Directions: Choose three scenarios and develop a Response Plan, in the form of an outline. Scenario One: Inpatient nephrology unit You are the new nurse manager for a busy nephrology medical/surgical unit in a large university medical center. The renal physicians have complained that daily weights and intake/output records are not being completed. This lack of documentation affects the patient’s plan of care and is resulting in an increased length of stay for the unit. The night-shift nurses think the day-shift nurses need to do the daily weights since they have more staffing. The day-shift nurses think the night-shift needs to do the weights since breakfast arrives during report most days. No one is consistently recording the intake/output records. How will you handle this problem?
• National Kidney Foundation: Clinical Practice Guidelines. Scenario Two: Outpatient chest pain/stroke unit You have just been promoted to the nurse manager position in a 12-bed chest pain/stroke outpatient center. The hospital is at 18 months of the 36-month Joint Commission accreditation cycle, so you are expecting a survey sometime within the next 18 months. You are reviewing the Joint Commission Core Measures for Outpatient Departments. You discover an issue with the administration of aspirin on arrival for the chest pain/acute MI patients not being documented 50 percent of the time. Also, the time to CT scan for ruling out acute ischemic stroke patient is 75 minutes, which is 30 minutes above benchmark time of 45 minutes. Who needs to be involved in examining these processes in order to improve compliance prior to the survey? Would you develop one team to work on both issues or two teams so that each works on one issue? Why? Scenario Three: School nurse You are the only school nurse in a high school (grades 10, 11, and 12). The school is located in a small rural conservative town. There has been a 15 percent increase in students contracting sexually transmitted diseases and three girls in the junior class are pregnant. The community insists that the area schools only teach abstinence to the students. The school board does not want to anger the parents. While you respect the culture of the town, you realize this is a huge community health problem. Where do you start to address this issue?
• CDC: Adolescent and School Health; Sexual Risk Behaviors. Scenario Four: Inpatient psych unit You are the nurse manager of an inpatient psychiatric unit and are preparing a report for a Joint Commission survey. An epidemic of bath salts abuse has struck the community. Following initial treatment in the intensive care unit, violent psychiatric patients are being admitted to the unit. You reviewed the Joint Commission guidelines and discovered deficiencies in several categories of the patient discharge records and your seclusion hours are increasing.
• Hospital Based Inpatient Psychiatric Services (HBIPS).
Who will you involve in the interdisciplinary team to work on the discharge issues? How will you work on decreasing seclusion hours in these patients? Scenario Five: Pediatric vaccinations. You are the nurse manager in a large pediatric practice. It is late summer and parents are bringing their children in to get their “blue cards” filled out for school. Several parents have been asking for medical exemptions because the local news has been reporting on a rash of adverse reactions to vaccinations, even linking an incident relating a child’s recent diagnosis of autism to an MMR vaccine. How will you proceed in obtaining the best evidence to help work with the parents?