Addressing a Communication Gap Case Study
You are a new graduate nurse just finishing your 3-month probation period at your first job in acute care nursing. Your usual assignment is to be a team leader for eight patients, with one licensed practical nurse/licensed vocational nurse and one nursing assistant on your team. Today, your assignment included an elderly confused patient. You requested, during work assignments with your team, that the nursing assistant pay attention to this patient’s intake and output (I & O) as you feel he may need some intravenous fluids if his I & O remain poor. You asked the nursing assistant to notify you if there was significant change, so you could notify the physician. It was a very busy day, and you have barely had a moment to reorganize and collect your thoughts.
It is now 2:30 PM, and you are preparing your end-of-shift report. When you review the patient’s 2:00 PM I & O sheet, you note a significant drop in intake and the total output for the shift is only 90 mL. You meant to check the I & O sheet during the day but kept getting sidetracked by problems with other patients. However, you are also upset that the nursing assistant did not keep you informed of this condition.
You now go to the patient’s room and assess the patient and find his vital signs and other findings similar to this morning’s assessment. You check with the nursing assistant to make sure the I & O recorded for the day is accurate, and you call the physician to obtain an order to begin intravenous fluids. When you ask the nursing assistant why she did not report the significant drop in output to you, she said, “I forgot.”
At this point, you are not sure what you should do next. You feel you should handle this yourself and not go to the charge nurse. You are a new nurse and do want to get started on the wrong foot by speaking too harshly to the nursing assistant, yet you feel this lack of following instructions cannot go unanswered. The reality is that if you do nothing, it is likely that no one else will ever know about the problem.
The doctor did not seem upset when you called him about the drop in output, he just ordered the fluids, but the need to start the intravenous line and give report caused you to work overtime. By the time you finished your shift, the nursing assistant had gone home and you are left to spend your evening at home pondering what, if anything, you should do to follow up on this tomorrow.
Decide how you will proceed. Determine whether you will use a systematic problem-solving model, intuition, or both in making your choices. How did your values, preferences, life experiences, willingness to take risks, and individual ways of thinking influence your decision?
Returning to School for a Bachelor of Science in Nursing Degree
You have been a registered nurse (RN) for 5 years. Right after high school, you became a licensed vocational nurse (LVN) and after 6 years decided to attend a local LVN to associate degree in nursing program at a local community college. You have become increasingly interested in attending a baccalaureate university to complete requirements for your Bachelor of Science in Nursing (BSN) degree. You are still undecided; some of your friends are urging you to do this, and others ask why you need the degree.
Not only must you make up your mind about pursuing this option but you also have two different local opportunities. The regional university is 60 miles away and would require significant amounts of driving if you did the on-campus program; however, the university’s school of nursing also offers an online course that would require only four full Saturdays of attendance each semester. Both options have pros and cons.
After making a payoff table, calculating chances for advancement and salary increase weighed against cost of your new degree, you decided that it made economic sense to get a BSN degree.
Now that you have decided to get your baccalaureate degree, you must decide between three alternatives: (a) attending a distant university 60 miles away, (b) attending your local university and enrolling in their on-campus program, or (c) enrolling as an online student.
Create a decision grid for the three alternatives, weighting the same criteria for each, using such things as cost, travel, quality of campus life, reputation and quality of the university, and so on. Assign each of your criteria a weighted score for the value that you personally view it. What did your final grid look like and what was your final decision?