Delegation patient/staff homework assignment help

[nessaben11]

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.

[TriciaJ, RN]

I would start by getting the two ready for surgery, because when they are called for, they have to be ready to go. You aren't going to be able to delegate this to your aide, because you are going to have to sign off on the OR checklist, give the famotidine and have the IV antibiotics hanging and ready to run just as the case is starting. These tasks might be LPN-appropriate, though.

Next, I would assess the postop person with all the hardware and make sure everything looks like it's supposed to. TPN is usually hung at night so all you should have to do is make sure it's running on time. Your CNA should be able to do all the vital signs, assist with am hygiene and ambulation. I would assess the other postop patients next. (Your assignment calls them "second-day postop patients. This is confusing. The operative day is usually called postop day 0 and the next day is called postop day 1. So are these patients POD1 or POD2? You would want to clarify because it can make a big difference in terms of what to expect and what you need to do for them.)

When a patient has received discharge orders, he usually wants to be out the door asap. Get his teaching done and get him gone. Next, the transfer.

Your aide can get the 2 beds ready for the return of the patients you sent to the OR. Housekeeping needs to turn over the rooms of the people you discharged and transferred.

In between, you're going to be running in and out of the rooms with meds, dressing changes, suctioning, etc. Communicate with your LPN and sort out who does what. (If there are usually 2 RNs to a team and 1 shared LPN, does the other team have 2 RNs today? If so, you should request to have the LPN all to yourself.)

I realize this is just a bare-bones schedule, but it's how I would plan things if this was my assignment. Other nurses may have other ideas.