Organizing Nurse Workday - Case Study Example

Name: Tutor: Title: Organizing RN workday Course: Date: Organizing RN workday Delegation and the RN Mrs. Fatima Dilma The RN will delegate the EN to monitor the IV therapy 1000 ml of normal saline in progress. RN has the role of informing the EN to document the progress of the IV therapy. The EN can also be delegated to monitor the patient and report any adverse reaction to treatment to the RN. For Mrs. Fatima, the EN will be required to collect her health history and share the information with the RN in order to assist in establishing the best course of care for Mrs. Fatima (Gary 2012 pg 16-18). Since Mrs. Fatima will require basic nursing care, and owing to the fact that she is alone in the hospital, although her daughter visits often, the RN will delegate to the EN the role of bathing Mrs. Fatima since she is an elderly and taking care of her hygiene needs. However, the RN will be required to supervise the EN while she is bathing the patient especially for the first time. Therefore, it will be the responsibility of the RN to teach the EN how to bathe and provide basic hygiene care to the patient, ensure supervision and above all re-evaluate all the tasks delegated to the EN regularly. Mrs. Cathy The RN can delegate the EN to take blood pressure of the patient and the RN should inform the EN to inform him/her incase the blood pressure is outside the range of 120 to 170 systolic and 50 to diastolic and this is for monitoring the blood pressure of the patient (Steen 2009, pg 14). The RN can also delegate the EN to monitor the patient’s temperature and report any persistent fever above 39 C. Additionally, the RN can delegate the EN to monitor the patient for symptoms such as bleeding, increased abdominal swelling, persistent vomiting and nausea and also monitor the patient’s ability to eat or drink. The RN will advice the EN to report any such symptom because these are some of the complications that can develop after a laparoscopic cholecytecomy. The EN can also clean and monitor the state of the incision and report to the RN. The RN will teach the EN how to clean a laparoscopic cholecytecomy incision to ensure that the EN has the appropriate skills to do so (Medline Plus, 2012, pg 4). The EN can also prepare the painkillers for injection but the RN will administer the medications personally. The RN will assess if the EN has the suitable skills for these delegations by directly supervising these tasks. Mr Liam Farrell The RN can delegate the EN the role of preparing the patient for endoscopy. This will include the EN explaining the text to the patient and the associated risks as well as other surgical procedures. Before this, the RN should ensure that the RN has the appropriate knowledge regarding an endoscopy procedure (Gooszen 2010 pg 1). The EN can also take the medical history of the patient regarding the medication he has been taking and any allergies the patient might be having. The RN can also delegate the role of monitoring the patient to the EN to ensure that the patient does not eat or drink anything for prior to the endoscopy. The EN can also be delegated the role of monitoring the IV cannula insitu left hand of the patient and inform the RN regarding the progress (Gooszen 2010 pg 1). And because the patient is complaining of the chest pain, the EN can listen to the patient’s chest and inform the RN of the breath sound and also take the temperature. The EN can also set up the i.v but the RN should administer the i.v fluid. Additionally, the EN can also administer 15 L/m non-rebreather mask followed by 5 mg of nebulised Salbutamol e to the patient but the RN should supervise the EN while carrying out these tasks and make sure that the EN has prior experience in such tasks. Ben Hansen For the patient, the RN cannot delegate most of the tasks to the EN because most of the patient’s requirements, for example counseling due to distress cannot be delegated. However, the RN can delegate the EN the task of monitoring the patient and reporting any changes to the RN. Additionally, the EN can be delegated with the role of checking the telemetry monitoring and the RN should advise the EN to report incase he/she detects an electrical problem. However, it is the responsibility of the RN to decide of telemetry monitoring should continue or not (CRNBC 2007 pg 45). Mr John Rassmussen The RN can delegate the role of assisting the patient in mobility to the AIN. However, the RN will ensure that the AIN is under supervision while performing these tasks. If the patient has been hurt on the left hip, the RN should personally examine the patient for any injury and incase of a wound the EN can dress the wound and also prepare and give the painkillers to relieve the patient pain. The RN should direct the EN the appropriate painkillers for the patient. The EN can provide the patient with the basic nursing care while the patient is awaiting home placement but the RN can give the AIN the role of assisting the patient will feeding, hygiene and assisting the patient in mobility but with the RN’s supervision. Ms. Hannah Brown The RN is supposed to perform the pre-transfusion check with the assistant of the EN. The RN can assign the