical updates, and consistently implementing them in daily nursing care, such as correctly applying compression stockings and administering subcutaneous heparin as per protocol.

Furthermore, actively participating in regular ward-based audits and quality improvement initiatives, for instance, audits of surgical site infection rates or medication administration accuracy, is crucial. By proactively monitoring key indicators of care quality, such as post-operative pneumonia rates or compliance with early mobilization protocols for cardiac surgery patients, and engaging in root cause analysis when deviations occur, we can identify areas for improvement and implement targeted interventions to enhance practice. Promoting a culture of open communication and peer support within the ward team is also essential, especially in a high-stress environment like the surgical ward. This involves creating an environment where staff feel comfortable raising concerns about potential deviations from best practice, like incorrect surgical counts, asking questions about new surgical techniques, and providing constructive feedback to one another without fear of reprisal, fostering a collective commitment to upholding high standards of care, particularly in relation to patient safety in the operating theatre and post-operative care.

Actively engaging in regular professional development and continuing education, such as attending surgical nursing conferences or completing online modules on advanced wound care, is also vital for every nurse on the ward. This ensures that our knowledge and skills remain current and aligned with evolving best practices in surgical nursing care, and that we are equipped to deliver the most up-to-date and effective care to patients undergoing complex surgical procedures. Finally, effective leadership and role modeling from senior nurses and ward managers, such as the Surgical Ward Nurse Manager and Clinical Nurse Specialist, are paramount in setting the tone for good practice.

By consistently demonstrating exemplary clinical skills, upholding professional standards, and actively promoting a culture of safety and quality, senior staff can inspire and guide the entire team in maintaining and continuously improving ward practices specifically related to surgical patient care and recovery. In essence, a combination of individual responsibility, proactive quality monitoring, open communication, continuous learning, and strong leadership are all integral to fostering and sustaining a culture of good practice on the ward, particularly in the demanding and specialized setting of surgical nursing.

14. How do you feel when a colleague or patient holds an opinion that differs from your own?

When a colleague or patient holds an opinion that differs from my own, especially in the context of surgical nursing where decisions can be complex and have significant implications, I view it primarily as an opportunity for learning and a chance to broaden my perspective. I understand that diversity of opinion is inherent in any collaborative environment and especially within healthcare, where individual patient needs, cultural backgrounds, and values are paramount. Therefore, my initial feeling is usually one of intellectual curiosity, prompting me to understand the rationale behind their differing viewpoint, especially if it pertains to post-operative patient care decisions. I believe that respectful dialogue and considering alternative perspectives are essential for both professional growth as a surgical nurse and for providing truly patient-centered care in the complex surgical environment.

It’s through these differing opinions that we can challenge our own assumptions about surgical best practices, patient preferences, or optimal care pathways, identify potential biases we might hold, and ultimately arrive at more well-rounded and effective approaches to patient care. I recognize that my opinion, even with my seven years of surgical nursing experience, is just one perspective, and while I value my own clinical judgment and experience, I also deeply value the insights and experiences of others, whether they be fellow surgical nurses, surgeons, anesthetists, or, most importantly, the patients we serve recovering from major surgical interventions. Therefore, differing opinions, when approached with openness and respect, are not a source of conflict for me in the surgical ward setting but rather valuable contributions to a richer and more comprehensive understanding of a situation and the optimal path forward for each individual patient.

15. Can you tell me about a time that this has happened?

Yes, I can recall a specific instance where a colleague and I held differing opinions regarding a patient’s pre-operative bowel preparation regimen before elective colorectal surgery. The patient, Mr. David Chen, who was scheduled for a laparoscopic sigmoid colectomy, and while I felt that a more aggressive bowel preparation, including both oral laxatives and enemas the day before surgery, was warranted to ensure optimal bowel cleansing and minimize surgical site infection risk, my colleague, a very experienced surgical nurse who had worked on the colorectal team for many years, believed in a more streamlined approach, advocating for oral laxatives alone, citing recent evidence suggesting that overly aggressive bowel prep could be detrimental and lead to dehydration and electrolyte imbalance, particularly in elderly patients like Mr. Chen, who was 78 years old. Our differing opinions stemmed from our individual interpretations of evolving evidence-based practice in bowel preparation and perhaps slightly varied risk assessments for this specific patient – I leaned towards maximizing bowel cleanliness to reduce infection risk, while my colleague prioritized minimizing patient discomfort and potential complications associated with aggressive bowel prep, especially in older individuals.

16. How did you deal with the situation?

To address this difference in opinion regarding Mr. Chen’s pre-operative bowel preparation, I initiated a respectful and evidence-based discussion with my colleague, focusing entirely on the patient’s safety and the current best practice guidelines for colorectal surgery bowel preparation. I started by clearly articulating my rationale for advocating for a more comprehensive bowel prep, referencing older, established surgical literature emphasizing the link between bowel cleanliness and surgical site infection prevention in colorectal surgery, and my understanding of the surgeon’s usual preference on our unit. Crucially, I then actively listened to my colleague’s perspective, seeking to understand her reasoning for favoring the streamlined approach and acknowledging her extensive experience on the colorectal surgical team and her awareness of more recent studies questioning the benefit of aggressive bowel prep and highlighting potential harms, particularly in the elderly. She shared her understanding of updated hospital guidelines that were leaning towards less aggressive regimens based on this newer evidence.

Recognizing the validity of both our viewpoints and acknowledging the evolving nature of best practice in this area, we agreed to collaboratively review the most recent hospital bowel preparation protocol together, accessing the electronic policy database and critically appraising the current recommendations based on the latest evidence. We then jointly presented our findings, including the slightly nuanced hospital policy that allowed for some clinical judgment based on patient factors, and our individual rationales to the surgical consultant on call, clearly outlining the patient’s specific characteristics, including his age and co-morbidities, and our slightly different perspectives on the optimal bowel prep strategy in this case. The surgical consultant, appreciating our proactive and collaborative approach and considering both our input and the updated hospital guidelines, ultimately decided to opt for the streamlined bowel preparation with oral laxatives only, but emphasized the importance of excellent intraoperative bowel handling and surgical technique to minimize infection risk, and also ordered pre-operative intravenous hydration to mitigate any dehydration risks in Mr. Chen.

Following this decision, we both ensured the streamlined bowel prep was implemented correctly, monitored Mr. Chen for any signs of dehydration or electrolyte imbalance, and communicated effectively with each other and the surgical team throughout his perioperative journey to ensure optimal patient safety and surgical outcomes. This situation highlighted to me the vital importance of staying current with evolving evidence-based practice in surgical nursing, the value of respectful dialogue and evidence-based discussion when navigating differing professional opinions, and the necessity of patient-centered decision-making, taking into account individual patient factors and the most up-to-date clinical guidelines. By focusing on the patient’s best interests and engaging in open, evidence-informed communication, we were able to reconcile our differing approaches and ultimately contribute to delivering appropriate and safe pre-operative care for Mr. Chen.

17. In the event of the death of a patient, how would you manage this situation?

In the event of a patient’s death, particularly in the often emotionally charged environment of a surgical ward like the surgical oncology unit, my management would prioritize providing compassionate and dignified care for the deceased patient and offering sensitive and supportive care to the family and loved ones, while also ensuring appropriate post-mortem procedures are followed with respect and efficiency and supporting my colleagues who may also be deeply affected. Immediately following confirmation of death by the medical team, for instance, after a prolonged and challenging post-operative period following a major Whipple’s procedure for pancreatic cancer, my first action would be to ensure the patient, perhaps Mrs. Isabella Rossi, is treated with the utmost respect and dignity. This involves preparing the body according to hospital protocols and cultural sensitivities, ensuring a respectful post-mortem care process, including removing lines and tubes, gentle cleansing, and appropriate shrouding, providing privacy and a peaceful environment in the immediate aftermath, perhaps by dimming the lights in the room and minimizing noise outside. Simultaneously, I would prioritize sensitive and timely communication with Mrs. Rossi’s family, who have been vigilantly at her bedside for the past few days. This communication should be delivered in a private and quiet setting, such as the ward bereavement room, with empathy and compassion, providing clear and honest information about Mrs. Rossi’s peaceful passing. I would allow the family time and space to grieve, actively listening to their needs and offering emotional support, perhaps offering tissues and a quiet presence, while also providing practical information regarding next steps, such as contacting clergy if requested or arranging funeral services and informing them about hospital bereavement resources like the social work department and grief counseling services.

