You have been working as a team leader on the oncology unit on the evening shift at Swift River Hospital for the last 5 years. Besides yourself, you have two LPNs and two nursing assistants assigned to your floor. You have 18-20 patients during the evening. Your normal staffing ratio is one LPN working with a nursing assistant for each 9-10 patients. You supervise the entire team and do all the duties that only an RN can do such as intravenous meds, doctor rounds, nursing care plans, patient teaching, and evaluation of patient care.

This afternoon when you reported for duty you had an LPN, Erin, assigned to your team who normally works on Labor and Delivery. During the report, you asked her if she was comfortable administering oncology medications and monitoring blood transfusions. Erin indicated that she was nervous but would come to you with any questions.

It has been a very busy evening with new admissions and two high-acuity patients. You start a blood transfusion on Mr. Smith before you go to dinner and tell Erin to keep a close eye on him because he has a history of a severe reaction to a blood transfusion. Although Mr. Smith was given medication to control blood reactions, you want him monitored closely. You come back from dinner and find a commotion in Mr. Smith's room. He had experienced an anaphylactic reaction to his blood transfusion. Erin did not realize that she should have stopped the transfusion and reported it to another RN, who was covering for you in your absence. Erin was waiting until you came back from dinner to report the reaction to you. It was not until another LPN entered the room and noticed the reaction and then stopped the transfusion. You had assumed Erin knew that the unit protocol calls for the immediate secession of blood transfusions when the first sign of a reaction appears. Erin said she was unaware that she should have stopped the transfusion or reported it immediately.

What are the legal ramifications of this case? Should Mr. Smith die from this, would the legal ramifications be different than if he recovered from the incident? Who among the staff is responsible for this error in judgment? Discuss what you should do, if anything. What responsibility and liability exist for the supervisor that assigned Erin to your unit, Erin, and yourself? Use scholarly resources to support your decision.

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