Staffing Question

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    Hello! I'd appreciate all the input i can get on this. I apologize now because I'm sure this will be kind of lengthy. Ok, i have a staffing assignment for a management class. Last semester, i really want to pass, but i need some help. The assignment is to pick the staff to go with each patient, and to prioritize the patients in numerical order. The staff available are: LPN (for 5 years and hostile with you), BSN (new grad and just finished orientation), CNA (8 years, likes to talk more than anything). In summary, here is what i THINK the order of priority and the staffing should be. I'm a novice, so please give me some direction

    #1: cirrosis of liver; hepatic coma x 2 days, skin on coccyx and R ankle reddened, hyperlimentation with central line, peripheral line for blood. Staff= BSN, CNA

    #2: Thrombophlebitis, bed rest, warm packs to legs, IV heparin. Staff= RN, CNA

    #3: New dx IDDM, Diabetic comma. Woke up, does own FSBS, needs to learn to do insulin. Staff= RN, CNA

    #4: Infectious hepatitis, new admit, BR, BRP, enteric precautions, needs to be taught about infection control, transmittal, etc. Staff= BSN, CNA

    #5: Pneumonia; admit yesterday in RDm BR, IV antibiotics, O2 4L, PRN suction, Sputum specimen, Xray Staff=BSN, CNA

    #6: Acute Bronchitis hx of COPD; needs smoking cessation, needs med education, d/c in AM, multiple meds, nervous, anxiety. Staff = LPN, CNA

    #7: Dehydration and Alzheimers; Going to transfer out to nursing home, not eating well, can ambulate with a lot of assistance. Staff= LPN, CNA

    #8: Pulmonary malignancy; ambulates, restless last night because chest pain, SOB, anxious and complains. Staff= LPN, CNA

    #9:RSV; loud, angry, IPPB and nebulize, O2 2L Staff= RN, CNA

    Like I said. incredibly new at this. I'm sure I butchered it. All comments welcome, much guidance appreciated.
  2. 10 Comments so far...

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    why are you giving your bsn new grad all the hard patients and your rn and lpn easier patients? how many years experience does your rn have??? i won't do your homework assignment, but i can guarantee you in the real world i would never give a bsn, msn, or any new grad my hardest patients! work experience and scope of practice counts for a lot in the real world. in my state rn = rn... having a bsn does not give the registered nurse a higher scope of practice then an adn (i know that this is taught in school or that there are rumors of it, but it is a lie). so the new grad bsn should be getting easier (stable) patients if the rn (my guess adn) has many more years of experience. as for the lpn with lots of experience, i would assign patients within that lpn’s scope of practice and take into account the lpn’s years of experience.
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    I hope this does not come off as rude, as it is not my intention. I'm not asking anyone to do my homework. There are several more extensive parts to this assignment that i did not include (about 7 other sections of work requiring quite a bit of writing.) This was my answer to this specific part of the assignment. I wanted to know if my way of looking at it was skewed, and it appears that it was. I was only looking for some sort of input to help guide me. Unfortunately our school has given us very inconsistent teaching, and cannot settle on instructors to get us through a whole semester. This then lands me and my fellow students looking for help, that our instructors are unwilling to provide. I do appreciate your most valuable insight, and will look over my list and see where i can adjust it.
  5. 1
    Quote from snowmaiden2005
    unfortunately our school has given us very inconsistent teaching, and cannot settle on instructors to get us through a whole semester. this then lands me and my fellow students looking for help, that our instructors are unwilling to provide. i do appreciate your most valuable insight, and will look over my list and see where i can adjust it.

    that is horrible... hopefully you manage to graduate!!

    well, to do this assignment check out your state's scope of practice for bsns (to see if there is a different scope of practice compared to adns by the bedside), rns, lpns, and cnas. afterwards look the person's years of work experience along with their licensed scope of practice to determine the proper assignments. gl!
    snowmaiden2005 likes this.
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    thanks a lot! I will do that
  7. 1
    Look at the hardest patients/most acute patients and prioritize them first. Then look at the experience of your staff. An RN is an RN, at least on the floor, and most hospitals/facilities do not make the distinction--scope of practice is the same for an ADN and a BSN. If your RN is an experienced RN, doesn't matter if she or he is a diploma nurse, an ADN, or a BSN. On the other hand, your BSN is a new grad and needs guidance and time to work up to extremely medically complex patients. Also don't ignore your LPN--scope of practice has narrowed for them, but there's generally a lot of experience there so they can do a lot and get help from the RN when needed. Just remember: prioritize patients first, then look at experience and scope of practice.
    caliotter3 likes this.
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    I'm confused, I thought you only had a CNA, LPN and new grad BSN. Where did your RN come from?
  9. 0
    You poor thing. How can they expect you to do this when you've no idea the true strengths of your nurses?

    THIS is theory.
    Application is SOOOOOOO different.

    Good luck to you. I would knock the heads in of the prof who thinks this is a good assignment.

    And be my guest, please let her see my post.

    She/He needs a reality check.
  10. 0
    Thanks everyone for your input . I thought if i could get someone who has experience to give me some pointers, it would help, and it has. I've been working on this assignment all day.

    Your Right. How am i to know the strengths/limits of those nurses? I have an awful text book that tells me extremely little. Everyone in class is having an issue with this, so I'm not alone.

    To answer the question of where the other RN came from: The other RN is the Team Leader making the assignments. Which in turn is me.

    Again, many many thanks in you all in sharing your vast experience with me. I'm hoping to have this all done by tonight! And then get this thing turned in (including the other 7 massive parts of writing yuck.)
  11. 0
    it depends on the nurse.
    a new grad can be horribly intelligent and be able to handle some of these patients, whereas an lpn with 5 years experience might be a lazy slob. or vice versa
    when we are staffing for rns and lpns, we are usually asked if our assignment would be "good for an lpn".
    the number one thing we take into account, is if the patient has iv fluids/ antibiotics ordered as an lpn cannot hang tpn and things like that into a central line or draw labs in the morning (i work nights)
    if the lpn is assigned to a patient that has a lot of iv stuff, it puts a strain on the charge nurse and staff nurses during the day, as they have extra things to do.
    other than that, every patient is pretty much fair game as far as who gets who.
    maybe looking at the code status of these patients would help also?
    the full codes who may seem stable may not be so stable as the shift goes on, so theres that.
    a dnr who wont need things like tpn or possible transfusions is also something to consider.

    i think so far your assessment of the staffing needs are pretty accurate.
    you couldnt pay me enough to do staffing though.


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