Gina Is The Charge Nurse Of The 3:00 PM To 11:00 PM Shift ✓ Solved

Gina Is The Charge Nurse Of The 300 Pm To 1100 Pm Shift

Gina is the charge nurse of the 3:00 PM to 11:00 PM shift on the acute care unit where you have worked for 18 months since your graduation. Your supervisor has asked you if you would like to learn the duties of the relief charge nurse. You were thrilled that she approached you for this position. Because it was a relief position, it was permissible for your supervisor to appoint you and not necessary for you to formally apply for the position. One day each week, for the last 2 weeks, you have been working with Gina about the responsibilities of the position.

There are several things Gina does that bother you, and you are not sure what you should do. For example, if used supplies were inadvertently not charged to patients at the time of service, Gina admitted she would just charge them to whoever patients she thought were likely to have used them. When you questioned Gina about this, she said, “Well, at the end of the day, the unit needs to make sure that all supplies have been charged for, or the CFO will be after all of us. It is one of the charge nurses’ responsibilities, and I don’t have time to chase everyone down to find the correct patient to charge and besides everyone has insurance and so it does not come out of the patient’s pocket. Most importantly, we must make sure the hospital gets reimbursed or we won’t have our jobs.”

In addition, when Gina does the staffing correlation for the upcoming shift, you notice that she fudges a bit and makes sure the night shift is given credit for needing more staff than they need. When questioned, she said, “Oh, we have to take care of each other, better too much staff than not enough.” You think Gina’s actions are unethical, but you do not know what to do about it. It does not directly harm a patient, but you feel uncomfortable about what she is doing and feel it is not the ethical thing to do.

Assignment Instructions

You have many options here including doing nothing. Using the MORAL ethical problem-solving model, solve this case and compare your solution with others in your class. Making Sound Staffing Decisions You are the staffing coordinator for a small community hospital.

It is now 12:30 PM, and your staffing plan for the 3:00 PM to 11:00 PM shift must be completed no later than 1:00 PM. (The union contract stipulates that any “call offs” that must be done for low census must be done at least 2 hours before the shift begins; otherwise, employees will receive a minimum of 4 hours of pay.) You do, however, have the prerogative to call off staff for only half a shift (4 hours). If they are needed for the last half of the shift (7:00 PM to 11:00 PM), you must notify them by 5:00 PM tonight.

A local outside registry is available for supplemental staff; however, their cost is two and a half times that of your regular staff, so you must use this resource sparingly. Mandatory overtime is also used but only as a last resort.

The current hospital census is 52 patients, although the emergency department (ED) is very busy and has four possible patient admissions. There are also two patients with confirmed discharge orders and three additional potential discharges on the 3:00 PM to 11:00 PM shift. All units have just submitted their patient classification system (PCS) calculations for that shift. You have five units to staff: the intensive care unit (ICU), pediatrics, obstetrics (includes labor, delivery, and postpartum), medical, and surgical departments.

The ICU must be staffed with a minimum of a 1:2 nurse–patient ratio. The pediatric unit is generally staffed at a 1:4 nurse–patient ratio and the medical and surgical departments at a 1:6 ratio. In obstetrics, a 1:2 ratio is used for labor and delivery, and a 1:6 ratio is used in postpartum. On reviewing the staffing, you note the following:

• Intensive Care Unit Census = 6. Unit capacity = 8. The PCS shows a current patient acuity level requiring 3.2 staff.
• One of the potential admissions in the ED is a patient who will need cardiac monitoring.
• One patient, however, will likely be transferred to the medical unit on 3:00 PM to 11:00 PM shift. Four registered nurses (RNs) are assigned for that shift.
• Pediatrics Census = 8. Unit capacity = 10. The PCS shows a current acuity level requiring 2.4 staff. There are two RNs and one certified nursing assistant assigned for the shift. There are no anticipated discharges or transfers.
• Obstetrics Census = 6. Unit capacity = 8. Three women are in active labor, and three women are in postpartum. Two RNs are assigned to this department.
• Medical Floor Census = 19. Unit capacity = 24. The PCS shows a current acuity level requiring 4.4 staff. There are two RNs, one licensed vocational nurse, and two CNAs assigned. Three of the potential ED admissions will come to this floor. Two of the potential discharges are on this unit.
• Surgical Floor Census = 13. Unit capacity = 18. The PCS shows a current acuity level requiring 3.6 staff. Because of sick calls, there is only one RN and two CNAs assigned. Both confirmed discharges and one potential discharge are from this unit.

