TEXT: Weberg, D. & Mangold, K. (2022). Leadership in nursing practice: The Inter

TEXT: Weberg, D. & Mangold, K. (2022). Leadership in nursing practice: The Intersection of Innovation and
Teamwork in Healthcare Systems (4
th ed.). Burlington, MA: Jones & Bartlett Learning. ISBN: 978-1-284-
24889-0
You are the day charge nurse on a Medical-Surgical Unit that is divided into 2 pods. You are assigned as
the charge nurse within this 14-patient pod (1 of 2 pods) for the week and you have the following staff:
● Nurse Manger of the Unit – Role is to oversee the entire Unit and is not a clinical member of the
staffing model.
● Charge Nurse – Charge of 2 pods – Charge nurse is in charge of creating fair patient assignments
with input from her staff based on the information provided in report
● 3 RNs on pod:
o Registered Nurse 1 – New Graduate, 22 yr. old female – just off of orientation
o Registered Nurse 2 – Novice Nurse – one year of experience, 36-year-old male
o Registered Nurse 3 – Expert Nurse – with ten years of experience, 34-year-old female
● PCA 1 – has worked on the unit for fifteen years -, 40-year-old male
Patient Diagnoses and Brief Scenarios:
1. Pneumonia: A 89-year-old male, new admission, O2 NC, IV antibiotics, Poor O2 saturation,
oriented to person only, full code
2. Chronic obstructive pulmonary disease (COPD): A 70-year-old female, 3rd day and anticipating
discharge today or tomorrow, long history of smoking, on 02 CPAP, IV saline lock, oral meds
3. Urinary tract infection (UTI): A 80-year-old female, new transfer from nursing home with acute
confusion, IV antibiotics, wound care for decubitus
4. Cellulitis A 29-year-old male admitted two days ago for significant pain in his right arm and slight
redness of the area. Reddened area progressing. Concerned about necrotizing fasciitis. On IV
antibiotics and pain meds.
5. Renal failure: A 65-year-old male with a history of type I diabetes. Admitted yesterday with
renal failure and will be getting dialysis today and on sliding scale insulin.
6. Falls: A 48-year-old female admitted last evening with recent history of leg weakness and hx of
falls. Working patient up for neuromuscular disorders, such as muscular dystrophies, multiple
sclerosis (MS), amyotrophic lateral sclerosis (ALS).
7. Dehydration: A 26-year-old male admitted this morning from the ER with dehydration – he was
working outdoors in the extreme heat. Received 2 liters of fluid in the ER but lab work showed
poor kidney function. Receiving IVs and repeat blood work later today and if blood work
improves, he will be discharged.
8. Diabetes: A 20-year-old female transferred here from ICU post DKA. Receiving IVs with Insulin.
If blood work this morning good IVs will be discontinued and discharge will be planned for
tomorrow. Dietician to see the patient today.
9. Congestive heart failure (CHF): A 93-year-old female admitted from a Senior Residence through
the ER and arrived on the unit at 5AM. Patient presented with increased shortness of breath
and pedal edema. Patient receiving IV diuretics. On O2 NC. Patient is oriented x 4. A bit
disgruntled about being admitted and wants to go home.
10. Syncope: A 60-year-old female transferred to the unit from ICU last night post pacemaker
implant. Patient passed out while driving and crashed into the median wall. She has multiple
contusions, no broken bones. EKG on arrival showed bradycardia with heart rate dropping into
the 30’s at times. EKG is showing paced rhythm about 30% of the time.
11. Total knee replacement (TKR): This is a 66-year-old male admitted yesterday for a TKR. He was
to be discharged home after surgery, but anesthesia had a difficult time waking the patient up.
He should be discharged home today once seen by the orthopedic surgeon. He is on IVs but has
tolerated diet well. Taking oral pain meds. PT to see the patient this morning.
12. Bowel Obstruction: This is a 72-year-old female admitted with a bowel obstruction and had
surgery yesterday for the removal of adhesions from a previous surgery. Patient has IVs, IV
antibiotics, PCA for pain, pain is not well controlled, Nasogastric tube to low intermittent
suction, O2 on NC at 4L, should be up three times a day and patient does not want to move or
get out of bed.
13. Your pod is expecting two admissions this morning (this will fill this pod): a 58-year-old newly
diagnosed type 1 diabetic and a chronic asthmatic 28-year-old who had an acute episode and on
a non-rebreather mask.
Assignment:
1. Create staff assignments for the 12 patients and 2 expected admissions utilizing the staff listed
above. Use a table or grid to make the assignment, similar to the staffing grid in your textbook
(Ch. 6 – Table 6-1), but make it your own.
a. Consider patient acuity.
b. Consider other resources you may need/have, such as a diabetic educator, WOCNs,
Dietician. Consider other resources you may need not listed.
2. Be creative and write a brief paragraph detailing the staffing model/plan that you would use for
this unit/patient pod:
a. Stating what your resources are if a staff member “calls in”.
b. What are the shift lengths and times.
c. Other resources or needs you may need based on your readings and pre-work for this
assignment.
NOTE: Your staffing model is your own, meaning there may be variations in comparison to other
students in this class as to how you would staff this pod. However, there are some decisions that
should be made based on all the information above, such as staff available and patient acuity.