Management of Care Q 20
The charge nurse on the cardiac unit is planning assignments for the day. Which of the following is the most appropriate assignment for the float nurse that has been reassigned from labor and delivery?
A. A one-week postoperative coronary bypass patient, who is being evaluated for placement of a pacemaker prior to discharge.
B. A suspected myocardial infarction patient on telemetry, just admitted from the Emergency Department and scheduled for an angiogram.
C. A patient with unstable angina being closely monitored for pain and medication titration.
D. A postoperative valve replacement patient who was recently admitted to the unit because all surgical beds were filled.
Correct Answer: A. A one-week postoperative coronary bypass patient, who is being evaluated for placement of a pacemaker prior to discharge.
The charge nurse planning assignments must consider the skills of the staff and the needs of the patients. The labor and delivery nurse who is not experienced with the needs of cardiac patients should be assigned to those with the least acute needs. The patient who is one-week post-operative and nearing discharge is likely to require routine care.
Option B: A new patient admitted with suspected MI and scheduled for angiography would require continuous assessment as well as coordination of care that is best carried out by experienced staff. Nurse-patient assignments are typically allocated based on estimated direct patient care requirements with little consideration for other activities that must be completed throughout a shift. In an effort to improve upon previous assignment methodologies, new measures and metrics were considered in this study to reduce and balance demands placed on nurses through the assignment of required activities.
Option C: The unstable patient requires staff that can immediately identify symptoms and respond appropriately. In most hospitals, a unit charge nurse is responsible for the shift assignment of patients to nurses based on experience and past practices. The nurse-patient assignment process is also often a manual process in which the charge nurse must sort through multiple decision criteria in a limited amount of time.
Option D: A postoperative patient also requires close monitoring and cardiac experience. Balancing workload among nurses on a hospital unit is important for the satisfaction and safety of nurses and patients. To balance nurse workloads, direct patient care activities, indirect patient care activities, and non-patient care activities that occur throughout a shift must be considered.