Furthermore, I would ensure all necessary post-mortem care and documentation are completed meticulously and respectfully, following all legal and hospital guidelines for death certification, release of the body to the hospital mortuary, and careful handling of personal belongings, ensuring they are cataloged and prepared for handover to the family with sensitivity. This includes accurate and timely completion of all required paperwork, such as the death notification form and handover documentation for the mortuary, and ensuring respectful transfer of the deceased to the appropriate location.
In addition to caring for the patient and family, I would also attend to the needs of the ward team, particularly the nurses who have been providing intense care for Mrs. Rossi over the past weeks and may be feeling the emotional impact of her passing, and perhaps the junior surgical doctors who were closely involved in her care. The death of a patient, especially one who has been under our care for a prolonged period, can be emotionally impactful for staff, and providing a supportive environment for colleagues to process their emotions is vital. This might involve offering a brief debriefing session for the team, providing a space for quiet reflection in the staff room, and ensuring team members have access to appropriate support services like employee assistance programs or peer support groups if needed.

In essence, my approach to managing patient death, especially in the complex and often emotionally taxing surgical environment, is guided by unwavering principles of compassion, dignity, respect, and adherence to protocol, comprehensively encompassing the needs of the deceased patient, their grieving family, and the often-affected healthcare team.

18. How do you ensure that you maintain good working relationships with your senior colleagues?

Maintaining positive working relationships with senior colleagues, such as surgical consultants, senior registrars, and the ward’s Nurse Unit Manager, is essential for effective teamwork, optimal patient care, and a harmonious ward environment, particularly on a busy surgical ward like the trauma and emergency surgery unit. My approach focuses on proactive communication, consistent demonstration of respect for their extensive experience and leadership, and a collaborative spirit in all interactions.

Firstly, I prioritize clear, concise, and respectful communication in all interactions, especially in the fast-paced surgical setting. This involves providing timely and accurate updates on patient status, ensuring my patient handovers are thorough and focused, seeking clarification promptly when unsure of surgical orders or protocols, and communicating any concerns or potential issues proactively and professionally, always using SBAR communication techniques for structured and efficient information exchange. I ensure my communication is always respectful of their very demanding time and workload, being concise and focused in my interactions, and using pagers and phone calls judiciously and only for essential matters.
Secondly, I consistently demonstrate deep respect for their vast surgical expertise and leadership within the surgical team. I actively and attentively listen to their guidance and advice during ward rounds, post-operative reviews, and surgical planning meetings, recognizing their wealth of clinical knowledge and surgical expertise honed over many years of practice. When seeking input or making suggestions, I do so respectfully, acknowledging their senior role and framing my contributions as collaborative efforts to enhance patient care and improve surgical outcomes, ensuring my suggestions are always evidence-based and patient-focused.

Furthermore, I aim to be a reliable, proactive, and supportive team member, consistently demonstrating a willingness to contribute to the smooth running of the ward and ease the workload for senior colleagues whenever possible. This includes being flexible and adaptable when surgical priorities shift suddenly, readily assisting colleagues, including senior doctors, with tasks when needed, and proactively seeking out opportunities to take initiative and contribute positively to the team’s goals, for instance, by preparing complex discharge summaries or proactively coordinating equipment for upcoming surgical procedures. I also value actively seeking constructive feedback from senior colleagues and consistently acting upon it to improve my surgical nursing practice. This demonstrates a commitment to continuous professional development and a genuine willingness to learn and grow from their extensive surgical experience and mentorship.

Finally, consistently fostering a positive, professional, and courteous demeanor in all interactions, even during stressful periods in the OR or during demanding post-operative patient management, contributes significantly to building and maintaining good working relationships. Maintaining a respectful, courteous, and collaborative attitude, even in challenging high-pressure surgical situations, helps build trust and strong rapport with senior colleagues over time, fostering a cohesive and high-performing surgical team. In essence, my strategy for maintaining good working relationships with senior surgical colleagues is firmly based on proactive, respectful, and concise communication, consistent demonstration of respect for their expertise and leadership, a genuinely collaborative approach to patient care, a proactive willingness to learn and improve, and a consistently professional and courteous attitude, all essential elements for success in a demanding surgical environment.

19. What measures will you put in place if a patient is anxious and wants to be visited by family when there are currently no visitors allowed in the hospital?

If a patient, such as an elderly patient recovering from hip surgery who is feeling particularly lonely and isolated, were to become anxious and express a strong desire for family visits when hospital visitor restrictions are in place due to a recent local surge in respiratory infections, my priority would be to acknowledge and validate their anxiety and explore all possible avenues to safely facilitate connection with their family while rigorously adhering to hospital policy and strict infection control guidelines, especially on the post-operative ward.
Firstly, I would listen empathetically to the patient’s concerns, acknowledging their anxiety and distress at being separated from family, particularly during their post-operative recovery, validating their feelings of loneliness and isolation and explaining the rationale behind the visitor restrictions in a clear and compassionate manner, emphasizing patient safety and the need to protect vulnerable post-surgical patients from potential infection exposure as the primary drivers for the policy. I would then explore alternative methods of connection with the patient and their family, proactively offering practical solutions to bridge the communication gap. This would include proactively facilitating virtual visits using the ward’s dedicated tablet devices or assisting the family in setting up video calls on their personal smartphones, ensuring both the patient and family are comfortable with the technology and assisting with setup and providing any necessary technical support if needed.

If virtual visits are not sufficient to alleviate the patient’s distress, I would investigate the possibility of limited, exceptions-based visits depending on University Medical Center’s current visitor policy and the specific extenuating circumstances. This might involve liaising with the ward manager or infection control team to explore options for compassionate exceptions, particularly for patients who are very distressed, cognitively impaired, struggling with disorientation due to lack of familiar faces, palliative, or facing significant emotional challenges due to the prolonged visitor restrictions. If a limited visit is deemed possible and approved as a compassionate exception, I would meticulously ensure strict adherence to all infection control measures, emphasizing to the family the absolute necessity of pre-screening visitors for symptoms, strictly limiting visit duration to a short period and the number of visitors to one designated family member only, ensuring mandatory and correct mask-wearing throughout the visit and scrupulous hand hygiene before and after, and designating a safe visiting area, perhaps the patient’s private room or a designated area away from other patients, to minimize any potential infection risk to other vulnerable post-surgical patients on the ward.

Furthermore, to supplement the limited family connection and address the patient’s anxiety, I would enhance my own nursing presence and support for the patient to actively mitigate their feelings of isolation and anxiety during this visitor restriction period. This might involve intentionally spending extra time with the patient during my shift, offering frequent reassurance and emotional support, proactively engaging in conversation beyond just clinical tasks, and providing diversional activities such as reading aloud, listening to music, or assisting with simple cognitive stimulation activities to alleviate loneliness and boredom in the absence of family visits. I would also ensure the patient is aware of and has access to other hospital support services, such as the hospital chaplaincy for spiritual support or the volunteer patient companionship program, if their anxiety and emotional distress are significant and require additional resources.