Answer the following questions:

1. Which units are overstaffed, and which are understaffed?
2. Of those units that are overstaffed, what will you do with the unneeded staff?
3. How will you staff units that are understaffed? Will outside registry or mandatory overtime methods be used?
4. How did staffing mix and PCS acuity levels factor into your decisions, if at all?
5. What safeguards can you build into the staffing plan for unanticipated admissions or changes in patient acuity during the shift?

Sample Paper For Above instruction

In addressing the complex staffing issues within a hospital setting, it is crucial to analyze each unit's staffing needs based on patient acuity, census, and staffing ratios. The application of ethical principles, particularly from a moral perspective, guides decision-making to ensure safety, equity, and professional integrity.

Assessment of Overstaffed and Understaffed Units

Based on the provided data, the obstetrics unit, with a census of 6 and a capacity of 8, likely has sufficient staffing given the current ratio of 1:3, which exceeds the standard 1:2 for labor and delivery. The pediatric unit with 8 patients and a capacity of 10, at a ratio of 1:4, aligns with the standard, thus neither over- nor understaffed. The ICU, with 6 patients out of 8 capacity, and a required acuity-based staffing of 3.2, appears appropriately staffed, especially considering the minimum ratio of 1:2. The medical unit with 19 patients in a 24-capacity ward and a PCS requirement of 4.4 staff is potentially understaffed given the acuity needs, especially with the incoming admitted patients. The surgical unit, with a census of 13 and a capacity of 18, and a PCS requiring 3.6 staff with only one RN assigned, is clearly understaffed, risking patient safety.

Strategies for Managing Staffing Levels

For overstaffed units such as obstetrics, excess staff can be temporarily reassigned to units facing shortages. This enhances flexibility and maintains quality care. For instance, staff from obstetrics might assist in the medical or surgical units, particularly during peak hours or unexpected admissions.

Understaffed units, notably the surgical ward and medical floor, require deliberate action. The use of outside registry staff, although costly, may be necessary to fill critical gaps, especially if patient acuity and safety are compromised. Moreover, mandatory overtime could be employed selectively to reinforce staffing levels during peak demand times, ensuring that patient care standards are maintained without overburdening existing staff.

Role of Staffing Mix and PCS Acuity Levels

Staffing decisions must incorporate staffing mix—such as the ratio of RNs to CNAs—and patient acuity levels from the PCS calculations. Higher acuity levels necessitate a higher proportion of registered nurses, as evidenced in the ICU and obstetrics. These metrics inform staffing to ensure that patient needs are met through appropriate skill mix, ultimately fostering safe and effective care delivery.

Safeguards for Unanticipated Changes

Building safeguards involves flexible staffing, such as cross-training staff for multiple units, to adapt quickly to unexpected admissions or shifts in acuity. Maintaining a small reserve pool, whether through on-call staff or a limited contingent of registry personnel, can act as a safety net. Implementing real-time monitoring of patient acuity and census enables proactive adjustments. Clear communication channels and contingency plans help ensure responsiveness and safeguard patient safety.

Conclusion

Effective staffing management requires a balanced approach that considers ethical principles of fairness, safety, and resource utilization. Employing tools such as PCS calculations, considering staffing ratios, and planning for contingencies are vital for optimizing patient outcomes and staff well-being. Upholding ethical standards in staffing decisions supports the overarching goal of high-quality patient care within healthcare organizations.

References

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