EN the role of checking blood product for any signs of leak, lumps or unusual color (Better Medicine 2012, pg 1). The EN can also identify the patient by checking the name, DOB and UR on the Blood Transfusion Record as well as package label and confirm if they match with the patient’s name, DOB and UR on the patient’s wristband. The EN can also be delegated with the role of blood product identification, whereby the EN will check the pack number on the Blood Transfusion Record., package label and the product and confirm if they are identical and also do the blood group check whereby the EN will confirm if the blood group matches the patient’s. Finally, the EN will check the expiry date of the blood package and medical orders (Better Medicine 2012, pg 1). The RN will the complete documentation by signing and delegate the role of recording and filing the Blood Transfusion record within the medical record of the patient to the EN (Cipriano 2010 pg 10). The RN will supervise the EN while doing these tasks and prepare the patient for blood transfusion. In addition, the RN can delegate the EN to monitor the patient during blood transfusion for any sign of potential transfusion’s complications. Before delegating this role, the RN should inform the EN regarding all potential complications so that EN will be in a position to identify them during monitoring. The RN can also delegate the RN to take and record the patient’s temperature, pulse rate, respiratory rate as well as blood pressure and give the records to the RN for interpretation (Better Medicine 2012, pg 1). The EN will perform most of these tasks in presence of the RN and hence the RN will be able to directly assess the EN. Plan for the Shift 0700 The RN will take the list of the patients to care for. Identify the allocated patients, their age and their diagnosis. The patients’ diagnosis include, two days post-op # Right NOF, severe epigastric pain, drug overdose of an unknown drug and alcohol, threatened miscarriage 12 weeks, post- laparoscopic cholecytecomy and a patient of Social admission. 0715 The RN will listen to the report of all the nurses going off shift, and pay special attention to his six patients. Since the report is tape recorded, any questions are supposed to be asked from the leader of the night shift. 0730 The RN will go through the records of the six patients and check every care plan, describing tasks as well as schedules for the day. The RN will also check on any planned discharge or any therapy or diagnostic examination and accordingly the RN will lay his schedule basing on these events as well as on the medication and care schedule of every patient. Around this time, the RN discovers that Mrs. Williams is complaining of abdominal pain. The RN will then ask the EN to prepare the pain killers (Morphine 10 mg IMI and Metoclopramide 10mg IMI) and administer the drugs to the patient (Nanda 2011 pg 64). 0830 The RN will accompany the six patients’ doctors to report on any changes within the previous 24 hours and collect information on the next step in the doctor’s plan. On getting Mr. Farrell’s call regarding the central chest pain, the RN will examine the patient with the help of an EN and call the patient’s doctor and suggest some medication changes to reduce the pain (The Royal Children’s Hospital Melbourne 2012 pg 5). 8.45 Patient should have breakfast: The RN should make sure that patient environment is set up (Boone 2011). 9.00 The RN will collect and store the single-dose medications for the six patients from the pharmacy technician. The RN will then check the doctor’s documentation for new orders and authorize them and set them in motion for each of the six patients. Medications should be administered before patients go to their therapy with rehabilitation or other forms of treatment and examination. On noticing that Mrs. Fatima has a temperature of 38.3 degrees Celsius, Heart rate of 112 beats/per/min and irregular, BP of 135/80, respirations of 20 per/min, Sp02 of 93% on room air, the RN will fast inform the patient’s physician for immediate examination (Gary 2012 pg 4). 0945/ 1000 The RN should fit the morning tea around his/her workload, in consultation with team members because it is vital for him/her to take a break. 1000/ 1130 The RN should do "rounds" on the six patients again to examine blood pressures and other crucial signs and to keep an eye on everyone. On getting a call from the pathology lab regarding Ms. Hannah, the RN should inform the patient’s physician and arrange for blood transfusion, prepare the patient and perform the pre-transfusion check with the assistant of the EN (Linda & Hopper 2007 pg 4). During blood transfusion, the RN will monitor the patient for any complications also with the help of the EN. -1130 -1215 First lunch and Second lunch should be during this duration. When the RN is informed of the Mr. Rasssmussen who is found lying on the floor next to his bed and seemingly in pain, the RN with the help of the AIN or the EN will help the patient back to his bed. The RN will then examine the patient, and advice him not to stand up quickly and to seek for help anytime to he wants to get out of the bed. The RN will then administer the appropriate painkillers and assess any further injury, for instance a fracture. Additionally, the RN will delegate the AIN to assist the patient in mobility any time the patient wants to get out of bed (Levine 2011 pg 4-6). On the arrival of Ben’s fathers, the RN will talk with the patient’s father to answer questions, provide reassurance and explain the condition of the patient to his father since the patient is a minor. The RN will then call the patient’s doctor as the father wants. 