In essence, my comprehensive approach would be to carefully and compassionately balance the patient’s very real emotional and social needs with the absolutely critical need for stringent infection prevention and adherence to hospital policy during visitor restrictions, exploring all safe and policy-compliant avenues to facilitate some form of family connection, however limited, while simultaneously maximizing my own supportive nursing presence and diligently utilizing available hospital resources to effectively alleviate the patient’s anxiety and feelings of isolation during a challenging time.

20. What would you do if a family member is constantly coming up to you with questions and is disrupting your planned work activities?

If a family member, such as Mrs. Rodriguez, the daughter of a patient recovering from a complex liver resection, were to frequently approach me with questions, understandably seeking detailed information about her father’s post-operative progress and prognosis, but in doing so was consistently disrupting my planned work activities on the busy hepatobiliary surgical ward and potentially impacting my ability to efficiently attend to other patients also requiring complex post-operative care, my response would prioritize skillfully balancing compassionate and empathetic communication with Mrs. Rodriguez with the absolute need for effective time management and ensuring equitable and safe delivery of care for all my assigned patients on the ward.

Firstly, I would acknowledge Mrs. Rodriguez’s understandable anxiety and very valid desire for frequent and detailed information about her father’s condition with empathy, patience, and a professional demeanor. Recognizing that her repeated questions and anxious approaches likely stem from deep concern and love for her seriously ill father post-major surgery, I would start by reaffirming my complete commitment to providing regular updates to her and answering all of her questions thoroughly and transparently, but also gently explaining my responsibility to ensure all patients under my care receive timely and attentive nursing, especially on a high-acuity surgical ward.
I would then proactively establish a structured and mutually agreed upon communication plan with Mrs. Rodriguez to effectively manage her very understandable need for information without inadvertently disrupting the crucial ongoing care delivery to all patients on the surgical ward. This might involve scheduling a designated time each day, perhaps after my initial morning medication round and patient assessments are complete, or during a quieter period mid-morning before surgical procedures begin, to provide Mrs. Rodriguez with a comprehensive and uninterrupted update on her father’s condition, reviewing his overnight progress, current vital signs, any changes in his surgical plan, and proactively and fully addressing all of her specific questions and concerns in a focused and unhurried manner. I would clearly communicate this agreed-upon communication plan to Mrs. Rodriguez, emphasizing that while I am, of course, always available to address any genuinely urgent or acutely concerning issues that arise, scheduling a specific, dedicated time for more detailed updates and in-depth question-and-answer sessions will ultimately allow me to provide her with my undivided attention and ensure I can also efficiently and effectively manage the complex care needs of all my other post-surgical patients on the ward, maintaining safety and optimal care for everyone.

In the interim, when approached by Mrs. Rodriguez outside of these scheduled, pre-arranged communication times for non-urgent queries or simply for reassurance, I would provide brief, compassionate, and reassuring updates, offering a few key pieces of information about her father’s immediate status, and then politely and gently redirect her to our agreed-upon dedicated communication time, reiterating my commitment to addressing all of her questions fully and comprehensively at that scheduled point in the day. For example, I might say, Mrs. Rodriguez, I understand you have more questions about your father, and I absolutely want to answer them all for you thoroughly and thoughtfully. To make sure I can give you my full attention without any interruptions, and also ensure I can effectively and safely attend to all of my other patients’ complex needs at this busy time, let’s plan to talk in more detail and go through all of your questions together at agreed time, around 10:30 am, how does that sound?

In the meantime, please be assured that your father is stable and resting comfortably, and I will, of course, contact you immediately if there are any urgent changes in his condition before then. Furthermore, recognizing the high level of anxiety and informational needs in this particular situation, particularly given the complexity of a liver resection and the potential for post-operative complications, if Mrs. Rodriguez’s anxiety or her need for frequent reassurance and detailed information is exceptionally high or continues to escalate, or if her frequent interruptions, despite the structured communication plan, are still significantly impacting overall ward workflow and potentially compromising patient safety or equitable care delivery, I would proactively and promptly involve other key members of the healthcare team, such as the charge nurse for ward management support, the surgical consultant to directly address complex medical questions and prognosis, the patient liaison nurse to facilitate enhanced family communication and support, or the hospital social worker to provide additional emotional support and coping strategies for Mrs. Rodriguez and her family, to develop a more robust and comprehensive communication and support strategy that effectively addresses Mrs. Rodriguez’s understandable needs while simultaneously safeguarding the efficient and equitable delivery of safe and high-quality surgical nursing care to all patients on the ward. This collaborative and multidisciplinary team approach ensures that Mrs. Rodriguez’s needs are fully met with empathy and compassion.

21. Your patient becomes visibly upset when told she can be discharged. How would you deal with this situation?

“If a patient becomes visibly upset upon hearing about their discharge, particularly after a significant surgical procedure like a total knee replacement, my immediate response would be to recognize and validate their emotional reaction. Discharge can evoke a range of feelings – relief, certainly, but also anxiety, fear, and a sense of loss of security, especially after a period of intensive hospital care. Therefore, I would first ensure we are in a private and comfortable setting, away from the busier ward environment, to allow the patient to express their feelings openly without feeling self-conscious. I would then actively listen to their concerns, asking open-ended questions like, “I can see you’re feeling upset about your discharge, can you tell me what’s making you feel this way?” or “What are your biggest worries about going home?” It’s crucial at this stage to truly hear and understand their specific anxieties. Perhaps they are worried about managing pain at home, unsure about wound care, anxious about mobility, or simply feel unprepared to leave the security of the hospital environment after their knee replacement surgery.

Based on their expressed concerns, I would then tailor my response to address each specific point. If their anxiety stems from pain management, I would reiterate the discharge pain plan in detail, reviewing the prescribed medications, dosages, and administration schedule, ensuring they have a clear written pain management plan and understand how to access pain relief at home, perhaps even providing a demonstration of effective pain management techniques and ensuring they have adequate supplies of medication on discharge. If their concern is wound care, I would thoroughly review wound care instructions, both verbally and in writing, ensuring they, or their caregiver, are confident in performing dressing changes and know the signs and symptoms of infection to watch for and who to contact if concerned. If mobility is a worry, I would recap their current mobility status, review their physiotherapy plan for home, ensure they have any necessary mobility aids like crutches or a walker organized, and connect them with community-based physiotherapy or occupational therapy services if required for ongoing rehabilitation after their knee replacement.

Crucially, I would also assess their level of social support at home. If they live alone or have limited support, I would proactively involve our hospital social work team to ensure appropriate support services are in place for a safe and successful discharge, such as home health nursing visits or community support programs for patients recovering from orthopedic surgery. Throughout this conversation, I would consistently offer reassurance and positive reinforcement, emphasizing their progress throughout their hospital stay, highlighting their achievements in recovery post-surgery, and empowering them to feel confident and capable of managing at home with the resources and support we are providing.

Ultimately, my goal is to transform their anxiety into confidence by directly addressing their individual concerns, providing comprehensive discharge education and planning, ensuring adequate support networks are in place, and fostering a sense of empowerment as they transition back home after their knee replacement surgery and hospital stay.”
22. What measures will you put in place if a patient is really anxious and wants to be visited by family when there are currently no visitors allowed in the hospital?

