Trans Case Study

Amy is a new graduate RN. She has assumed her new role in the facility in which she has worked for years as an LPN/LVN. She and another co-worker, Brenda, have become good friends over the years, but Brenda did not return to school and remained an LPN/LVN. During her role as an RN, Amy learned that she must do rounds on patients with patient-controlled analgesia (PCA) pumps containing narcotic analgesics every 2 hours. An RN must verify the vital signs and check to make sure that basal rates and PRN dose calibrations are set correctly and monitor the patients respiration rate and pain level. During the middle of the day, Amy becomes increasingly busy and realizes that she needs to do her PCA rounds. After hurrying through the first hallway, she meets Brenda in the doorway. Brenda tells her not to worry, that she will do the rounds on this hallway because she has most of the patients, and that Amy can come later before the shift is over and sign her name. Brenda states that she will let her know if there are any problems. Amy knows that Brenda has been a nurse for many years and they have worked together often. She trusts that Brenda will monitor these patients correctly, and she returns to the desk to make a call to surgery for a patient report. At the end of the shift, Amy makes her final PCA rounds, and she finds that Mr. Johnson has a respiration rate of 10 and is having difficulty breathing. She assesses the calibrations of the PCA syringe to find that he is obtaining a high basal rate that is in error with orders. She quickly reacts to the condition of Mr. Johnson, administers the overdose emergency medication, and phones the physician. After Mr. Johnson is stabilized, Amy runs into Brenda in the nurses’ lounge. Brenda reports to her that she had intended to check on Mr. Johnson, but she was distracted by a patient who had pulled out her IV and was in the hall and covered in blood. The case is reviewed by the facility medication error task force, and Amy is reprimanded for her negligence and improper execution of procedure. Questions: 1. RNs are to assess situations and make decisions based on priority. What is the threshold for delegating procedures when prioritizing tasks? 2. What would be the difference in this decision between a novice nurse and an expert nurse? 3. What made Amy think that leaving the rounds to Brenda was okay? Did their friendship have anything to do with it?