Question

Scenario 1

You are the day charge nurse working on staffing for the overnight shift. Three nurses will be working the night shift, and you note that two of the three nurses have been on the floor for less than six months. You are extremely concerned about the patient in 3212 who is detoxing and requires medication to be given every hour along with the frequent rounding and monitoring. You call the staffing office and tell them you need four nurses for the night shift to safely staff the floor. The staffing offices tell you only three nurses are needed and that’s all you are getting.

Reflection

When reading this scenarios, why would the staffing be unsafe?

How could you professionally explain your situation to the staffing office and ask for help?

If the staffing office continues to say no, what will your response be?

Answer 1

Answer 1:

• There are the following problems in this scenario:
  1. Less number of nurses - Adequate number of nurses are required for just a division of labor. This will ensure work is down on time and reduces the possibility of accidents
  2. Less number of experienced nurses - Some patients need extra care due to their condition. Therefore, skilled nursing staff is needed. Some skills are only acquired with experience. The presence of an experienced nurse will provide mental support to the other nurses and also ensure patient safety
  3. More work
  4. A patient with special needs - The management of some patients requires special skills. so more number of nurses are needed to assess the patient frequently
• All these 4 problems, make the staffing unsafe.

Answer 2:

• I would say, Thank you for providing me with 3 nurses. They are skilled and enthusiastic about patient care. However, there is a patient in 3212 who is serious and needs more attention. The staff nursing given are doing their best and I appreciate it. However, this patient's needs are different and can only be managed by a nurse who has had some experience in the patient with managing such patients. I am concerned that patient care might get compromised and the workload on the 3 nurses might increase. This could harm the patient and nurses. Plus, this might give rise to a medico-legal situation. Please provide one more nurse with experience in managing patients undergoing detoxification.

Answer 3:

• If the reasons for not providing an extra nurse are valid, it would select one nurse amongst the three who has the highest experience. I would release her of some of her duties ( not all) and ask her to take care of the patient in 3212.
• The other two nurses will have to shoulder their own as well as some of the responsibilities of the senior nurse.
• I would keep a meticulous written/ electronic record of all the communication between me and the staffing office. ( this may be required later in case there is some medicolegal problem)
• I would prepare a comprehensive report of all that has happened during the night and present that report to the hospital establishment, human resources, and seniors in the staffing office. This is to bring to their kind notice the lack of manpower in the hospital.