Patient Management and Delegation
Sentinel Hospital’s simulation in the Medical/Surgical selection was heavily reliant on determining acuity levels, prioritization, and delegation. As the “charge nurse,” I was responsible for determining the patient’s level of acuity. You had to look at each patient’s specific situation and analyze factors like vital signs, assessment findings, and lab results to do so. You would then assign them a “high, medium, or low” rating. High acuity indicates a high risk of needing life-saving intervention, medium acuity indicates a stable need for multiple interventions, and low acuity indicates that little intervention is required. The assignment and nurse assigned to the patient are determined by the category in which they are placed. The nurses who are available to take patients are classified according to their skill level and experience. Because some nurses are more skilled than others, they can accept more difficult patients.
As the “charge nurse,” you went through these patients and assigned them to a nurse based on their “low, medium, or high acuity” while keeping their experience level in mind. Within the patient assignments, you would prioritize patient care for the nurse from first to last. You would assess the situation to determine which patient requires the most attention. You’d consider the patient’s level of stability, pain level, and code status. The final level included determining acuity, creating staffing assignments, and five simulated days of prioritization. You had to account for daily changes in the weather. This can either raise or lower the patient’s acuity level, affecting which nurses can or cannot take the patient. Staffing assignments needed to be updated to accommodate changes in the patient’s condition so that a more experienced nurse could take a more unstable patient, or a patient whose condition had improved could be reassigned to a nurse with less experience.
While working on this scenario, I realized it was very similar to real-life situations. When you make assignments as a charge nurse, you’re not just dividing up patients. There’s a lot more to it than simply assigning nurse rooms one through three, and then four through six, and so on. Some nurses are newer, and it would be more appropriate for them to be assigned to lower-acuity patients for the sake of the patient’s safety. Nurses with more experience would be better suited to take on patients with more serious issues because they would be able to provide better care. In practice, charge nurses do their best to ensure that the patient load is distributed evenly among the nurses. That is, one nurse is not assigned all high-acuity patients, while the other nurses are assigned all low-acuity patients. Charge nurses should ensure that the patients are suitable for the nurse. I made several errors while working through this scenario. I initially struggled with determining the patient’s acuity. I wasn’t digging deep enough into the patient’s situation. I was just looking at the diagnosis and determining their acuity based on that. So I had to go back and look into fine details like labs and assessment findings a few times. This would provide a better understanding of how the patient was doing. I also had to make certain that I looked at the date they arrived. A patient with a STEMI may present as a high-acuity patient. However, if they have been in the hospital for a week, they may be classified as a low-acuity patient. I also made sure to check to see if the patient was on any drips, and if so, what kind, as this can affect the acuity level. Acuity can also be affected by the amount of care required, as the patient will require more care and will be a heavier workload for the nurse. When assigning patients to nurses, I made sure to give the highest acuity patients to the most experienced nurses and the lowest acuity patients to the least skilled nurse. However, I had to redo it a few times because some of the nurses were given extremely difficult assignments and were, therefore, dissatisfied.
Many aspects of this scenario can be used in real-world practice. Fair staffing assignments for nurses are an important issue. Adequate staffing affects not only patient safety but also job satisfaction. Units with adequate staffing and fair assignments have higher retention rates and lower staff turnover. While the nurse-to-patient ratio is important, acuity should also be considered when staffing units. Some patients may be more critical than others and require more involved care. Furthermore, adequate staffing will reduce errors, unintended complications, and mortality rates and improve patient satisfaction (Shimp, 2017).
Patient prioritization is another skill learned from this simulation that is commonly used in nursing practice. Nurses constantly prioritize throughout their shifts. The hospital can be a hectic place at times. Nurses are always on the go and must prioritize getting the most important tasks completed first. They must prioritize based on the patient’s acuity and the significance of the task. When prioritizing activities, there are different levels of importance, beginning with addressing emergent patients and unstable situations first. They would then prioritize patient concerns such as pain management and other essential caregiving tasks. They would then prioritize more routine tasks such as medication and charting (Patterson et al. 2011). Assessing the patient’s acuity level is critical for proper delegation and prioritization. Nurses must be able to analyze diagnoses and findings to determine which of their patients have the highest acuity in order to provide them with the additional care and monitoring they require.
References
Patterson, E. S., Ebright, P. R., & Saleem, J. J. (2011). Investigating stacking: How do registered nurses prioritize their activities in real-time? International Journal of Industrial Ergonomics, 41(4), 389-393.
Shimp, K. M. (2017). A systematic review of Turnover/Retention and staff perception of staffing and resource adequacy related to staffing. Nursing Economics, 35(5), 239-258,266A. Retrieved from http://americansentinel.idm.oclc.org/login?url=https://search-proquest- com.americansentinel.idm.oclc.org/docview/1954857855?accountid=169658
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Question 
Think back to the beginning of the course and consider your thoughts on learning about nursing theory. Did you question the usefulness of spending a term learning about theory? Next, consider your current practice environment now that you know more about theory. Is theory used in practice, or is there a theory-practice gap that needs to be addressed?
Patient Management and Delegation
- If you think the theory is known and used in practice, support your view with evidence.
- If you think a theory-practice gap exists, support your view with evidence.
Additional tips and instructions:
I am a registered nurse; the discussion post should be only a page long. APA style. 3 references must be used, from the year 2015 and beyond. Below ill provide the grading rubric for discussions.