I am presenting this tomorrow in class... It is a student lead discussion. I have been going back and forth with my answers to this assignment and i was just hoping to get some different point of views that maybe i could add to the discussion. Any feedback would be great!
James works at a large teaching hospital in a major metropolitan area. This institution services the entire geographical region, including indigent clients, and because of its renowned reputation also administers care to international clients and individuals who reside in other states. Like all health-care institutions, this one has been attempting to cut costs by using more UAP. Nurses are often floated to other units. Lately, the number of indigent and foreign clients on James's unit has increased. The acuity of these clients has been quite high, requiring a great deal of time from the nursing staff.
James arrived at work at 6:30 am, his usual time. He looked at the census board and discovered that the unit was filled,and bed control was calling all night to have clients discharged or transferred to make room for several clients who had been in the ED since the previous evening. He also discovered that the other RN assigned to this unit called in sick. His team consists of himself, two UAP, and an LPN who is shared by two teams. He has eight clients on his team:3 clients need to be ready for surgery, including pre-op and post-op teaching,1 of which is a 35 year old woman scheduled for a modified radical mastectomy for the treatment of invasive breast cancer; 3 clients are second day post-ops requiring IV antibiotics, dressing changes, NG suctioning, chest tubes, TPN and lipids, central line dressing changes, Foleys, and ambulation; 1 client needs transferred to the rehab unit with report called prior to the transfer and finally, 1 client is to be discharged home and requires discharge teaching on insulin and dressing changes.
1. How should James organize his day?
2. Which client is a priority?
3. Who do you assess first?
4. What type of client management approach should James consider in assigning the staff
5. If you were James, which clients and/or tasks would you assign to your staff?
6. Explain your rationale for this assignment.