Management of an Oncology Unit

RN CASE STUDY Management of an Oncology Unit RN Case Study This scenario demonstrates leadership and management on an oncology unit. Using effective leadership skills, the charge nurse demonstrates skill in priority setting, delegation, supervision, and client care assignments. Students on the oncology unit have the opportunity to observe effective communication and team collaboration resulting in the provision of safe client care. Ms. Young asks the nurse about the lab data and the nurse responds by saying "i'm not sure. I Don't know what happened to the lab reports this morning." How should Ms. Young respond? I need you to find the reports as quickly as possible. (This is an assertive, non-judgemental response that places the responsibility back on the nurse accountable for the report) One of the clients has a hemoglobin level of 6.0 g/dl since the last time labs were drawn the previous day. Which action should the charge nurse implement in response to this information? Contact the healthcare provider immediately to report the lab test results verbally. (lab results are critical values that should be reported immediately. The information should be confirmed by the HCP by repeating the information back to the nurse. Image: One of the clients has a hemoglobin level of 6.0 g/dl since the last time labs were drawn the previous day. Which action should the charge nurse implement in response to this information? What is the best response by the charge nurse? You may obtain data from the charts until the staff nurse assigned to your client has time to give report. (To ensure the provision of safe care, the students need a current report on the assigned clients. However, the students need to understand that other priorities may take precedence over the provision of the report.) A PN may be assigned to care for a client with which nursing diagnosis? Disturbed body image related to alopecia (this client needs emotional support, which can be provided by a PN) Which of the clients is experiencing pain management problems is the most appropriate assignment for the PN? Complaining of constipation after opioid analgesics for 1 week. Guidelines for Assigning Client Care Determine the amount of nursing care time required and the complexity of the activities allocated. Identify who, of the available staff, is best qualified to provide the client's care, considering attitudes, skills, demeanor, and efficiency. Consider each staff member as an individual with a unique combination of needs,skills, and talents. Strive to maximize continuity of care and reduce fragmentation. Combine assignments to increase efficiency; consider treatment schedules and geographic location of clients. Describe the assignment in measurable terms; be specific about expected results. Designate one person or an absolute minimum number of staff to be responsible for each client's care. Plan to provide additional help, direction, or instruction as necessary to match the needs of individual staff members. Communicate assignments clearly, preferably in writing. Follow-up frequently during the shift to check progress and any changes in clients and subsequent changes in assignments. Assign responsibility for holistic care: avoid assigning only nursing procedures. Assigning Client Care Work to Be Done Based on Client Needs Health condition: Unstable Unpredictable Infectious Complex Environmental factors: Location of client to needed utilities Number and frequency of time-consuming tasks Interdisciplinary treatmentschedules Other needed agency resources: Equipment Supplies Physical plant Coordination of other therapies Staff Assignment Considerations Employee's scope of practice: Legal requirements Legal restrictions Employee's position description Agency's division of work: Formal organization policies Employee's characteristics: Need for in-service education to use safely and cost-effectively Skills and special talents Credentials, personality Related experiences Attitudes One of the nurses speaks confidently with Ms. Young and confides that she suspects another staff nurse is stealing and using controlled medications instead of administering them to clients. What action should Ms. Young implement first? Observe the suspected abuser's behavior to confirm the nurse's suspicions. Signs and Symptoms of Possible Substance Abuse SIGNS Psychosocial problems Irritability Moodiness Tendency to isolate self Social changes Eating alone Avoiding social gatherings Changes in personal appearance Changes in dress Unkempt appearance Flushed complexion Red eyes Swollen face Hand tremors Mental status changes Forgetfulness Confusion Decreased alertness General behavior changes Inappropriate responses Elaborate excuses for behavior Intolerance of others Suspiciousness Nervousness SYMPTOMS Odor of alcohol Slurred speech Unsteady gait Errors in judgment How should Ms. Young respond? Random drug testing protects all the staff and clients from unsafe practice. this response is assertive but non-judgmetal and supports the desired outcome of having the nurse participate in the random drug testing How many total people should sign the log when a narcotic is wasted? 2 when wasting narcotics, the nurse disposing of the drug must sign the narcotic log in presence of a witness Which client care assignment makes use of this nurse's expertise? Monitor a client with thrombocytopenia receiving platelets. A RN working in a surgical setting is likely to have expertise in the administration of blood products and the care of clients at risk for bleeding Image: Which client care assignment makes use of this nurse's expertise? Which client should be assigned to the RN rather than the PN? Unwilling to observe his new ileostomy stoma and pouch. This client needs emotional support, assessment and teaching that is provided by RN Which client care activity should be assigned to the PN from the float pool? Provide postmortem care. This activity requiresthe least expertise, making it the best assignment for the float PN PN prepares to administer postmortem care and asks UAP to provide assistance, Ms. Young overhears this request and notes the UAP refuses to help stating several of her other assigned tasks must be completed first. What action should the charge nurse implement? Review the tasks assigned to the UAP to help determine priorities. The charge nurse should help the UAP prioritize and evaluate the assigned tasks to determine if the UAP has time to assist the PN with the postmortem care. Upgrade to remove ads Only $3.99/month A student tells the