Delegation patient/staff homework assignment help

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I am in the RN program, and we are working on leadership assignments. I am wondering if anyone could help me answer these questions. I will post below what I have so far & any questions what I am questioning. Thanks ?

Julio arrived at work at 6:30 a.m., 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 emergency department since the previous evening. He also discovered that the other RN assigned to his team called in sick. His team consists of himself, two NAP, and an LPN who is shared by two teams. He has eight patients on his team:

· Two need to be readied for surgery, including preoperative and postoperative teaching, one of whom is a 35-year-old woman scheduled for a modified radical mastectomy for the treatment of breast cancer.

· Three are second-day postoperative clients, two of whom require extensive dressing changes, are receiving IV antibiotics, and need to be ambulated.

· One postoperative client who is required to remain on total bedrest, has a nasogastric tube to suction as well as a chest tube, is on TPN and lipids, needs a central venous catheter line dressing change, has an IV, is taking multiple IV medications, and has a Foley catheter.

· One client who is ready for discharge and needs discharge instruction.

· One client who needs to be transferred to a subacute unit,

and report must be given to the RN of that unit.

Once the latter client is transferred and the other one is discharged, the emergency department will be sending two new clients to the unit for admission.

1. How should Julio organize his day? Set up an hourly schedule.

2. Make a priority list based on ABC’s

3. What type of client management approach should Julio consider in assigning staff.

appropriately?

4. If you were Julio, which clients and/or tasks would you assign to your staff? List all of them,

and explain your rationale.

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Specializes in SICU, trauma, neuro.

I don’t think you’re supposed to delegate your homework to strangers on the internet. ?

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Specializes in ER.

If you have an early surgery scheduled, you'd better start there. Have that pt ready to go. Hopefully nightshift did their part. Then, morning meds and treatments. After the big med pass you can work on the DC and transfer.

That's a start

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I apologize if it came off that way, but I didn't delegate my homework or ask anyone to do it. I was literally asking for advice, as I want to make sure I am doing it properly because I want to be a good nurse and I am learning. The assignment isn't worth any points, it's just for practice. I've been working on it and just came back to post what I have thought out so far & wanted opinions -

#2.) Make a priority list based on ABC’s

1.) Patient with a chest tube

2.) Pt being transferred

3.) Patient with IV medications

4.) Pt with cancer needing pre/post op education

5.) Pt being discharged

#3.) If you were Julio, which clients and/or tasks would you assign to your staff? List all of them, and explain your rationale

RN :

-Administer IV antibiotics/medications

o Julio is the only registered nurse on the floor. Administering IV medications/fluids is not within the LPN or NAP scope of practice. The RN has the education to start, monitor, and/or discontinue IV medications if needed. TPN/lipids need to be hung by an RN and monitored for complications (electrolyte imbalance.)

- Give report on patient that needs to be transferred.

o Julio should give report on the patient being transferred to another RN using SBAR to report information and status of the patient. The RN should have the most information about the patient by assessing the patient and working with the healthcare team to care for the patient. The RN can provide information about the patient, medical diagnosis, providers, plan of care, progress, concerns, vital signs, medications, allergies, advanced directives, etc. It is an RNs role to collaborate with the interprofessional teams.

- Provide preoperative and postoperative teaching.

o Registered nurses are responsible for providing education and answering any questions the patient may have.

- Providing discharge instructions and discharging patient.

o The RN is in charge of providing discharge education including step-by-step instructions for home, medication instructions, precautions to take at home, adverse effects related to health issues or medications that should be reported to their provider, names/numbers, and plans for follow-up care and therapy.

- The RN should assess and change the dressing of the central venous line

o Central venous line needs to be assessed by an RN. The RN needs to assess the site for signs of infection or complications, change the dressing using sterile technique, make sure the line is in place, administer any medications/check the proper rate of medications is being given,

LPN :

- Dressing changes

o Dressing changes are within the LPN’s scope of practice.

- Ng suctioning

o Ng suctioning is within the LPN’s scope of practice.

- Foley catheter cares

o An LPN can provide Foley catheter cares and empty/chart output.

§ Administer any oral medications

NAP

- Vital signs and answer any call lights

- Get the patients ready for surgery and transferring

o A NAP can get a patient ready for surgery (a RN must provide teaching)

o A NAP can transfer a patient from one unit to another (unless specific conditions require an RN)

- Ambulate patients

- Foley catheter

o A NAP can empty a Foley Cather and chart output.

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1 hour ago, Here.I.Stand said:

I don’t think you’re supposed to delegate your homework to strangers on the internet. ?

I apologize if it came off that way, but I didn't delegate my homework or ask anyone to do it. I was literally asking for advice, as I want to make sure I am doing it properly because I want to be a good nurse and I am learning. The assignment isn't worth any points, it's just for practice. I've been working on it and just came back to post what I have thought out so far & wanted opinions. Sorry! Thank you for taking the time to view my post. I do appreciate any help!

