You are a Registered Nurse on the afternoon shift on a short-stay (24 hours) in surgical
ward. One other Registered Nurse, an Enrolled Nurse (Who can administer medication but
cannot administer IV medication) and three Assistant in Nursing are also on duty. The
Nurse Unit Manager is off Sick, and the other Registered Nurse is acting as NUM as well as
taking a patient load. The ward is full, there are 22 patients, 14 of whom went to surgery in
the morning, and 8 are going on your shift. Half of these a patient have intravenous access
and antibiotics at some time during your shift.
Using your knowledge and experience of various patient allocation models, (such as total
patient care, team nursing, and task allocations), outline how you would allocate the staff to
the patient. Include in your discussion, your rational for the model of allocation chosen,
and the scope of practice of the various staff.
Roles in Nursing: Case Scenario
An efficient patient allocation model is vital for the safe delivery of nursing care to
patients. Such a model should maximize on the abilities, roles, responsibilities, and actions of the
available staff especially considering that nursing practice is prone to a shortage of practitioners.
Halcomb et al. (2014) put it that role development is an issue worth attention when seeking to
strengthen primary care delivery in the Australian clinical setup. This article takes an evidence-
based approach to develop a workable task allocation in a case in which there are five nursing
professionals with different education and experience levels.
According to Ferguson and Cioffi (2011), factors worth considering when managing
nursing staff and allocating tasks include skills, experience, education, and the gains of patients
and the service providers. On their part, McHugh and Lake (2010) asserted that when expertise is
matched to responsibilities, it is possible for nursing staff to deliver high-standard care.
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Therefore, in addition to prioritizing on what types of services nursing professionals in the case
study can deliver, it is also necessary to ensure that the staff is placed at a position from where it
would gain and encounter minimum discomfort. The approach would facilitate teamwork and
motivate service providers to be responsible while delivering with minimum supervision.
The Nursing and Midwifery Board of Australia (2016) defined the capabilities of
registered nurses as including delivery of evidence-based and person-centered curative,
palliative, restorative, formative, preventive, and supportive care to their clients. In the case
scenario, registered nurses are best placed for context assessment and plan development as well
as outcome evaluation and implementation. As such they would be required to supervise the
enrolled nurse and the three nursing assistants while also administering intravenous medications
to patients. Since one of the RNs is on administrative duties, the remaining one should actively
engage in clinical duties.
On their part, enrolled nurses in Australia are accountable for the services they deliver
when delegated (Monash University, 2016). These include administering direct care to patients
and monitoring its impact. However, as Jacob et al. observed, ENs in Australia may end up
practicing beyond their scope as the country faces staff and economic challenges (2010).
Nevertheless, nurses should purpose to do their best for the wellness of their patients as they
communicate their concerns through the relevant avenues. However, it is important that ENs be
conversant with the law as there are restrictions to the types of care they should deliver
depending on whether they have a notation or not (Nursing and Midwifery Board of Australia,
2016). In the case scenario, the EN can administer antibiotics to patients, interact supportively
with patients, monitor individuals, and update the RN on patient statuses accordingly.
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ROLES IN NURSING
Lizarondo et al. (2010) investigated the importance of assistants in healthcare and
concluded that they are valuable in service delivery and institutions should engage them
effectively. In nursing, assistants are mandated to deliver services such as personal care for
patients, manual transportation, preparing patients for clinical services, and ensuring that patient
access recreational facilities when appropriate (Queensland.gov, 2013). In the case scenario,
assistants should engage in the promotion of patient wellness through approaches such as
maintaining high levels of hygiene. It is worth noting that surgical patients are prone to
infections and therefore, the hospital should promote hygiene so as to prevent nosocomial
complications (Mathur, 2011).
Reference
Ferguson, L. & Cioffi, J. (2010). Team nursing: experiences of nurse managers in acute care
settings. Australian Journal of Advanced Nursing, 28(4), 5-12.
Halcomb, E. J., Salamonson, Y., Davidson, P. M., Kaur, R., & Young, S. A. (2014). The
evolution of nursing in Australian general practice: a comparative analysis of workforce
surveys ten years on. BMC Family Practice, 15, 52.
Jacob, E. R., Barnett, A., Sellick, K., & McKenna, L. (2013). Scope of practice for Australian
enrolled nurses: evolution and practice issues. Contemp Nurse, 45(2), 155-163.
Lizarondo, L., Kumar, S., Hyde, L., & Skidmore, D. (2010). Allied health assistants and what
they do: A systematic review of the literature. Journal of Multidisciplinary Healthcare, 3,
143–153.
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Mathur, P. (2011). Hand hygiene: Back to the basics of infection control. The Indian Journal of
Medical Research, 134(5), 611–620.
McHugh, M. D., & Lake, E. T. (2010). Understanding clinical expertise: nurse education,
experience, and the hospital context. Research in Nursing & Health, 33(4), 276–287.
Monash University. (2016). The enrolled nurse (EN) scope of practice.
Nursing and Midwifery Board of Australia. (2016a). Registered nurse standards of practice.
Nursing and Midwifery Board of Australia. (2016b). Fact sheet: enrolled nurse and medicine
administration.