“If a patient, such as a younger patient undergoing cancer treatment who is feeling intensely isolated and emotionally distressed, were to become really anxious and express a strong desire for family visits when hospital visitor restrictions are unfortunately still in place due to ongoing public health concerns regarding a new variant of COVID-19, my priority would be to acknowledge and deeply validate their anxiety and explore absolutely every possible and safe avenue to facilitate meaningful connection with their family, whilst rigorously adhering to the necessary hospital policy and infection control guidelines.
Firstly, and most importantly, I would prioritize empathetic and compassionate listening, deeply validating the patient’s understandable anxiety and profound distress at being separated from their family, especially during a stressful and emotionally challenging time like cancer treatment, clearly and sensitively explaining the rationale behind the very difficult visitor restrictions, emphasizing patient safety, protection of all vulnerable patients on the oncology ward, and wider public health concerns as the absolute drivers for maintaining the policy. I would then immediately and proactively explore every single alternative method of facilitating connection with their family that is safe, practical, and emotionally meaningful for the patient and their loved ones, going above and beyond standard options. This would certainly include proactively facilitating and maximizing frequent and extended virtual visits using the ward’s dedicated tablet devices or ensuring family have support to set up reliable video calls on their personal devices, providing technical assistance as needed and proactively scheduling these virtual visits at times convenient for both the patient and their family, making these calls a regular and anticipated part of their day.

Beyond standard virtual visits, I would also actively investigate and advocate for any possibility of more creative and compassionate solutions to enhance family connection within the constraints of the visitor policy. This might include exploring the potential for window visits if the patient’s room allows, carefully coordinated outdoor socially distanced visits in a designated hospital garden area if the patient is well enough to mobilize, or even facilitating pre-arranged phone calls with family during specific times when the patient knows to expect the call and can have dedicated quiet time to connect. I would also strongly advocate for consideration of a compassionate, exceptions-based in-person visit with the ward manager and infection control team, meticulously exploring the possibility, particularly if the patient’s emotional distress is overwhelming, they are facing a significant emotional or psychological challenge due to isolation, or if their clinical condition is deteriorating and family presence is deemed crucial for emotional well-being, even if a full in-person visit is not possible.
If any form of limited in-person visit is exceptionally approved as a compassionate exception, I would ensure meticulous and uncompromising adherence to the strictest infection control measures, working closely with the family to ensure they fully understand and commit to pre-screening for symptoms, strictly limiting the visit to a very short duration and to only one essential family member, ensuring mandatory and correct use of enhanced PPE including N95 masks and gowns, rigorous hand hygiene, and designating a completely safe and isolated visiting area, such as a negative pressure isolation room if available, or a carefully designated area away from all other patients, to absolutely minimize any potential infection risk to the patient and to all other vulnerable individuals in the hospital.

Crucially, alongside exploring all these avenues for family connection, I would also significantly enhance my own nursing presence, emotional support, and therapeutic communication with the patient to actively combat their feelings of isolation and profound anxiety during this challenging visitor restriction period. This would mean intentionally dedicating even more time to spend with the patient, offering frequent and genuine reassurance and empathetic listening, proactively engaging in meaningful conversations beyond just routine care tasks, actively assessing their emotional state and mental well-being, and providing a range of diversional activities tailored to their interests, such as reading aloud, playing calming music, facilitating access to online mindfulness or relaxation resources, or simply offering quiet companionship and a consistent, reassuring presence to alleviate their distress and feelings of profound loneliness in the enforced absence of physical family visits.
I would also ensure the patient is comprehensively assessed for and has immediate access to other essential hospital support services, such as referral to the oncology social work team for specialized psychosocial support, consultation with the hospital chaplaincy for spiritual comfort if desired, or referral to the psychology team for further assessment and management of their anxiety and distress, ensuring a truly holistic and patient-centered approach to managing this very difficult situation. In essence, my comprehensive and compassionate approach would be to meticulously balance the patient’s critical emotional and social needs with the absolute imperative of stringent infection prevention and adherence to hospital policy during visitor restrictions, tirelessly exploring and advocating for every safe and policy-compliant option to maximize family connection and alleviate isolation, whilst concurrently maximizing my own enhanced supportive nursing presence and diligently utilizing all available hospital resources and multidisciplinary team expertise to effectively manage the patient’s very understandable anxiety and profound emotional distress in this exceptionally challenging and isolating situation.”

23. Tell us about a time when you were unable to do what you said you would do.

“There have been inevitable instances in my nursing practice where, despite my best intentions, I was unable to fulfill a commitment exactly as initially planned. One example occurred during a particularly busy shift on the surgical admissions unit. I had promised a newly admitted patient, Mrs. Davies, who was quite anxious and awaiting urgent appendectomy surgery, that I would personally ensure her family was updated immediately after her surgery and that I would call them within an hour post-operatively to give them an update and reassure them.

However, shortly after Mrs. Davies went to the theatre, we experienced a sudden influx of emergency admissions, including a major trauma patient requiring immediate resuscitation and a patient with a suspected perforated bowel needing urgent surgical intervention. Managing these critical emergencies, coordinating care, and ensuring patient safety became the absolute priority, demanding my full and immediate attention, as well as the attention of the entire nursing team. In the midst of managing these critical situations, and with the shift becoming increasingly demanding, I unfortunately realized that more than an hour had passed since Mrs. Davies’ surgery, and I had not yet been able to contact her family as I had promised. As soon as the immediate emergencies were stabilized and patient care was safely handed over, I immediately recognized my oversight and the unmet commitment to Mrs. Davies’ family.

My first action was to promptly contact Mrs. Davies’ family myself, sincerely apologizing for the delay in communication and explaining honestly and transparently the unforeseen emergency circumstances on the unit that had understandably diverted my immediate attention. I provided them with a comprehensive update on Mrs. Davies’ surgery and her immediate post-operative condition, reassuring them that she had come through the procedure well and was stable in recovery. I also made sure to personally visit Mrs. Davies in the recovery area as soon as possible after contacting her family, explaining the situation to her directly, and again sincerely apologizing for not being able to update her family as promptly as I had initially intended. I ensured she was comfortable, reassured her surgery had been successful, and reiterated that her family had now been updated and were relieved.
To prevent similar situations in the future, I reflected on this incident and recognized the importance of robust time management and contingency planning, particularly in a fast-paced and unpredictable environment like surgical admissions. Since then, I have implemented strategies such as setting timely reminders and prioritizing communication tasks even during busy periods, and also, importantly, proactively communicating potential delays or changes in plans to patients and families as early as possible when unforeseen circumstances arise, rather than waiting until after a commitment is missed. This experience underscored the importance of honesty, accountability, and proactive communication in managing unavoidable deviations from planned commitments, and the critical need for robust time management strategies, particularly in demanding and unpredictable surgical nursing settings, while always prioritizing patient and family well-being and clear communication.”

24. How do you think the role of the nurse differs between India and England?

“Based on my understanding and research, and considering the experiences of colleagues who have practiced in both India and England, there are several key differences in the nursing role between these two countries, particularly in areas such as drug names and administration, nurses’ paperwork and documentation, working hours and staffing ratios, and the approach to reflective practice. Regarding drug names, a significant difference lies in the common use of generic drug names in India versus the more prevalent use of branded drug names in England. This requires nurses transitioning between these systems to develop familiarity with both generic and brand names to ensure safe medication administration and prevent errors.
Additionally, the availability and range of certain medications and formulations may differ, necessitating adaptation to local formularies and prescribing practices in each country. In terms of nurses’ paperwork and documentation, while both countries emphasize thorough and accurate record-keeping, there can be variations in the specific documentation systems and formats used. England predominantly utilizes electronic health record systems, whereas paper-based documentation may still be more prevalent in some settings in India.

