Julio works at a large teaching hospital in a major metropolitan area. Th is institution services the entire geographical region, including indigent clients and, because of its reputation, administers care to international clients and individuals who reside in other states. Similar to all health-care institutions, this one has been attempting to cut costs by using more NAP. Nurses are often fl oated to other units. Lately, the number of indigent and foreign clients on Julio ’ s unit has increased. Th e acuity of these clients has been quite high, requiring a great deal of time from the nursing staff .

Julio arrived at work at 6:30 a.m., his usual time. He looked at the census board and discovered that the unit was fi lled, and Bed Control was calling all night to have clients discharged or transferred to make room for several clients who had been in the emergency department since the previous evening. He also discovered that the other RN assigned to his team called in sick.

His team consists of himself, two NAP, and an LPN who is shared by two teams. He has eight patients on his team:

• Two need to be readied for surgery, including preoperative and postoperative teaching, one of whom is a 35-year-old woman scheduled for a modifi ed radical mastectomy for the treatment of breast cancer.

• Th ree are second-day postoperative clients, two of whom require extensive dressing changes, are receiving IV antibiotics, and need to be ambulated.

• One postoperative client is required to remain on total bedrest, has a nasogastric tube to suction as well as a chest tube, is on total parenteral nutrition and lipids, needs a central venous catheter line dressing change, has an IV, is taking multiple IV medications, and has a Foley catheter.

• One client is ready for discharge and needs discharge instruction.
• One client needs to be transferred to a subacute unit, and a report must be given to the RN of that unit.
Once the latter client is transferred and the other one is discharged, the emergency department will be sending two clients to the unit for admission.

1. How should Julio organize his day? Set up an hourly schedule.

2. Make a priority list based on the ABC plus V method.
3. What type of client management approach should Julio consider in assigning staff appropriately?
4. If you were Julio, which clients or tasks would you assign to your staff ? List all of them, and explain your rationale.
5. Using the Delegation Decision-Making Grid, make staff and client assignments.