Introduction: This assignment asks you to make client care assignments for an oncoming
shift and articulate rationales for your choices.
Assignment: As the RN charge nurse, you are preparing to make assignments for the oncoming
shift on the medical-surgical unit. Your unit has 12 beds. Currently, your census is 11, with one
empty bed. Besides yourself, you have the following staff:
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Raul, an experienced RN.
Tara, an RN orientee assigned with Raul for the shift. It is her third day on the unit.
Monique, a supplemental RN. The last assignment in this unit was three weeks ago.
Dorothy, an experienced LPN.
Timmy, an experienced nursing assistant.
Val, unit secretary. Split between your unit and the one next door as theirs called in
sick
Please assign these patients to staff, being mindful of the scope of practice and ability levels of
staff members. You may wish to review course materials from Nursing 108 on delegation and
supervision. Please adhere to the LPN practice in your state; for instance, in New York, LPN’s
cannot do the initial assessment, but they can contribute and sign off on it. Please utilize and
reference (APA style) the National Guidelines for Nursing Delegation when completing this
document.
In your assignment address the following:
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What nursing intervention is the top priority for each patient?
Fully utilize your staff. Most patients will have more than 1 staff assigned.
Rationales are key. WHY did you assign staff in this fashion? Include information
about how you will assign yourself and your support staff during the shift. Keep in
mind that an empty bed will mean somebody will get admission during the shift.
In addition, address the following questions in this document:
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Who is the sickest patient? Please justify your response.
The LPN is sick and leaves. A float nurse comes onto the unit to pick up her
assignment. Would you readjust the assignment at all? Please justify your response.
During your work this week, observe someone delegating. What went well and why?
Please reference the National Guidelines for Nursing Delegation when addressing
this question.
Patients currently on unit:
#2201: 51-year-old female with T1DM (type one diabetes) who has ESKD (end-stage kidney
disease). She was admitted for a revision of her A-V fistula. She has a temporary Hemodialysis
catheter in place. She’s scheduled for hemodialysis this morning.
Assignment:
Raul, Tara, and Timmy
Rationale:
Patient is a high-risk patient with multiple complex conditions and is
scheduled for a procedure. Raul is an experienced RN and is best suited to
provide care and monitoring for this patient. Patient is not stable. So, I will
not assign the LPN. An RN must assess the kidney function, old AV fistula
site, and temporary hemodialysis catheter. In addition, T1DM
complications sure be assessed. Evaluate and assess after returning from
hemodialysis also (Hinkle & Cheever, 2018). Raul can be assigned. Tara
can help him with revision of the AV fistula, taking blood glucose, vitals,
urine, intake and output under Raul’s supervision. Timmy can also be
assigned to assist the patient with ADL’s, feeding, and toileting if needed
(Catalano, 2020).
#2202: 72-year-old male patient with a CBI (continuous bladder irrigation) who is post-op from
a TURP yesterday. He has had many clots passed through the CBI and has needed the catheter
manually irrigated three times during the past shift.
Assignment:
Raul, Tara, and Timmy
Rationale:
Patient is post-op and requires close monitoring, but his care does not
require advanced skills. Tara is an RN orientee and will be supervised by
Raul. This assignment will provide Tara with the opportunity to learn and
practice post-op care while ensuring the patient receives appropriate care.
#2203: empty bed.
Assignment:
Raul and Tara
Rationale:
A new admission would be helpful to orient Tara to the unit. Raul would
be assigned to new admission and Tara would observe and assist.
#2204: 88-year-old female patient admitted two days ago with urosepsis. She’s currently
getting IV antibiotics through a peripheral IV every eight hours. She has been incontinent of
urine twice during the past shift. She is currently complaining about pain at the site of her IV.
Assignment:
Dorothy, Monique , and Timmy
Rationale:
Patient is an older patient with multiple complex conditions, and her care
requires close monitoring. Monique is an experienced RN and has been
assigned to the unit previously, making her familiar with the patient
population and unit policies and procedures. Monique can provide
appropriate care for this patient. Other than pain at the IV site, this patient
seems stable with no unexpected outcomes anticipated (Catalano, 2020).
Dorothy can assess the IV site for complications, maintain IV stability, and
give IV antibiotics. Dorothy will report to Monique IV complications
which will then need to be assessed by the RN (Treas, et al., 2018).
Monique can restart the IV or insert a new one if needed. Timmy can assist
the patient with ADL’s, feeding, and toileting if needed (Catalano, 2020).
#2205: 44-year-old female patient who had a cystoscopy yesterday for a biopsy of her bladder.
