Question

Shared Scope of Practice Case Study

Susan and Barry work together on a surgery unit which has 3 patient care pods. Each pod has 6 beds. Today, Susan and Barry are assigned together in pod 1 and there are six patients in this pod. Susan is a RN with six months’ experience and Barry is a LPN has 15 years’ experience on this unit. At this institution LPNs are working to their full scope of practice. Mr. Green is one day post-op. His V/S at 0630h were: Oxygen saturation: 93% on room air BP: 90/50 Pulse: 48 Respiratory rate: 14 Temperature: 36.8 He must remain on bed rest, has a NG tube to suction, a Foley catheter, as well as a chest tube. He is receiving TPN and Lipids via CVP line and requires a CVP dressing change. Mrs. Martin has a deep incision which requires wound packing twice during this shift. Mr. Smith is two days post-op and requires a dressing change and IV antibiotics. Mrs. Hooper requires discharge teaching regarding new medications and care of her incision. Mr. White is three days post-op. He was started on a continuous heparin infusion overnight for a suspected DVT in his right leg. There is one patient in ER with a hip fracture who is waiting to be admitted for surgery this afternoon for a total hip replacement.

1.The patient assignment must be divided between Susan and Barry. Which patients would the Patient Care Facilitator (PCF) assign to Barry (LPN) and Susan (RN)? Provide a rationale for your decisions.

2.Dr. Ross makes rounds at 1100h. He does not think Mrs. Martin’s incision is healing well and decides to order a VAC dressing. Would this change of care require a change to the assignment of patients? Provide a rationale.

3.At 1100, the patient from ER, Mrs. Kelly, has been admitted. She is scheduled for surgery this afternoon at 1500h and requires pre-op teaching. She has a previous history of angina and had been complaining of chest pain in the ER which was relieved with nitroglycerin. Who can be assigned to care for Mrs. Kelly? Provide a rationale.

4.Mr. Smith is now complaining of chest pain. He has no prior cardiac history. Would this require a change to the assignment of patients? Provide rationale.

5.Identify areas where collaboration between Susan (RN) and Barry (LPN) could occur during the shift to ensure safe, competent and optimal care is provided to all patients.

Answer 1

1) patient assignment

For susan_patients

1)mr martin_he only have wound packing,so Sudan can do the dressing .

2)mr smith_iv antibiotic and dressing change

3)Er patient_for surgery so nothing to do more so susan can take care for him.

For Barry

1)Mr green_have NG tube, chest tube,and Foley's,also vitals have to be take care so Barry can take care for Mr green.

2)mr White _ heparin infusion is ongoing so have to be take care so Barry can take care

3)Mr Hooper_medication teaching and education regading insicion care

2)may susan have no experience in vac do barry can help her to do the care.no need to change the assignment.It is a limited medical resources procedure.so once she assisted she can do better.

3)susan can provide education regading surgery , pain and medication,also psychological support.because she have 6 years of experience.

4)mr Smith have chest pain means no need to change any assignment ,can call doctor and susan can assist what he is saying.she can manage the patient, because here is no any other problems and also patient needs only observation.

5)susan and barry can help each other in any difficult situation.barty can help the Susy to do the care and ask help if she is difficult to manage and if busy for Barry susan also help.barry can teach Susy during care so she can improve the knowledge.