You work in an intensive care unit where there is an all-RN staff. The staff work 12-hour shifts, and each nurse is assigned one or two patients, depending on the nursing needs of the patient. The unit has always used total patient care delivery assignments. Recently, your unit manager informed the staff that all patients in the unit would be assigned a case manager in an effort to maximize the use of resources and to reduce LOS in the unit. Many of the unit staff resent the case manager and believe that this has reduced the RN’s autonomy and control of patient care. They are resistant to the need to document variances to the care MAPs and are generally uncooperative but not to the point that they are insubordinate. Although you feel some loss of autonomy, you also think that the case manager has been effective in coordinating care to speed patient discharge. You believe that at present, the atmosphere in the unit is very stressful. The unit manager and case manager have come to you and requested that you assist them in convincing the other staff to go along with this change. ASSIGNMENT: Using your knowledge of planned change and case management, outline a plan for reducing resistance.

 

You are working on the evening shift of a surgical unit. Mr. Jones returned from the post-anesthesia care unit following a hip replacement 2 hours ago. While in the recovery room, he received 10 mg of morphine sulfate intravenously for incisional pain. Thirty minutes ago, he complained of mild incisional pain but then drifted off to sleep. He is now awake and complaining of moderate to severe incisional pain. His orders include the following pain relief order: morphine sulfate 8–10 mg, IV push every 3 hours for pain. It has been 2½ hours since Mr. Jones’ last pain medication. What would you do?