Furthermore, the specific details and level of granularity required in nursing documentation may differ, reflecting variations in legal and professional standards and healthcare system structures between the two countries. Concerning working hours and staffing ratios, while both countries face pressures on nursing resources, there are often notable differences in typical nurse-to-patient ratios and average working hours. Anecdotally, staffing ratios may be more challenging in some settings in India, potentially leading to heavier workloads and different time management demands compared to the UK context, where there are more regulated staffing guidelines, although pressures still exist.
Finally, regarding using reflection to learn from practice, while reflection is increasingly recognized as a valuable tool for professional development in nursing globally, the formal emphasis and integration of reflective practice into routine nursing workflows and continuing professional development may vary. Reflective practice is highly emphasized and structurally integrated into nursing professional development and registration requirements in England, whereas the formal implementation and cultural integration of reflective practice may be at different stages of development within nursing in India. Despite these differences, the core values of nursing – patient safety, compassionate care, and professional commitment – remain consistent across both India and England. Nurses in both countries are dedicated to providing high-quality care within their respective healthcare systems, and the key for nurses transitioning between these systems is adaptability, a willingness to learn and embrace new protocols and practices, and a commitment to providing culturally competent and patient-centered care within the specific context of their practice setting.”

25. Do you keep up to date about changes in healthcare/ Medicine?

“Absolutely, proactively keeping up to date with changes in healthcare and medicine is a fundamental aspect of my professional commitment as a surgical nurse. Given the constantly evolving nature of healthcare, particularly in surgical specialties with rapid advancements in techniques and technologies, continuous learning is not just beneficial but essential for providing the best possible patient care. I employ several strategies to stay current. Firstly, I regularly engage with peer-reviewed nursing and medical journals, specifically those focused on surgical nursing and my areas of specialization, such as the Journal of Perioperative Nursing and the British Journal of Surgery. I make it a habit to review the table of contents and relevant articles to stay informed about new research findings, evolving best practices, and advancements in surgical procedures and post-operative care protocols.

Secondly, I actively participate in continuing professional development (CPD) activities, both within and outside of the hospital. This includes attending hospital-sponsored in-service training sessions on new surgical techniques or updated infection control guidelines, participating in online webinars and e-learning modules on surgical nursing topics, and attending relevant surgical nursing conferences and workshops when possible, such as those organized by the Royal College of Nursing or specialist surgical nursing societies. I meticulously maintain my CPD portfolio, ensuring I meet all revalidation requirements and proactively seeking out learning opportunities to enhance my knowledge and skills.

Furthermore, I actively engage with professional online resources and platforms relevant to surgical nursing, such as reputable websites for surgical nursing organizations, evidence-based practice databases like Cochrane Library and NICE guidelines, and professional nursing forums and discussion groups where I can engage with colleagues and learn about emerging trends and best practices. I also make it a practice to discuss new developments and research findings with colleagues and senior surgical staff during ward-based meetings or informal learning opportunities, fostering a culture of continuous learning within the team and ensuring we are collectively informed about the latest advancements impacting our practice.

Finally, I am always receptive to feedback and actively seek opportunities to reflect on my practice and identify areas for improvement, viewing every clinical experience as a learning opportunity and using reflective practice techniques, such as structured reflection using Gibbs’ Reflective Cycle, to analyze my performance, identify knowledge gaps, and proactively seek out information to address them. This proactive and multifaceted approach to continuous learning ensures I remain up-to-date with changes in healthcare and medicine, allowing me to consistently provide evidence-based and high-quality surgical nursing care.”

26. Give a recent example of how you have tried to improve your performance.

“A recent example of my proactive approach to performance improvement centers around enhancing my skills in managing post-operative delirium in elderly surgical patients, a common and challenging issue on the surgical ward for older adults where I previously worked. Recognizing that delirium significantly impacts patient outcomes, increases length of stay, and causes distress for both patients and families, I identified this as an area where I could enhance my practice to improve patient care.

Initially, I undertook a period of self-directed learning, reviewing the hospital’s clinical guidelines on delirium prevention and management, researching current best practices and evidence-based interventions in reputable nursing journals like the Age and Ageing Journal and online resources such as the National Institute for Health and Care Excellence (NICE) guidelines on delirium. I focused specifically on non-pharmacological strategies for delirium prevention and management, such as cognitive stimulation, re-orientation techniques, sleep hygiene promotion, and early mobilization, recognizing the importance of these approaches in minimizing medication use, particularly in elderly patients.

Following this self-education phase, I actively sought opportunities to put my new knowledge into practice on the ward. I focused on proactively implementing non-pharmacological delirium prevention strategies for my elderly post-operative patients, such as initiating regular reality orientation, engaging patients in cognitive activities during bedside care, and advocating for early and consistent mobilization with physiotherapy colleagues. I also consciously focused on improving my delirium assessment skills, utilizing validated assessment tools like the Confusion Assessment Method (CAM) more systematically and diligently to identify early subtle signs of delirium in my patients.

Furthermore, I actively sought feedback from senior nurses and the geriatric medicine consultant on the ward regarding my approach to delirium management, asking for specific guidance on how I could further refine my assessment and intervention skills and incorporating their expert advice into my daily practice. I also shared my learning and newly acquired skills with my nursing colleagues during ward handovers and informal discussions, aiming to disseminate best practices within the team and encourage a more proactive and consistent approach to delirium prevention and management across the ward. Finally, to formally evaluate the impact of my focused efforts, I began informally tracking relevant patient outcomes related to delirium in my patient cohort, noting instances of delirium onset, duration, and the effectiveness of implemented non-pharmacological interventions. While this was not a formal audit, it allowed me to reflect on my practice and identify areas for further refinement and ongoing learning. This proactive approach to self-education, practical application, seeking feedback, sharing knowledge, and informally monitoring outcomes demonstrates my commitment to continuous performance improvement and enhancing patient care in a complex area like post-operative delirium management in the surgical setting.”

27. You are on the ward and find a patient unresponsive. What would you do?

“Finding a patient unresponsive on the ward immediately triggers a critical emergency response, prioritizing rapid assessment, summoning help, and initiating basic life support according to established protocols. My immediate first action upon discovering an unresponsive patient, for example, Mr. Jones in bed 5, would be to immediately and loudly call for help, activating the ward emergency buzzer or shouting for colleagues to alert the wider team to the emergency situation unfolding. Simultaneously, while calling for help, I would immediately assess the patient’s airway, breathing, and circulation (ABC). This rapid primary survey involves checking for responsiveness by attempting to rouse the patient verbally and tactilely, opening the airway using a head-tilt chin-lift maneuver (unless contraindicated by suspected spinal injury), checking for breathing by looking, listening, and feeling for chest movement and breath sounds, and assessing for circulation by checking for a carotid pulse.

Based on my ABC assessment, I would then initiate appropriate basic life support interventions immediately. If the patient is not breathing but has a pulse, I would commence rescue breaths, administering breaths at the appropriate rate and depth. If the patient is not breathing and has no pulse, I would immediately commence chest compressions, initiating cardiopulmonary resuscitation (CPR) at the correct rate and depth, ensuring effective chest compressions are delivered in line with current resuscitation guidelines. Throughout this initial response, I would continually reassess the patient’s ABCs and adapt my interventions accordingly.

While initiating basic life support, I would ensure that someone else has already called the hospital emergency response team – often designated as the ‘Code Blue’ team or medical emergency team (MET) – providing them with the patient’s location, ward, and a concise summary of the situation and the patient’s condition, stating “unresponsive patient in bed 5, surgical ward, no pulse, CPR in progress”. Once the emergency response team arrives, I would immediately provide a clear and concise handover, detailing the patient’s presenting condition, my initial assessment findings, and the interventions already undertaken, including any basic life support measures initiated and vital signs if obtainable. I would then actively assist the emergency response team as directed, providing support during advanced resuscitation efforts, including medication administration, airway management, and further assessments, acting as a runner, documenting events as they unfold, and providing any assistance needed to optimize the resuscitation attempt.

Following the immediate resuscitation phase, regardless of the outcome, I would ensure thorough documentation of the entire event, including the time of unresponsiveness, initial assessment findings, interventions performed, the arrival time of the emergency response team, the subsequent management, and the patient’s outcome, whether successful resuscitation, transfer to a higher level of care such as ICU, or unfortunately, confirmation of death. This documentation is crucial for accurate patient records, for communication within the healthcare team, and for potential review and learning from the event. In essence, my response to finding an unresponsive patient would be immediate, decisive, and protocol-driven, focused on rapid assessment, summoning expert help, initiating life-saving basic life support measures without delay, and providing seamless handover and assistance to the emergency response team to maximize the patient’s chances of a positive outcome.”