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26 minutes ago, Emergent said:

If you have an early surgery scheduled, you'd better start there. Have that pt ready to go. Hopefully nightshift did their part. Then, morning meds and treatments. After the big med pass you can work on the DC and transfer.

That's a start

Thank you ?

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I think it seemed that way because there was a delay in your reply that contained all the work you had done so far. But it's okay; let's move on. ?

As far as the assignments portion of your answer - you have the general idea. Looks pretty good.

If they are asking you to literally prioritize according to ABCs (what that commonly means/entails) and not according to anything else like freeing up beds or delays in care, then I think your prioritizations need to be tweaked.

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4 minutes ago, JKL33 said:

I think it seemed that way because there was a delay in your reply that contained all the work you had done so far. But it's okay; let's move on. ?

As far as the assignments portion of your answer - you have the general idea. Looks pretty good.

If they are asking you to literally prioritize according to ABCs (what that commonly means/entails) and not according to anything else like freeing up beds or delays in care, then I think your prioritizations need to be tweaked.

Ok awesome, thanks so much!! I was confused about that too & trying to figure out how to prioritize that other than the chest tube pt. ? Thanks again! I will keep working on it.

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Let me clarify so that I don't lead you astray.

It's a nursing school question that is just begging you to figure out how you're going to get the patients to surgery on time, get the discharge and transfer completed ASAP so that they can put two new patients in your rooms, and take care of the 4 post-ops.

But then they went and asked you to prioritize by "ABCs." ? See what I mean? I suspect they want you to struggle with everything (as already noted) - but ABCs would dictate (IMVHO) that the RN start by at least assessing the 4 post-ops, beginning with the most high-risk one of those 4.

Because with each of the other patients, there is system/political pressure to do stuff with them ASAP, that's just not the same as physical needs such as ABCs.

I don't want to take you off track. Do you think they're trying to be tricky? ? I don't know....

Maybe @Wuzzie or others will come along to help decide if I'm making this more complicated than what they "probably" want for an answer....

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@JKL33

Yes, I agree. Sorry I wasn't very clear either. It's been a long day of homework ?

It says in the description, "bed control was calling all night to have clients discharged or transferred to make room for several clients" but then it asks for the clients prioritized in ABC's. When I did my leadership preceptorship, my preceptor focused on getting all of the patients discharged ASAP for the new admits. I started by planning to give report for transfer & discharge education, but then the ABCs threw me off and I restarted the assignment haha.

Regardless, maybe I'm just tired and overthinking it. I can always find out later this week when I turn it in, but it is nice to have some insight from other nurses besides my nursing school friends. I bet you guys don't miss nursing school ?

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Specializes in SICU, trauma, neuro.

My apologies nessaben11. A fair amount of students come here with a copy-pasted assignment, which is what I saw initially. I’m glad to be wrong in this case! ?

For the most part it looks good. Typically LPNs can’t give IV push meds, but they can absolutely hang piggybacks.

Also — keeping in mind that I graduated in 2003 and no longer work with LPNs, so I could be wrong — the hanging of TPN. TPN everywhere I have worked is required to be dually checked. I don’t see why an RN and an LPN can’t check it together and the LPN hang it. The RD is going to be closely monitoring the pt’s nutritional status including labs, and the MD/APRN will order any needed lab tests, but the RN can note lab results and communicate them to the team without having done the task of hanging the TPN. Does that make sense?

Also in the ideal world, some initial pt teaching would have been done by an RN on an earlier date, and the LPN could then reinforce that teaching. Julio would then be freer to concentrate on that day’s initial teaching and discharge teaching in addition to all of the assessments and care planning he has to do that day.

I don’t love “prioritize according to ABCs” questions... yes I get the point is to help you prioritize what would kill the pt first. In practice it isn’t always that simple. For example, take 1) a 14 year old is wheezing because her rowing coach is a sadistic overlord with a roomful of Ergs.... or 2) her teammate goes into septic shock when his full-thickness blisters get contaminated with lake germs. Septic shock is more serious than a garden-variety asthma exacerbation..... but breathing comes before circulation.

Likewise, a chest tube may be a lower priority than teaching — say if the pt has been rock stable for days BECAUSE OF the chest tube... while another pt is leaving NOW, with or without discharge teaching.

Hopefully that didn’t confuse you further! This does get more intuitive with practice

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@Here.I.Stand I completely understand!!! Trust me, I watch (some) classmates get all of their homework online and then party every weekend. ? I don’t understand how they learn anything or even pass!!! Their loss though. I know my hard work & effort will help me become a better nurse for my patients! ?

That definitely all makes sense. Thank you so much for taking the time to reply with a detailed explanation and reading through everything. I truly appreciate it!!!

The real world is definitely different than these confusing assignments haha which makes them even more complicated. One more month until I graduate & I think it’ll all come together when it’s not just on paper!

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