Prioritization and Delegation in Nursing: A Case Scenario

QUESTION

ohn is a new nurse, still in orientation with a preceptor, on the intermediate care unit. The following patients are assigned to John:

• Room 230—A 48-year-old admitted yesterday evening with an acute myocardial infarction; waiting for an angiogram and needs vital signs taken.
• Room 231—A 72-year-old patient with chronic congestive heart failure; taking multiple medications for blood pressure and just finished eating. PO intake needs to be documented in the chart.
• Room 232—A 51-year-old patient who had a coronary artery bypass graft 3 days ago; waiting for IV to be discontinued and needs teaching prior to discharge.
• Room 233—A 54-year-old patient in the ED with a medical diagnosis of uncontrolled atrial fibrillation; has admitting orders. Needs transported to the floor and admission assessment completed.

John is caring for the patients under the supervision of Dana, his preceptor, who is also the day shift charge nurse. He has completed his first assessment and is looking at the medications for his patients. He notes multiple medications ordered for bed 231, new medications ordered for bed 230, and medication teaching needed for bed 232. As he makes the notations to himself, Dana gives him abnormal lab values for the patient in 230, with instructions to notify the provider. The LVN on the floor reminds John of the admit waiting in ED. The nursing assistant points out that the patient in 232 is very impatient; he is waiting for his diet and medication instructions as well as the IV to be discontinued so that he can be discharged. At this point, John becomes frustrated trying to juggle all the demands on his time.

1. Discuss John’s top three priorities and provide a rationale why each one is a priority.

2. What other personnel are available to John as a resource for delegating tasks?

3. What tasks can be delegated to the LVN?

4. Which tasks can be delegated to the nursing assistant?

ANSWER

Prioritization and Delegation in Nursing: A Case Scenario

Introduction

In this case scenario, John, a new nurse in orientation, is facing multiple patient care responsibilities under the supervision of Dana, his preceptor and the day shift charge nurse. The demands on his time and the varying needs of his patients are causing frustration and uncertainty. This essay will discuss John’s top three priorities and rationale, identify available personnel as resources for task delegation, and outline tasks suitable for delegation to the LVN and nursing assistant.

John’s Top Three Priorities and Rationale:

Room 230—Acute Myocardial Infarction Patient: John’s first priority should be attending to the patient in Room 230, who was admitted with an acute myocardial infarction. The patient’s condition is critical, and vital signs need to be taken regularly to monitor for any signs of deterioration or improvement. Early detection of any changes is essential to ensure timely intervention and optimal patient outcomes.

Room 232—Post-CABG Patient: John’s second priority should be the patient in Room 232, who had a coronary artery bypass graft 3 days ago and is waiting for discharge instructions. It is crucial to provide the patient with the necessary education on diet and medications to ensure a smooth transition from the hospital to home care. Discontinuing the IV and preparing for discharge will also contribute to the patient’s overall well-being and satisfaction.

Room 231—CHF Patient with PO Intake Documentation: John’s third priority should be the patient in Room 231, who has chronic congestive heart failure and requires documentation of PO intake. Proper documentation is crucial for tracking the patient’s fluid intake and response to medications, helping to maintain the patient’s stability and preventing complications related to CHF.

Available Resources for Task Delegation:

Dana, Preceptor and Charge Nurse: Dana can serve as a valuable resource for John to seek guidance, clarification, and support in managing patient care responsibilities. As an experienced nurse, Dana can provide mentorship and help prioritize tasks based on patient acuity and needs.

LVN (Licensed Vocational Nurse): The LVN on the floor can assist John in various tasks that are within their scope of practice, such as administering medications, performing wound care, and collecting vital signs. Delegating appropriate tasks to the LVN can help alleviate some of John’s workload and ensure efficient patient care.

Nursing Assistant: The nursing assistant can provide essential support to John by assisting with activities of daily living (ADLs), ambulation, and basic patient care tasks. Delegating appropriate tasks to the nursing assistant can free up John’s time to focus on higher-priority patient care responsibilities.

Tasks Suitable for Delegation to the LVN:

Administering medications, including those with new orders for Room 230 and multiple medications in Room 231.
Assisting with IV discontinuation and discharge preparation for the patient in Room 232.

Tasks Suitable for Delegation to the Nursing Assistant:

Assisting patients with ADLs, including ambulation and hygiene.
Providing comfort measures, such as offering water or blankets.
Transporting the patient from the ED to the floor for the patient in Room 233.

Conclusion

Prioritization and delegation are essential skills for nurses to manage complex patient care scenarios effectively. In this case, John’s top three priorities are based on patient acuity and immediate needs, while Dana, the LVN, and the nursing assistant serve as valuable resources for task delegation. By understanding the roles and responsibilities of each team member, John can enhance patient care, reduce stress, and improve overall efficiency in the intermediate care unit.