28. As an overseas nurse, you have experience giving IV fluids in a previous role. It is your first week in the clinical area in the UK, and you mentioned this to your colleagues. You have been asked to administer IV meds, take us through the process of what you will do. (new to UK, not in my role to give medication)

“Despite having prior experience administering intravenous fluids and medications in my previous nursing role in India, and even though I may have mentioned this experience to colleagues, upon being asked to administer IV medications in my first week in a UK clinical setting on the vascular surgical ward, my absolute priority would be to strictly adhere to UK hospital protocols and scope of practice for medication administration, recognizing that these may differ significantly from my previous experience, and ensuring patient safety is paramount.
Therefore, my first step, before even considering medication administration, would be to immediately and clearly clarify my scope of practice and confirm my competency to administer IV medications within the UK context with my supervising nurse or the nurse in charge on the ward. I would explicitly state that while I have prior experience with IV medication administration from my overseas practice, I am very new to the UK healthcare system and need to confirm the local protocols and my authorized scope of practice within this new setting, emphasizing my commitment to safe and compliant practice. Assuming I am confirmed as appropriately registered with the Nursing and Midwifery Council (NMC) in the UK and that my competency to administer IV medications is verified as within my current scope of practice under supervision in this initial period, my next step would be to thoroughly familiarize myself with the specific UK hospital’s medication administration policy and guidelines for intravenous medications. This would involve carefully reviewing the ward’s medication administration protocols, specifically focusing on IV medication administration, including any local guidelines on medication checking procedures, documentation requirements, and compatibility guidelines for intravenous infusions, and ensuring I understand any specific policies related to my role as a newly registered overseas nurse within the UK system.

Prior to administering any specific IV medication, I would then meticulously verify the medication prescription against the patient’s medication chart and the original prescriber’s orders, ensuring all ‘rights’ of medication administration are meticulously checked and double-checked: right patient, right drug (using both brand and generic name to cross-reference, being mindful of potential differences from Indian drug names), right dose, right route (IV route specifically confirmed), right time, and right documentation requirements according to UK standards. I would pay particular attention to confirming drug dosages and concentrations, recognizing that medication formulations and strengths can vary between countries, and ensuring I am using the correct UK-specific preparations and dosage calculations.

Before preparing the IV medication, I would also confirm compatibility with any existing intravenous infusions the patient is receiving, and double-check the correct diluent and rate of administration for the specific IV medication as per UK guidelines and the prescription, consulting the hospital’s IV drug compatibility resources and pharmacy guidelines if needed to clarify any uncertainties. For the actual administration process, I would gather all necessary equipment, including appropriate sized syringes and needles for IV administration according to UK sharps safety guidelines, alcohol swabs for aseptic technique, and appropriate IV giving sets and infusion pumps if required for rate-controlled infusion, ensuring all equipment is UK-standard and compliant with local safety regulations. Using strict aseptic technique, I would prepare the medication in a clean environment, carefully drawing up the correct dose and double-checking the medication label against the prescription once again. Immediately prior to administration, I would re-identify the patient using at least two patient identifiers as per UK hospital policy, confirming patient name and hospital number against the medication chart and patient wristband, and verbally confirming patient allergies before proceeding.

I would then explain the medication and its purpose to the patient, addressing any questions or concerns they may have, ensuring they understand what medication they are receiving and why, in line with UK patient consent and information sharing guidelines. Following administration, I would meticulously and promptly document the medication administration in the electronic patient record according to UK nursing documentation standards, including the drug name, dose, route, time, and my signature and NMC registration number as a UK-registered nurse, noting any patient response or observations, and ensuring all documentation is fully compliant with UK legal and professional requirements for medication recording.

Throughout this entire process, from initial clarification of scope of practice to final documentation, my overriding focus would be on patient safety and meticulous adherence to UK hospital medication administration policies and professional standards, recognizing that my previous experience in India provides a foundation, but adaptation and rigorous compliance with UK-specific protocols are absolutely essential in my first weeks of practice in this new healthcare system. If at any point I felt unsure or encountered any aspect of the UK medication administration process that was unfamiliar or unclear, I would immediately seek guidance and clarification from a senior UK-registered nurse or the ward pharmacist, prioritizing patient safety above all else and recognizing the importance of asking questions and seeking support when working within a new and complex healthcare system.”

29. You observe that one of the doctors undertaking ward rounds had not washed his hands and is wearing a watch. What action would you take?

“Observing a doctor on ward rounds not washing their hands and wearing a watch, both being breaches of fundamental infection prevention protocols, would require immediate and appropriately assertive yet respectful action, prioritizing patient safety above all else. My initial approach would be to address the situation directly and respectfully with the doctor in a private and discreet manner, focusing on patient safety and established infection control guidelines, using clear and professional communication.

As soon as I observed the lapse in hand hygiene and the watch, I would politely and discreetly approach the doctor, perhaps as they moved away from the patient’s bedside or in a quiet corner of the ward, to ensure privacy and minimize any potential embarrassment. Using a calm and non-confrontational tone, I would clearly and directly communicate my observation and concern, referencing established infection control protocols. For instance, I might say something like, “Excuse me, Doctor, I noticed you were moving between patients and haven’t had a chance to wash your hands just now. Also, I believe ward policy is for all staff to be bare below the elbows during ward rounds for infection control. Perhaps we could just take a moment to use the hand gel before you see the next patient?” or “Doctor, just a quick reminder for infection control, ward policy is for hand hygiene between each patient contact, and also no wristwatches during patient interactions. Could we just ensure we’re both adhering to these guidelines as we continue ward rounds?” This approach is direct and clear in stating the issue, but also respectful and framed as a gentle reminder of established protocols, focusing on patient safety as the shared priority, and offering a practical solution like using hand gel immediately available at most bedsides. The key is to communicate assertively but professionally, avoiding accusatory language and maintaining a respectful tone while clearly addressing the infection control breach. In most situations, a direct and polite reminder from a nursing colleague is usually sufficient to prompt immediate corrective action from a medical colleague, particularly when framed around shared patient safety goals.

However, if, for any reason, the doctor were to dismiss my concern, become defensive, or not take immediate corrective action (i.e., still not perform hand hygiene or remove the watch), then it would be my professional responsibility to escalate the concern to a more senior member of staff according to hospital policy for infection control breaches. This escalation pathway might involve immediately informing the ward’s Nurse in Charge or the ward manager, clearly explaining the situation, the observed breach of infection control protocols, and the doctor’s lack of response to my direct and polite intervention. Escalation is a crucial step when direct communication is ineffective in addressing a patient safety risk. The senior nurse or ward manager would then be responsible for addressing the issue further with the doctor, potentially involving senior medical staff or the infection control team if necessary, ensuring appropriate action is taken to rectify the breach and reinforce infection control standards. Documentation of the incident may also be required as per local hospital policy, particularly if escalation is needed.
In summary, my action would be to initially address the issue directly and respectfully with clear communication focused on patient safety and adherence to protocol, but to escalate appropriately and promptly if the direct intervention is not effective in ensuring immediate corrective action, ultimately prioritizing patient safety and upholding infection control standards as paramount.”

