Case study: Need inputs!!!

Hi Everyone , here is another case study I have to discuss

Maxine Overland is an RN, working on a medical-surgical unit in a partnership model of primary nursing. She has been on vacation for 2 weeks, and when she returns, she finds that the unlicensed assistive personnel she typically worked with is not expected to be back at work for several months because of a family emergency. A new nursing assistant, John Maxwell, who had worked in the hospital for only 2 weeks, is assigned as her partner.

Maxine was pleased to learn that John had previous experience in another hospital and is a certified nurse aide. However, as she began to work with him, she realized that he does not understand the delegation rules established by the state Board of Nursing. For example, she entered a patient's room to find that John was removing an IV from the patient's arm because it had infiltrated. Maxine took over the task, noting that the IV was in fact infiltrated. After leaving the room, she asked John why he had begun to remove the IV instead of calling her. He indicated that he had been taught how to do this at his last place of employment. She indicated to him that this was not a delegated task in this hospital. He responded, "Why? I know how to do it."

Later in the morning, Maxine was reviewing the vital signs of the patients to whom they were assigned. The values for all blood pressures, pulses, and respiration's were numerically very close, despite the fact that the patients had previously had widely different vital signs results.

If you were Maxine, what would you do?

MY ANSWERS:

According to what is happening here and if I were Maxine, I would speak with John and explain to him that this is a different place from where he was working before and it has different rules and regulations. Nursing Assistants do not do certain task that pertains to the Registered Nurses and he may read the rules and regulations books because every facility is different, the vital signs values and procedures are different. I will also encourage him to go to the nursing supervisor in case he has any questions and if he needs help I will be there. If something like this happens to me, I will talk to John and I will clarify to him that he is only allow to perform within the limits of his license as a CNA he is not allowed to perform as an RN, that I am the RN and I am liable for the care of the patient. I will point to him that the IV was infiltrated and the vital signs are not correct. I would tell him not to do my job. If he does not understand and replies the same way he did to Maxine then I will report the incident to the supervisor or nurse in charge so he can be corrected. If I were in a situation like she was I definitely talk to John clearly, letting him know that I am the RN and I am responsible for the health and wellbeing of the patient while under my care and that he is not qualified to do my job and it is not acceptable in any place a CNA to perform as an RN and then I will talk to my supervisor or nurse in charge. I would retake patient's vital sign again and I will record the results in the patient chart.