Cancer is suspected. She is currently waiting for the provider to write her discharge orders so
she can go home today.
Assignment:
Monique and Val
Rationale:
Patient is stable and awaiting discharge. Monique can prepare patient by
provide discharge instructions and teaching as needed. Val can be helpful
by printing discharge paperwork and scheduling follow up appointments
as needed (Catalano, 2020).
#2206: 69-year-old male patient with uncontrolled hypertension and chronic kidney disease
admitted last evening. He has a history of non-adherence to his medications at home and
comes into the hospital every four to five months with chest pain, high BP readings, and weight
gain. He’s been prescribed furosemide, lisinopril, and metoprolol. His provider would like to
send him home tomorrow. He has not been evaluated by the case-manager on your unit yet.
Assignment:
Raul, Tara, and Timmy
Rationale:
Patient is unstable. Due to uncontrolled hypertension, history of nonadherence to meds, and known CKD this patient should be assigned to an
experienced RN. Raul and Tara can provide education of the importance of
drug compliance and frequent cardiac and renal monitoring. They can
assess and monitor the patient to better formulate an appropriate treatment
plan while awaiting a case management consult. Timmy can assist the
patient with ADL’s, feeding, and toileting if needed (Catalano, 2020).
#2207: 21-year-old female patient with an acute kidney infection. She was admitted during the
night. The patient currently has IV of 0.9% normal saline infusing at 100 ml/hr via peripheral IV
and is complaining of 9 out of 10 back pain. Is febrile with a temp of 100.6 F
Assignment:
Dorothy, Raul, Tara and Timmy
Rationale:
Dorothy is able to monitor vital signs and perform a pain assessment. In
addition, Dorothy can report to Tara if needed. An LPN can medicate a
patient for pain and monitor intake and output. The LPN is responsible to
report any changes in the patient’s condition to the RN. The patient is a
young patient with a relatively simple condition, acute kidney infection,
and is stable. Tara is an RN orientee and will be supervised by Raul. This
assignment will provide Tara with the opportunity to learn and practice
managing acute infection while ensuring the patient receives appropriate
care. Timmy can assist the patient with ADL’s, feeding, and toileting if
needed (Catalano, 2020).
#2208: 60-year-old male patient with renal calculi diagnosed by CT scan. Being medicated with
IV Fentanyl every three hours for 10 out of 10 pain reported by the patient. Receiving IV fluids
and needs assistance to the bathroom. Urine must be strained each time the patient voids.
Assignment:
Monique and Timmy
Rationale:
Patient is unstable. IV Fentanyl and frequent assessments are beyond the
scope of practice for an LPN. Therefore, and RN should be assigned. The
UAP will be assigned to assist the patient with ADL’s and feeding, as
well as elimination needs and will be instructed by the RN to strain all
urine and report to the RN when the patient voids so the RN can inspect
the urine (Catalano, 2020). This patient requires close monitoring and
assistance with mobility and basic needs. Timmy is an experienced
nursing assistant and can provide appropriate care for this patient.
#2209: 72-year-old male admitted with hematuria. He is having diagnostic testing completed
for renal carcinoma. The patient has a history of leukemia as a 40-year-old. This patient and his
family are very upset by the diagnosis and the patient is intermittently tearful.
Assignment:
Dorothy, Raul, Timmy
Rationale:
This patient can be assigned to an LPN. It is within the LPN’s scope of
practice to prepare the patient for testing. Dorothy can provide support to
the patient and family. Dorothy can report to Raul if a referral is needed
for counseling. Timmy can assist the patient with ADL’s, feeding, or
toileting if needed (Catalano, 2020).
#2210: 55-year-old female admitted with community-acquired pneumonia. She is currently on
4 L NC and has an 02 saturation of 92% at rest. She is short of breath and has been ringing for
the nurse frequently as she is frightened of dying when she gets SOB. She is receiving
levofloxacin IV every 24 hours for her pneumonia. This patient also has an ileal conduit with a
drainage bag attached. She had her bladder removed ten years ago due to cancer.
Assignment:
Monique and Timmy
Rationale:
Monique will be assigned to care for the ileal conduit and focused
respiratory assessments through her shift. Monique can also provide
support for fear of death related to SOB and provide a referral to
counseling if needed. Timmy would assist with ADLs, and possibly
emptying the conduit after Monique teaches and observes him doing so
(Catalano, 2020).
#2211: 76-year-old male patient with cellulitis on his left shin. He’s on contact precautions for
MRSA. He has been receiving continuous peritoneal dialysis at night, he’s assigned to your unit,
as your staff has the training to use the PD equipment.
