Question

You are a staff nurse on a 32-bed cardiac step-down unit. You are assigned as the preceptor for Tony, RN, a new graduate nurse, who just started his nursing career on your floor.

1. You and Tony just received morning shift report on your patients. You are assigned the following patients. Which patient do you and Tony need to see first? Explain your answer.

1. Mr. Dodson, a 52-year-old patient who was admitted yesterday with a diagnosis of angina pectoris. He is scheduled for a cardiac stress test at 0900.

2. Mrs. Wallace, a 60-year-old patient who was transferred out of intensive care at 0630 today. She had uncomplicated coronary artery bypass surgery yesterday.

3. Mr. Workman, a 45-year-old patient who experienced a myocardial infarction 2 days ago. He is complaining of chest pain rated as 6 on a scale of 0 to 10.

4. Mrs. Harris, a 76-year-old patient who had a permanent pacemaker inserted yesterday. She is complaining of incision pain rated as a 5 on a scale of 0 to 10.

2. As you work with Tony on your unit, you notice that he has trouble with time-management skills when providing patient care. Which strategies will you suggest to Tony to help him improve organization of his delivery of patient care?

3. Sonya, a nursing assistive personnel (NAP), is paired to work with you and Tony. You overhear Tony giving Sonya directions for what she needs to do. Tony says, “Sonya, assist Mrs. Harris in room 418 with her afternoon walk. Take her pulse before and after she walks and record it in her chart. I'll check with you when you're finished to see how she did.” On the basis of what you know about delegation, did Tony give appropriate or inappropriate directions to Sonya? Provide rationale for your answer.

Answer 1

Q1. We will meet the third patient with MI, 2 days ago and still complaining pain rated as 6 in the scale. This should be attended first. Because patient is suffering from severe pain even after 2 days Of MI. It should be notified immediately to the physician and take appropriate measures as prescribed. I think pain management is the immediate priority.

Q2. Time management

​​Appropriate utilisation of time is the key factor of nursing care and professional nursing practice. The nurse is a person who have key responsibilities concerned to a patient, and it is very important to complete whole process within the time phrame.

There are certain strategies to organise time while giving nursing care

• Come earlier for the duty

Coming 20-30 minutes earlier will help you to watch all the patient just a look at the nursing chart and plan today's care accordingly.

• Set priorities

After seeing all the patients, you have to set your priorities on which patient requires immediate attention.

• Estimate approximate time for each task

It will be helpful for you toassure that you stick on the time frame and can save time and energy.

• Avoid outside activities during your shift

Stick on your wsrd duties, and should not involved in other activities like chatting with friends and colleagues. Focus on your responsibility and duties.

• Do not give much time in patient's petty concerns

Patient Queries are important. But if patient come to you with petty reasons, you should make aware of them that it is not an urgent affair and can be done later. By this way, you can save time

• Inculcate flexibility

Flexibility is a needed quarter for a nurse to change priorities according to the demand of the situation. ie. When a new person admitted to your ward requires immediate attention, need to look the new patient and give appropriate nursing care and stabilize the patient and come back to the original schedule.

• Be organized

You should ensure that your work space for friendly to deal avoid piling of patient case sheets and things. This will you make you exhausted and bored.

• Appropriate documentation

Documentation of events at the time will manage your time. Nurse's record should be maintained throughout the shift and can have reference of the patient in later shifts.A

• Appropriate delegation of responsibilities

You are a member of a health care team. It is not required to do all the responsibilities by your own. Appropriate delegation of responsibilities to your subordinates staffs like nursing assistant and attenders make you to concentrate your duties. But make sure that you delegate the duties appropriate to the person at the appropriate circumstances.

​​​​​​Q3.Delegation of responsibilities

Delegation of responsibilities is an important component of nursing care.

Delegation involves the assignment of the performance of activities or tasks related to patient to unlicensed assistive personnel but retaining accountability of the outcome.

Key principles of delegation are:

1. Right task
2. Right circumstances
3. Right person
4. Right supervision
5. Right direction and communication

As per the principles, It is not the appropriate delegation. Because, vital signs monitoring of a patient should not be done by an assistive personnel, it should be done and supervised by a qualified or licensed health care personnel especially a registered nurse. Also, the documentation of vital signs and keeping up to date Nurses Record is an important responsibility of a nurse which cannot be delegated.

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