30. Tell us about the biggest change that you have had to deal with. How did you cope with it?

“The biggest professional change I’ve had to navigate in my nursing career was transitioning from a very busy, high-acuity surgical unit in a large metropolitan hospital in India to a smaller, more specialized surgical center in a rural area in the UK. This transition encompassed a significant shift in not only the healthcare system and practice environment but also cultural and social adjustments. In my previous role at Apollo Hospital in Chennai, I was accustomed to a fast-paced, resource-intense environment managing a high volume of complex surgical patients, often with limited resources and high patient-to-nurse ratios. The ward was constantly dynamic, demanding rapid decision-making, efficient task management, and adaptability to unpredictable emergency situations.

Upon moving to the UK to work at the Royal Cornwall Hospitals NHS Trust, while the core nursing principles remained the same, the practice environment was markedly different. The surgical center, while providing excellent care, was smaller and served a more geographically dispersed, rural population. Staffing ratios were more structured and supportive, resources were more readily available, and the pace, while still demanding, was generally less frenetic than what I was used to. Culturally, I had to adapt to a new healthcare system, different communication styles, and a new social environment. Initially, I experienced a period of adjustment and culture shock. While I welcomed the improved resources and more structured environment in the UK, I initially missed the fast-paced dynamism and the strong sense of camaraderie I had developed with my team in India. I also had to actively learn and adapt to new UK-specific protocols, medication administration practices, electronic health record systems, and communication norms within the UK healthcare setting, which required a period of focused learning and adaptation. To cope with this significant change and ensure a successful transition, I employed several key strategies.

Firstly, I embraced a proactive and positive mindset, viewing the change as an opportunity for professional growth and expanding my nursing skills in a new healthcare context. I approached the transition with openness and a willingness to learn and adapt. Secondly, I actively sought out mentorship and support from senior nurses and colleagues in my new UK workplace. I proactively built relationships with my team, asking questions, seeking advice and guidance, actively participating in ward-based training and orientation programs, and readily accepting constructive feedback from my UK colleagues. This proactive approach to seeking support was invaluable in navigating the initial learning curve and feeling integrated into the new team.
Thirdly, I focused on active listening and observation in my new environment. I paid close attention to how senior colleagues practiced, how communication flowed within the UK team, and absorbed the nuances of the UK healthcare system by being a keen observer and listener in my first few months. This helped me quickly understand and adapt to the subtle differences in practice and communication styles. Furthermore, I made a conscious effort to connect with colleagues both professionally and personally, building relationships and fostering a sense of belonging within the new team. Participating in team social activities, showing genuine interest in getting to know my colleagues, and actively contributing to a positive team environment all helped me feel more settled and supported in my new workplace.

Finally, I maintained a commitment to reflection and continuous learning throughout the transition. I regularly reflected on my experiences, identifying areas where I was adapting well and areas where I still needed to develop my skills or understanding of the UK system. This reflective approach allowed me to proactively target my learning and continuously improve my performance and integration into the new environment. In summary, coping with this significant change required a combination of proactive adaptation, seeking support and mentorship, keen observation and learning, building strong team relationships, and a commitment to continuous reflection and professional growth. While initially challenging, this transition ultimately proved to be an incredibly enriching experience, broadening my professional perspective and enhancing my adaptability and resilience as a surgical nurse in an international context.”

31. During the medicine round, you can’t find Mr Smith to give him his tablets, you find him in the bath, and he asks you to leave them on the table next to his clothes in the bathroom. What is your next action?

If I were unable to find Mr. Smith during the medicine round and later located him in the bathroom, I would first ensure his privacy and dignity while addressing the medication administration safely. Upon his request to leave the tablets on the table next to his clothes, I would explain to him that, for safety and policy reasons, I cannot leave medication unattended. Instead, I would reassure him that I would return once he had finished in the bathroom to personally administer his medication.

I would take this opportunity to discuss the potential risks associated with leaving medication unattended, such as accidental ingestion by another patient, loss of medication, or possible alterations that could compromise its safety and efficacy. If Mr. Smith expresses concern or reluctance, I would address any issues he may have, ensuring he understands that my primary goal is his safety and well-being.
Additionally, I would document the situation appropriately, noting that the medication was not administered at the initial time due to the patient being in the bathroom and that I would return to complete the process. If necessary, I would also communicate with the wider healthcare team to ensure continuity of care and adherence to medication safety protocols.

32. It’s 6 am, and your colleague is off the ward on her break. An acutely ill patient has just arrived in the ward following surgery, and a patient has just fallen out of bed. What is your next action?

At 6 a.m., while my colleague is on break, I am faced with two critical situations: an acutely ill post-surgical patient arriving on the ward and another patient who has fallen out of bed. Prioritization and effective communication are essential in this scenario to ensure both patients receive appropriate and timely care.

My immediate priority is to assess the condition of the patient who has fallen. I would quickly check for any signs of collapse, injury, or distress while ensuring they are as comfortable as possible. Moving the patient without proper assistance could cause further harm, so I would not attempt to lift them back into bed until help arrives. Instead, I would provide reassurance and conduct an initial set of vital signs to determine their stability.

Simultaneously, I would call for assistance, either from nearby colleagues or, if necessary, by contacting my colleague on break. If additional help is required, I would escalate the situation to ensure adequate staffing support. I would then notify the medical team so that a full assessment of the fallen patient can be carried out promptly.
Once the patient’s immediate needs are addressed, I would ensure the acutely ill post-surgical patient is attended to, coordinating with the appropriate team members to facilitate their safe admission and monitoring. Finally, after both patients are stabilized and their care has been appropriately handed over, I would document the fall incident thoroughly in the incident report, ensuring that all necessary follow-ups, including any preventive measures, are taken to enhance patient safety on the ward.

33. What are your strengths and weaknesses?

One of my key strengths as a surgical nurse is my ability to remain calm and focused under pressure. Working in a high-stakes environment requires quick decision-making, and I am confident in my ability to assess situations rapidly and respond effectively, whether it involves handling post-operative complications, prioritizing patient care, or managing multiple tasks simultaneously. I am also highly organized and detail-oriented, ensuring that medication administration, surgical site monitoring, and patient documentation are accurate and thorough. Additionally, my strong communication skills allow me to work collaboratively with the multidisciplinary team while providing clear explanations and reassurance to patients and their families during what can often be a stressful time for them.

As for weaknesses, I sometimes find it challenging to delegate tasks because I take great responsibility for patient outcomes and want to ensure everything is done correctly. However, I recognize that teamwork is essential in nursing, and I have been actively working on improving my ability to trust colleagues with appropriate tasks to enhance overall efficiency and patient care. I also tend to be highly self-critical, always striving to improve my performance. While this drives me to continuously learn and refine my skills, I am learning to balance self-improvement with recognizing my achievements and maintaining a healthy work-life balance.

34. How would you support an HCSW who is new to healthcare and starting on your ward?

If a Healthcare Support Worker (HCSW) who is new to healthcare joins my ward, I would begin by giving them a warm welcome and introducing them to the team. A supportive and friendly environment is essential in helping new staff feel comfortable and confident in their role. I would take the time to explain the ward’s structure, key personnel, and daily routines to help them understand how the team functions.

To ensure they feel properly oriented, I would give them a tour of the ward and relevant departments, such as the medication room, storage areas, and emergency equipment locations, as well as introduce them to key teams they may need to collaborate with, such as physiotherapists, doctors, and the wider nursing staff. Understanding the layout of the hospital is crucial to helping them navigate their role more efficiently.
I would encourage them to ask questions and remind them that no question is too small. Starting in healthcare can be overwhelming, so I would promote an open and supportive culture where they feel comfortable seeking guidance. I would also emphasize the importance of asking for help when needed, reassuring them that teamwork is essential in providing safe and effective patient care.

Building a good working relationship is also key to their confidence and success. I would treat them with respect, provide constructive feedback, and acknowledge their efforts. By fostering a positive and inclusive environment, I would aim to support their growth and help them feel like a valued member of the team. Regular check-ins and mentorship would further reinforce their learning and development, ensuring they have the necessary support to excel in their role.