Assignment:
Raul and Tara
Rationale:
Patient would be assigned to Raul and Tara for post op care of
peritoneal dialysis, hemodynamic monitoring and maintaining contact
precautions while providing wound care for MRSA infection of left shin.
I would encourage them to provide all care for this patient so that the
UAP will not be exposed to the MRSA or inadvertently carry it through
out the floor to others.
#2212: 40-year-old female patient with a developmental disability from a group home setting.
She was admitted with pyelonephritis during the night. She is scheduled for discharge today.
She will need her IV discontinued and discharge instructions will need to be given to the patient
and her caregiver.
Assignment:
Dorothy, Monique, Val, and Timmy
Rationale:
Dorothy (LPN) can be assigned to this patient. The LPN can provide
care, education and perform IV removal. Monique can give initial
discharge instructions with Dorothy to reinforce with patient and
caregiver. Val can print paperwork and provide follow up scheduling for
the patient. Timmy can help assist the patient with ADL’s, feeding, and
toileting if needed (Catalano, 2020).
As the charge nurse, I will be supervising the other staff members and managing the overall care
of all the patients on the ward. I will also be available to assist in any high-acuity scenarios or
procedures that arise. I will work closely with Val, the unit secretary, to ensure that patient data
and documentation are accurate and up to date. I will assess needs and acuity of patients on my
unit. I will assign nurses to patients based on what staff is compatible and qualified to meet
patient’s needs. Daily assignment should be fair and as coordinator it is my job to oversee that
needs are being met correctly and appropriately. If needed, I would intervene if warranted and
provide staff education as needed. I am to be available to all staff for any questions and will lend
a hand on the floor if necessary. I will also be sure to remain available for any issues or problems
that occur on the unit, and be available to handle any family complaints that may arise (Catalano,
2020).
The most important nursing interventions:
#2201 - Assist in managing renal disease and diabetes by administering medicines and
monitoring her blood sugar levels.
#2202 - Monitoring and maintaining CBI is critical, including hand irrigation if required.
#2204 - Administer Intravenous antibiotics and monitor for any signs and symptoms of infection
or adverse reactions.
#2205 - The number one priority is making sure the patient has the right discharge planning and
follow-up care.
#2206 - The patient's biggest concerns are keeping an eye on his hypertension, ensuring sure he
takes his meds as directed, and getting him ready for discharge.
#2210 – Sickest Patient - She is a 55-year-old woman with community-acquired pneumonia who
is experiencing shortness of breath, has an ileal conduit, and is being treated with contact
precautions. At rest, her oxygen saturation is at 92%, and she is being treated with antibiotics via
IV. She has also had cancer in the past, so her health has to be closely monitored.
#2211 – post op care of peritoneal dialysis, hemodynamic monitoring and maintaining contact
precautions while providing wound care for MRSA infection of left shin
#2212 – IV removal and making sure the patient has the right discharge planning and follow-up
care.
As far as a staff member becoming ill and going home. If the primary LPN became ill and had to
leave, I would assign patients depending on the substitute nurse’s knowledge and skill level. I
would also consider the complexity of the patient's treatment and the level of acuity of each
patient. I would make sure the new nurse is aware of the patient's conditions, current
prescriptions, and treatment plans before reassigning them. Moreover, I would oversee and
supervise the substitute nurse and make sure that any work assigned to them was within the
parameters of their scope of practice (RN vs LPN).
When delegating, it is crucial to keep in mind:
The person receiving the delegation is qualified to perform the work or take on the obligation.
The person to whom the work or obligation is assigned possesses the knowledge, abilities, and
skills necessary to carry out the assignment safely. The person assigned the task or responsibility
is aware of what is expected of them and what the results will be. The individual to whom the
work or obligation is delegated is aware of their own limits and any potential hazards involved
with the assignment. The person to whom the work or obligation is assigned receives the
necessary guidance and assistance. The person to whom the work or obligation is assigned
receives the proper assessment and feedback.
References:
Catalano, J. T. (2020). Nursing now: Todays issues, tomorrows trends (8th ed.). The
Development of a Profession., Philadelphia, PA: F.A. Davis Company.
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarths textbook of medical-surgical
nursing (14th ed.). Philadelphia: Wolters Kluwer.
Treas, L., Wilkinson, J., Barnett, K., & Smith, M. (2018). Basic nursing second edition thinking,
doing, and caring. Philadelphia, PA: F.A Davis Company