Shawna, a new staff member, has been working from 7 a.m. to 3 p.m. on a since ob

Question

Shawna, a new staff member, has been working from 7 a.m. to 3 p.m. on a since obtaining her RN license 4 months ago. Most of the staff members with whom she works with have been there since the unit opened 5 years ago. On a typical day, the staffing consists of a nurse manager, two RNs, an LPN, and one technician for approximately 40 patients. Most patients are HIV positive with multisystem failure. Many are severely debilitated and need help with their activities of daily living. Although the staff members encourage family members and loved ones to help, mos them are unavailable because they work during the day. Several days a week, the nursing students from Shawna's community college program are assigned to the floor. n infectious disease Tina, the nurse manager, does not participate in any direct patient care, saying that she is "too busy at the desk." Laverne, the other RN, says the unit depresses her and that she has requested a transfer to pediatrics. Lynn, the LPN, wants to "give meds" because she is "sick of the patients constant whining," and Sheila, the technician, is "just plain exhausted." Lately, Shawna has noticed that the other staff members seem to avoid the nursing students and reply to their questions with annoyed, short answers. Shawna is feeling alone and overwhelmed and goes home at night worrying about the patients, who need more care and attention. She is afraid to ask Tina for more help because she does not want to be considered incompetent or a complainer. When she confided in Lynn about her concerns, Lynn replied, "Get real-no one here cares about the patients or us. All they care about is the bottom line! Why did a smart girl like you choose nursing in the first pface? 0 7. How is the nurse manager reacting to the changes in her staff members? 8. What is the responsibility of administration? 9. How are the patients affected by the behaviors exhibited by all staff members?

Explanation / Answer

1. Direct patient care is responsibility of all nurses irrespective of titles. A nurse manager tasks involves supervision of all activities under her perview which will involve in this case - desk job, direct patient care and delegating duties to other staff on a rotatory basis. A manager needs to know the mental framework of other staff under her also and encourage them to perform. She should be approachable at any given time to discuss issues that affect them all. In this case Tina, is quite passive and is comfortable sitting at the desk and letting her juniors make decisions pertaining to patient care. In fact it can be said that Tina is not reacting at all to any changes !!. This in turn is affecting performance and causing a disatisfaction among junior staff.

2. Responsibility of administration lies at the very core of patient needs and interest in this case. Obviously it is clear that patient care is the least important to the the administrative officer here and her attitude has spilled over to the other staff. A good administrator should always perform first and train juniors along the way. Assignment of rotating duties to all staff will ease burden on one particular staff only. Approachability and resolution of problems is critical for good administration.

3. As a direct consequence of failed administration patient care is affected by insincere efforts of the the caregivers. A few comments on giving meds randomly to stop patient whining is disturbing.

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