1230 Patient’s lunch. The RN should make sure that patient environment is set up (Chan 2007, pg 6). 1300-1430 This is the rest period for patients, and the RN will delegate the AIN to dim ward lights and. This is the period for observations, medications and finish off patient cares for the RN to his/her patient group. During this period, the RN will talk with the AIN regarding patient falls and how the fall can be prevented (International Journal of Evidence-Based Healthcare 2011 pg 2). 1400- 1445 The RN will write note of the six patients and handover using the Dictaphone (Boone 2011, pg 4). 1445 PM shift handover starts (Chan 2007, pg 4) 1515-1530 Handover at bedside to the night shift staff. The RN will give a report to the group of nurses who will be coming in the next shift. The RN will also document the care provide to all the patients during the shift and enter the information into a computerised record that has simple template for routine care (Cifu & Ioannidis 12 pg 25). Effective Communication/Handover The RN should ensure that the handover is taped and the RN is supposed to make time to dictate his/her handover for the next shift to hear. The RN and other staff members on the morning shift are not supposed to leave the ward until handover and bedside handovers is completed as this will allow the coming shift to ask any questions of the preceding shift staff. The RN should speak slowly and clearly and should always begin with the name of the patients along with the present EWS score. Additionally, it is advisory for the RN to give only the relevant information to the oncoming shift and clearly document other information within the patients’ notes (Chan 2007, pg 26-28). Basically, in order to achieve effective communication across the shifts and between inter-disciplinary teams the RN should make sure that all communication is clear and to the point. A multidisciplinary team meeting should be held since many clinicians will be present. The doctor who is directly responsible will present the current situation as well as the relevant background (Chan 2007, pg 28). The assessment will encompass a discussion between the RN and the clinician to clarify the clinical findings in addition to a joint analysis of the results of all pertinent investigations. Finally, recommendations will be agreed by all present and they will be documented within the records of the patients for implementation. Bibliography Better Medicine (2012). Epigastric Pain, Better Medicine, . Boone, K., 2011, IHE Patient Care Coordination (PCC) Technical Framework Supplement, Patient Plan of Care (PPOC): Trial Implementation. IHE International, Inc. Chan, C., 2007, Nursing handovers: do we Really need them? Journal of Nursing Management, Vol. 14/37-42. Cifu, A, & Ioannidis, J., 2012, Reversals of established medical practices: evidence to abandon ship, JAMA. Vol. 307(1):37-38. Cipriano, P., 2010, Overview and Summary: Delegation Dilemmas: Standards and Skills for Practice, OJIN: The Online Journal of Issues in Nursing, Vol. 15/2. . Retrieved on 25th July 2012. CRNBC, 2007, Assigning and delegating to Unregulated Care Providers, Practice Support, Vol. 98/429. Education - ISBAR presentation for staff, ISBAR for clear communication, . Retrieved on 25th July 2012. Gary, D., 2012, The Importance of Understanding Hypertension: The Role of a Registered Nurse as an Investigator, Journal of Nursing, Vol. 2/1. Gooszen, HG, 2010, Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews, Cochrane Database Syst Rev. Vol. 18318. International Journal of Evidence-Based Healthcare, 2011, Experiences of registered nurses as managers and leaders in residential aged care facilities: a systematic review, Int J Evid Based Healthc, Vol. 9/4. < http://www.ncbi.nlm.nih.gov/pubmed/22093388>. Levine, C., 2011, Supporting Family Caregivers: The Hospital Nurse's Assessment of Family Caregiver Needs, AJN, American Journal of Nursing, Vol.111/ 10, Pg 47 – 51. Linda, S., & Hopper, P., 2007, Understanding Medical Surgical Nursing, Davis Company, Philadelphia. < http://www.scribd.com/doc/44456928/Understanding-Medical-Surgical-Nursing>. Retrieved on 25th July 2012. Medline Plus, 2012, Gallbladder removal – laparoscopic, Medline Plus, < http://www.nlm.nih.gov/medlineplus/ency/article/007371.htm>. Nanda, J., 2011, Abdominal Pain Nursing Care Plan - Acute Pain. < http://nursing-care-plan-nanda.blogspot.com/2011/04/abdominal-pain-nursing-care-plan-acute.html>. Retrieved on 25th July. The Royal Children’s Hospital Melbourne, 2012, Blood administration, < http://www.rch.org.au/bloodtrans/prodadmin.cfm?doc_id=5322>. Retrieved on 25th July 2012. Steen, A, et al., 2009, Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial, JAMA. Vol. 302(20):2222-2229. Read More