Question

You are the house supervisor in an acute care hospital. Most of the units are full. The ED request 2 admissions to the step-down unit. The floor with appropriate and empty beds has only 4 RNs on duty for this 30-bed unit with a census of 20 patients. The charge nurse (one of the 4 nurses present) tells you that they can’t safely admit any more patients. You currently have no more float pool staff and upper administration has already said no to closing the unit for admissions at this time. What should be done? What is the ethical dilemma? How does this impact patient care? What possible solutions are there for this situation? Using the scenario prepare a 5 minute healthcare skit through which the roles of RN, LVN/LPN, AND UAP can be played out. Clear differentiation of roles and legal scope of practice should be apparent in the skit. The skit should include examples of appropriate delegation.

Answer 1

the ethical dilemma and what should be done:

Supervisor responsibilities must be " in a way of assisting and providing quality of care and maintaining the ethical obligations of the duties in profession. Ethical issues occurs whenever the choices has to made and don't have clarity on answers and ideas . The result could be declines in the quality of patient care, problematic clinical relastionships and moral distress which means knowing the right thing to do but not being allowed or able to do it.

In this situation, supervisor should consult with RN that "is it safe " to admit any more patients and if they cannot provide quality care to patients then he must decide that he can ask other RN working in other wards to come over to take care. if it is not possible then he must decide provide wor to LVN to take care.

-Supervisor's main job responsibilities are improving patient health care and quality and outcomes.

-Supervisor's job is to improve more number of staff in nursing throughout  facility while maintains workloads  for individual nurses. Achiving this balance decreases burnout and enhances work-life satisfation.

Impact on patient care: The main primary responsibility of any healthcare provider is to provide quality of treatment to them and help to achieve quality outcome.

- the nurse with heavy workload cannot provide good health care to patient. so asking other RN in other wards to give care also helps them to get better treatment within time. The patient needs doesnot stop for any healthcare person so its better to provide good care.

- The nurses should provide quality of care in comfortable environment. by providing individual care for patient,it helps them to fast recovery.

the roles of RN, LVN/LPN, AND UAP:

The registered nurse (RN) takes responsibility and accountability for the provision of nursing practice.  

LPN/ LVN means Licensed practical nurses / Licensed vocational nurses important role is to provide routine care , observe patients health, assist doctors and registered nurses and communicate instructions to patients related to medications , home based care and preventive life style changes.

UAP means Unlicensed assistive personnel main role and duties are observing , documenting and reporting clinical and treatment information , including patients behavioural changes.Assisting with motion excercises and other rehabilitative measuress. maintain and keep the data of blood pressure,body temperature, pulse, respiration rate and the body weight.

Assaignments:

- The RN enhance and assists in quality of care and providing of resources.

- The decision to assaignment is based upon the RN's judgement concerning the care complexity of the patient , availability etc.

-The Registered nurses should have knowledge about assaigning concept with mutual respect. The nurse leaders has duty to tasks assaign, monitoring and communicate the competence requirements in the delegation.

- Organisational policies on tasks assaigning are developed with the active involvement of registered nurses.