Scenario: The Registered Nurse arrives to begin the shift on a busy medical-surg

Question

Scenario: The Registered Nurse arrives to begin the shift on a busy medical-surgical floor and discovers the other RN scheduled to work has called in sick. The patient census is 30. Two unlicensed assistive personnel (UAP) have been assigned to the unit. The RN is responsible for administering all patients’ medications during the shift. One of the patients who is very ill requires the use of transmission-based precautions for chicken pox.

The RN approaches the room to administer the medication, notes the sign about the type of transmission-based precaution for this patient and thinks “I don’t need to use the precautions”. The RN enters the patient’s room and hangs the intravenous medication. Upon leaving the RN thinks “See I was only in there less than 5 minutes and no harm done. The greater good is I can get the other medications out to patients that need them now.”

Consider the chain of infection as you prepare a response to this situation.

What are the implications of the RN’s decision about the application of transmission based precautions?

Are there any reasons that support the RN’s action?

Think about risk vs. benefit

Explanation / Answer

The decision of RN was based on her thinking that precautions for the concerned patient were not necessary or needed. Her decision of disregarding patient’s health and safety was not right. She took the decision based only on short term current situation without considering the risk it can pose in future with long term or drastic effects. It is clear that her carelessness might lead to transmission of disease from one patient to another. Standardized quality measures should be mandatory in hospitals which when followed rigorously ensure the health of the patients. These measures include evidence based practice improvements which are focussed on avoiding deaths as well as injuries. Also there must be a doctor who supervises RN’s decision.

Based on the scenario given there are no reasons that support RN's actions.

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