The Three Factor Framework in Acute Care
Read the case below and answer all the questions that follow.
Case Scenario
There are two RN’s and four RPN’s working in a medical floor on a day shift in a hospital. All nurses are assigned four patients each. One RN has been assigned to two complex patients out of the four. The other RN, Shana has just started working in the hospital and is a new grad. The new Grad RN, Shana, is working with an RPN Melissa. Melissa has been working on the same floor from the last five years. The hospital has adequate support system, including support nurses, registered therapists, doctors on call and PSW’s to help. There is another RN present who is working as charge nurse.
Patient 1
Mr B has paraplegia from last 10 years. He has muscular contractures and is total care. He has been admitted for a week with diagnosis of left leg cellulitis. Mr B has family members that stay with him during the day and night. Mr B. is receiving IV antibiotics for his cellulitis. Mr B. is also scheduled to have daily dressing for his left leg cellulitis. MR B needs turning and repositioning every 2 hrs and as needed. His vital signs have been stable. The plan is to discharge him with PO antibiotics once the course of IV antibiotics is done. The patient is otherwise medically stable.
Patient 2
Mr C is just admitted from emergency today with diagnosis of acute heart failure and lower GI bleed. The Hgb is 75, the patient is ordered to have 2 units of PRBC. The patient gets SOB on minimal exertion and is on 5 L of oxygen. The oxygen saturations are between 94-95% on 5 L of oxygen. The patient is very anxious and is calling for help often.
The charge nurse assigns Mr. C to RPN Melissa RPN and Mr. B to Shana RN. The charge nurse thinks that Melissa has dealt with more complex situations in the past and is familiar with the routine and possesses more knowledge, skill and judgment.
Questions:
Is the assignment appropriate? Utilize the three-factor framework from the CNO guideline, the Nurse, the Client, the Environment to support your discussion.
If MR C is assigned to Shana, what resources are available to help her?
Do you think there is overlapping of roles in this scenario?
If Melissa considered the assignment to be inappropriate, what should she do?
Your response in 250-500 words and use APA referencing for citations.