Group A:

Learning exercise 21.5 – answer the questions posed in the exercise for Situations 1 & 4

Situation 1

You are a circulating nurse in the operating room. Usually, you are assigned to Room 3 for general surgery, but today, you have been assigned to Room 4, the orthopedic room. You are unfamiliar with the orthopedic doctors’ routines and attempt to brush up on them quickly by reading the doctors’ preference cards before each case today. So far, you have managed to complete two cases without incident. The next case comes in the room, and you realize that everyone is especially tense; this patient is the wife of a local physician, and the doctors are performing a bone biopsy for possible malignancy. You prepare the biopsy area, and the surgeon, who has a reputation for a quick temper, enters the room. You suddenly realize that you have prepped the area with Betadine, and this surgeon prefers another solution. She sees what you have done and yells, “You are a stupid, stupid nurse.”

Situation 4

You are a new nurse working on a busy medical/surgical floor. The mode of patient care delivery used on the unit is team nursing. You have grown increasingly frustrated, however, with a licensed vocational nurse/licensed practical nurse on your team who is unwilling to answer call lights. You have directly observed her both ignore call lights and go out of her way to avoid answering the lights. When you confront her, she always provides an excuse such as she was on her way to do something for another patient or that she did not notice the blinking call light. The result is that you often must run from one end of the hall to the other to answer the call lights because patient safety could be at risk. Your frustration level has risen to the point that you no longer wish to work with this person.

Group B:

Learning exercise 21.5 – answer the questions posed in the exercise for Situations 2 & 5

Situation 2

You are the intensive care unit charge nurse and have just finished an exhausting 8 hours on duty. Working with you today were two nurses who work 12-hour shifts. Each of you were assigned two patients, all with high acuity levels. You are glad that you are going out of town tonight to attend an important seminar because you are certainly tired. You are also pleased that you scheduled yourself an 8-hour shift today and that your replacement is coming through the door. You will just have time to give report and catch your plane.

It is customary for 12-hour nurses to continue with their previous patients and for assignments not to be changed when 8- and 12-hour staff are working together. Therefore, you proceed to give report on your patients to the 8-hour nurse coming on duty. One of your patients is acutely ill with fever of unknown origin and is in the isolation room. It is suspected that he has meningitis. Your other patient is a multiple trauma victim. In the middle of your report, the oncoming nurse says that she has just learned that she is pregnant. She says, “I can’t take care of a possible meningitis patient. I’ll have to trade with one of the 12-hour nurses.” You approach the 12-hour nurses, and they respond angrily, “We took care of all kinds of patients when we were pregnant, and we are not changing patients with just 4 hours left in our shift.”

When you repeat this message to the oncoming nurse, she says, “Either they trade or I go home!” Your phone call to the nursing office reveals that because of a flu epidemic, there are absolutely no personnel to call in, and all the other units are already short staffed.

Situation 5

You are a staff nurse on a small telemetry unit. The unit is staffed at a ratio of one nurse for every four patients, and the charge nurse is counted in this staffing because there is a full-time unit secretary and monitor technician to assist at the desk. The charge nurse is responsible for making the daily staffing assignments. Although you recognize that the charge nurse needs to reduce her patient care assignment to have time to perform the charge nurse duties, you have grown increasingly frustrated that she normally assigns herself only one patient, if any, and these patients always have the lowest acuity level on the floor. This has placed a disproportionate burden on the other nurses, who often feel the assignment they are being given may be unsafe. The charge nurse is your immediate supervisor. She has not generally been responsive to concerns expressed by the staff to her about this problem.

Group C:

Learning Exercise Learning exercise 21.5 – answer the questions posed in the exercise for Situations 3 & choose Situation 4 or 5.

Situation 3

You are the charge nurse on a step-down unit. It is your first day back from a 2-week vacation. The shift begins in 10 minutes, and you sit down to make staffing assignments. The central staffing office has noted that you must float one of your RNs to the oncology unit. When you check the floating roster, you note that Jenny, one of the RNs assigned to work on your unit today, was the last to float. (She floated yesterday.) That leaves you to choose between Mark and Lisa, your other two RNs. According to the float roster, Mark floated 10 days ago, and Lisa floated last 11 days ago. You tell Lisa that it is her turn to float.

Lisa states that she floated three times in a row while Mark was on vacation for 2 weeks last month. Mark says that vacations should not count and that he should not float because it is not his turn. Lisa says that Jenny should float, as she floated to oncology yesterday and already knows the patients. Jenny says that she agreed to come in and work today (on her day off) to help the unit, and she would not have agreed to do this if she had known that she would have to float. Mark says that it is the last day of a 6-day stretch, and he does not want to float. Jenny says that it is not her turn to float, and she does not want to float willingly.

Situation 4

You are a new nurse working on a busy medical/surgical floor. The mode of patient care delivery used on the unit is team nursing. You have grown increasingly frustrated, however, with a licensed vocational nurse/licensed practical nurse on your team who is unwilling to answer call lights. You have directly observed her both ignore call lights and go out of her way to avoid answering the lights. When you confront her, she always provides an excuse such as she was on her way to do something for another patient or that she did not notice the blinking call light. The result is that you often must run from one end of the hall to the other to answer the call lights because patient safety could be at risk. Your frustration level has risen to the point that you no longer wish to work with this person.

Situation 5

You are a staff nurse on a small telemetry unit. The unit is staffed at a ratio of one nurse for every four patients, and the charge nurse is counted in this staffing because there is a full-time unit secretary and monitor technician to assist at the desk. The charge nurse is responsible for making the daily staffing assignments. Although you recognize that the charge nurse needs to reduce her patient care assignment to have time to perform the charge nurse duties, you have grown increasingly frustrated that she normally assigns herself only one patient, if any, and these patients always have the lowest acuity level on the floor. This has placed a disproportionate burden on the other nurses, who often feel the assignment they are being given may be unsafe. The charge nurse is your immediate supervisor. She has not generally been responsive to concerns expressed by the staff to her about this problem.