Need help with delegation question

  1. My leadership and management midterm is take home and the following is the scenerio I was given with which to delegate. I hope you guys can help me with it!!! What would you do if you came in to this besides slit your wrists, which was my initial reaction after I read it!!

    You are the charge nurse for the 7a - 7p shift on an oncology unit. Immediately after report (around 7:30 AM), you overwhelmed by the following information:
    1. The nursing assistant reports that Ms. Johnson has become comatose. Although this is not unexpected, her famliy members are not present and you know they would liek to be notified immediately.
    2. There are 3 patients who need 7:30 sub q insulin injections. One of the patients had a 6 AM blood glucose of 400.
    3. Mr. Johnson has pulled out his central line when he was turning in bed. his wife just notifeid the medical receptionist by the call light and states she is appying pressure.
    4. The public toilet is overflowing and urine and feces is spilling into the floor
    5. Breakfast trays arrived 15 minutes ago and patients are usinf their call lights to ask where there breakfasts are?
    6. The medical director of the unit has just discovered that one of her patients has not been strated on the chemo drug she ordered three days ago, and is furious and is demanding to talk to you.

    You have the following personnel to delegate to: a medical receptionist, a nurisng assistant, a RN who graduated two montha ago and is still on orientation, a LPN who has worked on the unit for 10 years, and yourself. Decide who should do what and in what priority. justify your answers.
    I would greatly appreciate any advice.
    Thank you for your replies ahead of time!
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  2. Visit nursepotter05 profile page

    About nursepotter05

    Joined: Dec '04; Posts: 208; Likes: 11
    er nurse @ 2 critical access hospitals
    Specialty: 4 year(s) of experience in er, pediatric er

    23 Comments

  3. by   nesher
    Sounds like a regular day.
    What are your thoughts on who should do what and when and where?
  4. by   dbsn00
    OK, here it goes:

    The breakfast trays should be given out by the NA - occupy other patients, get those call bells quiet!

    While that's being done you can get to Mr. Johnson & his central line - this is a priority & your responsibility as the charge nurse.

    The new grad RN can begin the insulin injections (with practice comes experience...), starting with the 6AM blood glucose of 400 (priority), & after the LPN calls Ms. Johnson's family regarding her change in condition she can assist the new grad RN. (since pt.'s change in condition was expected this could be done by the "very familiar to the unit" LPN, the LPN then can oversee the orientee with the other insulin injections & continue to monitor the patient with the blood glocose of 400 after their injection)

    Meanwhile, the receptionist can call maintenance regarding the overflowing toilet. (the rationale should be obvious here)

    After you've dealt with Mr. Johnson's central line (& making sure the above has been done) you can call the Medical Director & get chewed out! (since all of the above is being done simultaneously you will be able to respond to the Medical Director within a reasonable amount of time). Hope this helps!!!
  5. by   nursepotter05
    I appreciate the help. I couldn't decide who to send to Mr. Johnson.I knew he was first priority. I knew that his condition warranted a RN, but I couldn't decide on me or the new grad. I REALLY appreciate the help
  6. by   happytobehere96
    Good response, the only one I disagree with is the LPN orienting the RN. Can't do.



    Quote from dbsn00
    OK, here it goes:

    The breakfast trays should be given out by the NA - occupy other patients, get those call bells quiet!

    While that's being done you can get to Mr. Johnson & his central line - this is a priority & your responsibility as the charge nurse.

    The new grad RN can begin the insulin injections (with practice comes experience...), starting with the 6AM blood glucose of 400 (priority), & after the LPN calls Ms. Johnson's family regarding her change in condition she can assist the new grad RN. (since pt.'s change in condition was expected this could be done by the "very familiar to the unit" LPN, the LPN then can oversee the orientee with the other insulin injections & continue to monitor the patient with the blood glocose of 400 after their injection)

    Meanwhile, the receptionist can call maintenance regarding the overflowing toilet. (the rationale should be obvious here)

    After you've dealt with Mr. Johnson's central line (& making sure the above has been done) you can call the Medical Director & get chewed out! (since all of the above is being done simultaneously you will be able to respond to the Medical Director within a reasonable amount of time). Hope this helps!!!
  7. by   BRANDY LPN
    I have helped orient many new grad RNs. Why do you feel this is a can't do? This LPN has ten years experience and certainly has MUCH more experience with monitoring blood glucose and administering insulin than a brand new grad. (No offense to any new grads, but with experience comes knowledge.)
  8. by   caroladybelle
    Quote from happytobehere96
    Good response, the only one I disagree with is the LPN orienting the RN. Can't do.
    This RN must disagree. The LPN can provide plenty of assistance and orientation to a new grad....if the new grad is willing to learn.

    I learned some of my best tricks of the trade from LPNs.

    And if the facility is worried about legalistic definitions of supervision and orientation, they should have provided an RN to do so.
  9. by   caroladybelle
    PS. Is the comatose patient a code or a no code?
  10. by   nursepotter05
    Quote from caroladybelle
    PS. Is the comatose patient a code or a no code?
    That is a good question. The scenerio does not say one way or another. Since it says that this was not unexpected, I assume she is a no code.
  11. by   hcmanp
    the clue is in the statement, the lpn oversees the rn - legally this is not an option. Yes, the lpn can assist the new rn, yes, the lpn knows WAY more than the new rn (most likely given the experience in this case), but the RN oversees the LPN legally. It was a semantic problem.
  12. by   LPN1974
    Quote from happytobehere96
    Good response, the only one I disagree with is the LPN orienting the RN. Can't do.

    I'd like to know why you think this.
    My DON just hired a new RN for supervisor on my evening shift, and we are helping this new nurse orient to HER job.
    She comes to us lowly LPNs for ADVICE. Imagine that.
    Some of us have been there 28, 25, 20 years and she's coming to us for advice.
    Don't you think that YEARS of experience counts for ANYthing?
    This new nurse has never worked in this type of situation before, we work with MR/DD.
    So I'd like to know why you think an LPN can't do anything to help a new RN orientate to her job?
  13. by   nurseinmilo
    does sound like a typical day
  14. by   truern
    2005 Lippincott Williams & Wilkins, Inc. Volume 35(2) February 2005 p 14 Who's in charge here? [ADVICE, P.R.N.: LPN SUPERVISING RN]

    At some nursing homes, including the one where I work, the trend is to put an LPN in charge as facility supervisor, even when RNs are on duty. I'm wondering what would happen if the LPN supervisor responded to an emergency herself, rather than directing an RN on duty to take over--even though the RN might be better qualified to intervene. What does your legal consultant say? --S.P., N.C.

    She says the situation you describe is both poor practice and at odds with the law. Most nurse practice acts specify that RNs supervise LPNs, not vice versa. Employers can't disregard the law to suit their convenience or their budget. If a patient were harmed in the circumstances you describe, the patient or his family could sue the LPN ...
    ************************************************** ****

    I'm not sure this addresses the question, but it was somewhat in the ballpark

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