Leadership Case Study – Delegation and Prioritization
You are the RN caring for these six patients on the day shift. The following table is information you gathered from the morning handoff report. You are working with an LPN/VN and a C.N.A. on your team. Both team members are competent and have worked on the unit for longer than 3 years.
Room 102 – Female age 77
- Diabetic, 1st day post op ORIF left hip
- Vital signs every 2 hours
- 0400: T 99.2F, HR 88, RR 24, BP 144/88
- Pedal pulses not palpable on left foot and left foot is cooler but cap refill is present
- Dressings are clean and dry
- IV: D5.25 NS @ 100 mL/hr
- Clear liquid diet – poor intake due to nausea
- Foley: drained 125 mL of concentrated urine
- Sliding Scale Insulin QID
- Turn every 2 hours, record I&O
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Room 107 – Male age 42
- Asthmatic Bronchitis
- Vital signs every 4 hours
- 0400: T 100.4F, RR 24, pulse ox 92%
- O2 @ 2L per nasal cannula
- Coughing thick colorless mucus
- Sputum specimen sent to lab for C&S
- Nauseated but taking clear liquids
- Resp therapy does nebulizer QID
- IV antibiotics QID, IV needs to be changed this shift.
- Voiding in urinal
- ABGs ordered for 0800
- I&O
- Minimal assist
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Room 103 – Male age 65
- Gastric resection yesterday
- Vital Signs hourly ranges: BP systolic 88-102, diastolic 44-62, HR 90-106, RR 22-24, afebrile
- NG to low intermittent suction – 675 mL sanguineous drainage
- IV: Lactated Ringers @ 150 mL/hr
- IV antibiotics every 6 hours
- Unable to void – cathed at 0430 with 250 mL
- Coughs and deep breathes poorly
- Oxygen at 2L via nasal cannula
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Room 108 – Male age 52
- Stable patient admitted on night shift from recovery for post-op colon resection without a colostomy
- Post-op vitals every hour, all WNL
- Record urine output every 2 hours
- IV: D5/.45 NS with 20 mEq KCL at 125 mL/hr
- NG irrigations every 4 hours PRN
- IV Pepcid every 12 hours, IV Push
- PCA Morphine
- Mark and reinforce dressing
- Oxygen at 2L via nasal cannula
- Oximetry every 4 hours
- IS every hour while awake
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Room 105 – Female age 42
- Admitted at 0600
- Scheduled for breast biopsy today
- Vital signs on admission: BP 128/82, HR 88, RR 22, Temp 98.5F oral
- NPO since midnight
- Up ad lib
- Pre-op checklist is completed
- IV: Lactated Ringers at 100 mL/hr
- Pre-op antibiotic and IM meds due at 0800
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Room 110 – Female age 76
- Admitted yesterday afternoon with COPD with pneumonia
- O2 @ 3L via nasal cannula
- Vital signs every 4 hours:
- 0400: Temp 99F oral, RR 22 at rest, BP 106/54, pulse ox 93% on 3L NC
- IV antibiotics every 4 hours
- Clear liquid diet
- Up in chair for 20 mins BID
- Significant dyspnea on exertion
- Requires complete assistance with ADLs
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- What type of staffing model is being used in this scenario?
- Which tasks can be delegated to the LPN/VN?
- Which tasks cannot be delegated to the LPN/VN?
- Which tasks can be safely delegated to the C.N.A.?
- Identify the highest priority patient to see first. What are your top 3 priority tasks? Provide your rationale.
- Plan your shift: Prioritize the remaining five patients in the order you will see first and your top 3 priority tasks for each.
| Patients in the prioritized order you will see them and the rationale for doing so |
Top 3 priority tasks for each patient |
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“Leadership Case Study – Delegation and Prioritization” by Melissa Hauge and Open RN is licensed under CC BY 4.0