35. You are on a night shift, and it is understaffed. You are doing the drug round, and a patient’s prescription chart does not look right to you. What would you do?

During a night shift, especially when understaffed, patient safety remains the top priority. If I come across a prescription chart that does not look right, I would pause before administering any medication and carefully review the prescription to identify the concern. This could include an incorrect dose, a potential drug interaction, an unclear instruction, or a missing signature from the prescribing doctor.
I would then cross-check the patient’s medical records and previous medication history to see if there is any clarification available. If the discrepancy remains unclear, I would immediately escalate the concern by contacting the prescribing doctor or the on-call medical team to verify the prescription before proceeding. It is crucial to ensure that the medication is safe and appropriate for the patient rather than risk administering something that could cause harm.

Additionally, I would inform the nurse in charge of the ward so that they are aware of the issue, and I would document my actions appropriately, including any communications with the doctor and any changes made to the prescription. Even during an understaffed shift, it is essential to adhere to safe medication administration protocols, as patient safety should never be compromised due to workload pressures.

36. You observe your patient laughing with his visitors. When you approach him, he is complaining of pain and asking for analgesia. What would you do and why?

If I observe a patient laughing and engaging with visitors but then complaining of pain and requesting analgesia when I approach, I would respond with a professional and non-judgmental approach. Pain is a subjective experience, and individuals express and tolerate it differently. Some patients may attempt to mask their discomfort in social situations, while others may have fluctuating pain levels.
First, I would assess the patient’s pain using an appropriate pain assessment tool, considering factors such as location, severity, type of pain (e.g., sharp, dull, throbbing), and any aggravating or relieving factors. I would also check their medical records and medication administration charts to review when their last dose of analgesia was given and whether they are due for another dose.

If the patient is within the safe time frame for their next dose and there are no contraindications, I would administer the prescribed analgesia and monitor their response. However, if their pain level seems inconsistent with their condition, or if they are frequently requesting analgesia beyond what is expected, I would consider other factors, such as inadequate pain management, potential medication dependence, or underlying psychological or social influences. In such cases, I would escalate my concerns to the medical team for further evaluation and possible adjustment of their pain management plan.

Regardless of the situation, I would ensure that the patient feels heard and supported, reinforcing that effective pain relief is a priority while maintaining professional judgment and adherence to safe medication practices.

37. Tell us about a time when you were unable to do what you said you would.

There was a time during a particularly busy shift when I assured a patient that I would return within 15 minutes to assist them with personal care. However, shortly after, I was called to an emergency situation involving another patient who had deteriorated rapidly and required immediate intervention. Given the urgency, I had to prioritize the critical patient’s care, which delayed my ability to fulfill my initial commitment.

Once the emergency was under control, I immediately went back to the first patient, apologized sincerely for the delay, and explained the situation. I reassured them that their needs were still important and proceeded to assist them as soon as possible. Fortunately, the patient was understanding, and I made sure to communicate more effectively moving forward, keeping patients informed of any delays and seeking assistance from colleagues when necessary to ensure that all patient needs were met in a timely manner.

This experience reinforced the importance of time management, prioritization, and clear communication with patients. It also highlighted the value of teamwork in ensuring that patient care remains consistent, even during challenging situations.

38. You check the observations for a patient who has presented with confusion and find the following RR 30, HR 125, BP 90/50, Sats 94% RA, T 39.8.

Upon reviewing these observations, I would immediately recognize that the patient is showing signs of potential sepsis or another serious underlying condition requiring urgent intervention. The combination of a high respiratory rate (30), tachycardia (HR 125), hypotension (BP 90/50), and a high temperature (39.8°C) suggests a systemic infection, while the confusion may indicate worsening sepsis or inadequate perfusion to the brain.

My immediate priority would be to escalate the situation by alerting the nurse in charge and the medical team, as this patient requires urgent assessment. I would ensure the patient is in a safe position, provide reassurance, and closely monitor their condition while preparing for further interventions. Given their low blood pressure and high respiratory rate, I would consider placing the patient in a high-observation area and ensuring access to oxygen if their condition deteriorates.

I would also anticipate the next steps, such as obtaining intravenous (IV) access for blood tests, including blood cultures, a full blood count, and lactate levels, as well as the administration of IV fluids and antibiotics as part of the Sepsis 6 protocol. If the patient’s oxygen saturation were to drop further, I would provide supplemental oxygen as needed and continue monitoring vital signs closely.

Finally, I would document all findings and actions taken in the patient’s notes to ensure clear communication with the wider healthcare team and support timely, effective treatment. Prompt recognition and intervention are crucial in preventing deterioration and improving patient outcomes.

39. Mr Smith is a 65 year old gentleman who has been diagnosed with bowel cancer. He is complaining of increasing abdominal pain and nausea. What actions would you take?

If Mr. Smith, a 65-year-old gentleman with a diagnosis of bowel cancer, is experiencing increasing abdominal pain and nausea, my first action would be to conduct a thorough assessment to determine the severity of his symptoms and identify any potential complications.
I would begin by checking his vital signs, including respiratory rate, heart rate, blood pressure, temperature, and oxygen saturation, to assess for any signs of deterioration, such as sepsis, obstruction, or perforation. Additionally, I would evaluate his pain using an appropriate pain assessment tool and assess his nausea severity, asking about any associated symptoms like vomiting, bloating, or changes in bowel habits.

If Mr. Smith has been prescribed analgesia and antiemetics, I would administer them as appropriate, ensuring they are within safe limits. If his current pain management regimen is insufficient, I would escalate my concerns to the medical team to review and potentially adjust his analgesic plan, especially considering the need for stronger pain relief, such as opioids, if indicated.

Given his bowel cancer diagnosis, I would also be vigilant for complications such as bowel obstruction. If I suspect obstruction—evidenced by worsening pain, abdominal distension, absence of bowel movements, or worsening nausea—I would escalate the case urgently to the medical team for further investigation and potential intervention, such as imaging or surgical review.

Throughout the process, I would provide reassurance to Mr. Smith, ensure he is comfortable, and offer non-pharmacological interventions such as adjusting his position or using relaxation techniques. I would also keep his family informed, as appropriate, and document all assessments, interventions, and communications clearly in his medical records to ensure continuity of care.

40. What specialty would you like to work in?

If Mr. Smith, a 65-year-old gentleman with a diagnosis of bowel cancer, is experiencing increasing abdominal pain and nausea, my first action would be to conduct a thorough assessment to determine the severity of his symptoms and identify any potential complications.

I would begin by checking his vital signs, including respiratory rate, heart rate, blood pressure, temperature, and oxygen saturation, to assess for any signs of deterioration, such as sepsis, obstruction, or perforation. Additionally, I would evaluate his pain using an appropriate pain assessment tool and assess his nausea severity, asking about any associated symptoms like vomiting, bloating, or changes in bowel habits.

If Mr. Smith has been prescribed analgesia and antiemetics, I would administer them as appropriate, ensuring they are within safe limits. If his current pain management regimen is insufficient, I would escalate my concerns to the medical team to review and potentially adjust his analgesic plan, especially considering the need for stronger pain relief such as opioids, if indicated.

Given his bowel cancer diagnosis, I would also be vigilant for complications such as bowel obstruction. If I suspect obstruction—evidenced by worsening pain, abdominal distension, absence of bowel movements, or worsening nausea—I would escalate the case urgently to the medical team for further investigation and potential intervention, such as imaging or surgical review.

Throughout the process, I would provide reassurance to Mr. Smith, ensure he is comfortable, and offer non-pharmacological interventions such as adjusting his position or using relaxation techniques. I would also keep his family informed, as appropriate, and document all assessments, interventions, and communications clearly in his medical records to ensure continuity of care.

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