Question

o   you (the charge nurse)

o   ICU staff RN - with 2 years of experience,

o   ICU staff RN - just finished 6-month orientation to the ICU

o   a float RN from oncology unit

o   an unlicensed assistive personnel (UAP) with 1 year of experience in the ICU

topic 1: Using Guidelines for Delegation and Assignment-Making

You are the charge nurse on an intensive care unit (ICU). There are five patients on the unit today. You need to make appropriate assignments. Explain your rationale for each assignment. Include specific instructions that the charge nurse needs to communicate with each staff member regarding their assignment.

Patient #1 - Trauma victim from two days ago, has a C4-5 fracture. Currently in a medically induced coma so the extent of injury is not known. Patient does have endotracheal (ET) tube in place and is on the ventilator.

Patient #2 - Elderly patient who had a cardiac catheterization three hours ago with two vessels stented. There is a continuous heparin drip per protocol. Orders include bedrest, keep left leg flat for 12 hours, continuous cardiac monitor and oximetry.

Patient #3 - Teenager with Type 1 diabetes mellitus. Admitted through the emergency department (ED) with blood glucose of 592 mg/dL, restless and agitated. Orders include IV 0.9% NS at 125 mL/hr and insulin drip with hourly accuchecks.

Patient #4 - Patient admitted from neurologist’s office with abrupt onset of profound lower extremity weakness. Admitting diagnosis is rule out Guillian-Barré syndrome. Orders include hourly neurological testing, pulmonary function testing and administration of intravenous immunoglobulin (IVIg) daily.

Patient #5 - Patient with acute renal failure of unknown origin. Patient is confused. Serum ammonia level is 82 mcg/dL. BUN 32 mg/dL, Creatinine 2.9 mg/dL. Patient will begin hemodialysis therapy in the next hour.

The staff available for this shift include you (the charge nurse), and ICU staff RNs - one with 2 years of experience, one who just finished 6 month orientation to the ICU, a float RN from oncology unit and an unlicensed assistive personnel (UAP) with 1 year experience on the ICU.

Answer 1

The specific staff patient ratio in ICU must be 1:1 or 1:2 depending on the patient stability. The charge nurse has to keep in my mind about the foundational knowledge and expeience in the nursing staff , prioritizing the seriousness of the patients condition and allot the case to the staff accordingly .

The ICU charge Nurse can assign;
ICU staff RN with 2 years of experience : patient # 5 and 3

since the patient #5 is having a critical illness and the treatment has to be started with haemodialysis, an experienced staff is needed to take care and assess the patient continously for complications.

patient #3 is less critical compared to #5 but also need to take greater care as there is a risk of developing hypoglycemia.

The work of the staff can be balanced as the nurse may not be overloaded with work and can concentrate on both the patient.
ICU staff RN with 6 month orientation to the ICU : patient 2

This staff can not be allotted with more critical patient as she has just completed her orientation period in ICU. This patient has already undergone the procedure and needs close observation which she can handle.
A float RN from oncology unit : patient 1 and 4

A float nurse has come to fill the shortage of staff in ICU . since she has one year experience . she can mannage 2 patients who are little stable compared to others and she can manage with necessary actions even if any complications arises.
An unlicensed assistive personnel (UAP) with 1 year experience on the ICU : has to assist the nurses in assesing vital signs and bed side care in patient # 3 and 4.

and the charge nurse is responsible to supervise on all the patients and staffs and can help them if neccessary.