VII. COLLABORATION/DELEGATIONC. SITUATIONS TO PRACTICE USE OF COLLABORATION AND DELEGATION

• Patient asks for a bedpan as nurse is hanging an IV med; nurse tells the patient she will get the nursing assistant.

• Nurse is putting information into the computer; nursing assistant comes to nurse and asks for help turning a patient; nurse refuses.

• Nursing assistant has 12 patients, several of whom are total care, several are incontinent. RN on computer, but does not appear “busy” . Patient calls for bedpan. Nurse calls nursing assistant to put patient on bedpan

Nurse from days leaves work incomplete, but does not inform nurse on evenings of work needing to be done

Orders left undone for next shift Patient rooms unstocked Environment a mess Care plans no complete Discharge plan not done Patient Teaching not documented

• TPN bag not ready for next hanging• Respiratory therapy does not come when called• Admissions defensive when nurse questions applicability of admission

of critically ill patient to the floor or ICU patient in CCU or visa versa• Getting patient out of ER when there is no bed • ER busy, floor busy; floor asks ER to hold patient in ER and ER won’t

do it• Patient arrives in PACU without OR report to PACU nurse• Patient returns from xray with vomit all over gown or on wet sheets,

cold• PT calls for patient; CAT scan calls for patient; breakfast tray arrives

ALL AT THE SAME TIME• Respiratory therapist is called to help assist a ventilator dependent

patient needing transport to CAT scan. Respiratory therapist has received two stat ABG (arterial blood gas) requests at another location. The nurse and nursing assistant have arrived and are ready for the transport and have several pressing assignments waiting. The nursing assistant states that he will not be free for another hour if this transport does not take place now. The nurse is expecting another admission momentarily. CAT scan is waiting for the patient

• MD won’t involve nurse in the planning of patient care

• MD leaves nurse uninformed about changes in patient

• Nurse makes suggestion to physician, MD walks away, interrupts or ignores nurse

• MD rude and insensitive to patient family• Doctor’s order unacceptable, not written in

a way that the nurse can read it or with enough information to implement.

Bob Jones is the 3-11 PM charge nurse on the oncology unit. Two nurses are out sick, as is the unit receptionist, no additional nurses will be replacing the sick nurses. He has 25 patients, 3 nurses and 2 techs. He meets with the staff at the beginning of the shift to come up with a plan for providing appropriate care for the 25 patients utilizing the staff available. Bob discusses alternatives with the staff.

How would you begin to solve this problem

What information would you need before coming up with a solution to this problem?

How can patient’s be provided with the appropriate care utilizing all staff members keeping in mind the scope of practice of each staff member?

What communication skills would you use when solving this problem as the charge nurse?