Question

After already assigning patients to her team (consisting of one RN, two LPN/LVNs, and one CNA), the charge nurse, Kate, an RN, is notified that her unit must accept four more patients in varying degrees of acuity. She must develop patient care assignments for her team, using the five rights of delegation and demonstrating she understands principles of delegation, supervision, and scope of practice.

SCENE 1: The charge nurse, Kate, an RN, has been notified that the post anesthesia care unit (PACU) has run out of beds due to unexpected surgeries, while three more ORs are still running. Four patients are being transferred to this unit. The staff that day includes John, an RN; two LPN/LVNs, Mike and Sabrina; and one CNA, Nina. The patients that need to be assigned are: fresh post-op patient from PACU following a herniorrhaphy; a 24-hr postop of a below-knee amputation (BKA) with dressing change needed; two overflow post-CVA patients (one with dysphasia, one with right-sided weakness who needs assistance ambulating).

1.     What do you notice about the location of the huddle where these new patients are being reassigned? Why or why not is it appropriate for this to occur in a conference room?

2.     How would you expect the charge nurse to assign these four patients among the RN, two LPN/LVNs, and CNA?

SCENE 2: Kate, the charge nurse, makes staff assignments while everyone looks at the white board in the conference room: The post-op BKA in need of a dressing change is assigned to Mike, an LPN/LVN; the post-op patient fresh from the PACU is assigned to John, the RN. The stable CVA patient with dysphagia is assigned to LPN/LVN Sabrina, and the stable CVA patient ready for discharge any day is assigned to Nina, the CNA.

  3.     Did the charge nurse delegate appropriately to the team? Why or why not? Do you see any problems with the assignments?

SCENE 3: Some time later, Mike comes running to the conference room to notify Kate that Mr. Gladys (the patient with dysphagia) is choking.

4.     Why would a rapid response team (RRT) be called in this situation?

5.     If you were the nurse manager of this unit, what aspects of the delegation in this case would you want to address with the charge nurse after this event?

6. What factors would you consider when delegating patient care assignments to this team or any team?

Answer 1

1) Ofcourse by assigning new patients in the Kate's unit where already patients are there , overcrowding will occur as the patients bed will be close to each other and it is not appropriate to shift the new patients to conference room because the conference does have the medical resources and facilities to take care of post operative patients .

2) Assignment of the patients :-

The post-op BKA in need of a dressing change will be assigned to Mike, an LPN/LVN

The post-op patient fresh from the PACU will be assigned to John, the RN.

The stable CVA patient with dysphagia will be assigned to John RN or Kate along with Sabrina ( for assistance )

The stable CVA patient ready for discharge any day is assigned to Nina, the CNA.

3) No ,the charge nurse have not delegated appropriately to the team

She must have delegated the patient with dysphagia to the RN or the LPN along with RN because the patient has dysphagia , anytime he can have aspiration if not monitored properly.

4) A rapid response team (RRT) is called in this situation because the patient with dysphagia had choking and to recover the patient with the help of heimlich manoeuvre (- a first-aid procedure for dislodging an obstruction from a person's windpipe in which a sudden strong pressure is applied on their abdomen, between the navel and the ribcage), the RRT was called .