UAP that he would like to assist the PN with postmortem care. Upon entering the clients room where the PN and Charge nurse are reviewing the care needed, the student nurse states that the USP told him he can assist the PN. How should Ms. Young respond? Allow the student to assist the PN with portmortem care, but remind him that the UAP may not delegate client care. The student should be encouraged to participate in learning experiences, but both the student and the UAP must understand that the UAP does not have the authority to delegate client care Image: A student tells the UAP that he would like to assist the PN with postmortem care. Upon entering the clients room where the PN and Charge nurse are reviewing the care needed, the student nurse states that the USP told him he can assist the PN. How should Ms. Young respond? Another nurse is caring for a client who had a tracheostomy 2 days earlier. The RN and UAP are providing morning care to this client when the RN gets called to help another nurse with an emergent care. Which task can be delegated to the UAP who is assisting the nurse? Monitor the client's oxygen saturation and respiratory rate Ms. Young seeks out the UAP when the care of the client with the tracheostomy is completed. She counsels the UAP about refusing to help with postmortem care and reminds the UAP that UAP's do not have the authority to delegate care, even to student nurses. Who Has Accountability? Delegator Own acts Acts of delegation Acts of supervision Assessment of the situation Follow-up Intervention Corrective active Delegatee Own acts Accepting the delegation Appropriate notification and reporting Accomplishing the task A student is assigned to care for a client with an DNR and pt has DNR bracelet in accordance with the policy of the medical center. The client asks the student to explain what DNR means. The student is not sure how to respond and leaves the room to ask the charge nurse for assistance. What action should Ms. Young implement? Return to the client's room with the student and explain the meaning of the DNR status to the client. The situation requires good communication skills the charge nurse can serve as a role model for the student when discussing this sensitive information with the client. The client tells the nurse that he wishes to remove the DNR order and wants life saving measures to be provided if necessary. After speaking with the client about the change in DNR status, what action should the charge nurse initiate first. After speaking with the client about the change in DNR status, what action should the charge nurse initiate first? Notify the healthcare provider of the client's wishes. Before any action can be taken in response to client's wishes, the student rushes to the nurses desk and tells Ms. Young that the client has stopped breathing and is responsive, What action should the charge nurse implement first? What action should the charge nurse implement first? Page the emergency response team. Since the client has expressed his desire to be resuscitated, the nurse should initiate resuscitation measures. This includes calling the emergency response team, even though the HCP has not been contacted about the change in DNR status Ms. Young thoroughly documents the conversation with the client their wishes to be resuscitate and also contacts the HCP to obtain a Prescription to cancel the DNR. THe client plans to talk about this with his family members when they come to visit later in the evening. The CNS is administering a vesicant chemotherapeutic agent and observes that the IV has infiltrated. After local antidote has been administered, the IV was discontinued. Which instruction is most important to emphasize with the primary RN caring for the client? Perform circulation checks every 15 minutes and report any changes. The CNS returns to the client's room in an hour and notes a distinct change in the client's circulation distal to the infiltration site. The RN reports that the UAP has been monitoring the IV site as directed and that no changes in circulation have been reported. What management error has just occurred? -The RN delegated care to the UAP which should have been performed by the RN. (assessment and analysis of the findings are the responsibility of the RN should not be delegated to the UAP) -The RN did not check the clients IV site as instructed (not a UAP task, its is RN responsibility for checking IV sites) The CNS notifies the charge nurse of the situation and reports that the HCP has been contacted about the change in the client's circulation. The CNS requests that the charge nurse meet with the staff involved in the incident as soon as possible. In addition, Ms. Young has several other tasks to complete. Which action should Ms. young take first? Assign an RN to assess a newly admitted client diagnosed with brain cancer. A newly admitted client must be assessed promptly to ensure basic client safety. This action has the highest priority since. safety is a concern, especially if the client is confused or disoriented due to the brain cancer. While making the new staff assignment, the UAP runs into Ms. Young's office yelling that one of the clients has become confused and combative. What action by the charge nurse has the greatest priority? Advise the primary nurse that a new admission will be arriving shortly. It is the responsibility of the primary RN to ensure safe admission of the new client. Notifying the primary RN prior to the arrival of a client allows the nurse to plan and prioritize care for the client's on the unit How should Ms. Young proceed? -Instruct the UAP to call security (if the client is becoming combative and may hurt someone, it is important to get security assistance as soon as possible) -Go into the client room to assist the RN Upgrade to remove ads Only $3.99/month Ms. young meets with a family member who is angry about his mother's care. Their conversation reflects the son's anger about his mother's impending death. He repeatedly states that his mother's illness and imminent death are unfair to to him and the other family members. He says he does not understand why this is happening. With whom should Ms. Young collaborate to revise the nursing plan of care for this man's mother? -The primary nurse caring for this patient -The hospital chaplain The mother and son decide that hospice care will be beneficial. The mother prefers to remain in the hospital rather than going home to die, and her son agrees. Which action should the charge nurse implement? Provide a list of hospices that are available in the area