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1) You have been working on a medical-surgical unit

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1) You have been working on a medical-surgical unit. As you complete your nursing program, you begin to interview at several hospitals. Set up a decision-making grid to help you analyze your choices. What factors are most important to you as you begin to consider your decision? Use Figure 4-5.

2) Use the decision-making process in Table 4-2 and ask yourself the critical thinking questions inspired by Table 4-3 when you are making decisions. Have I gathered the best, most up-to-date research and evidence to help with the decision? Is my information clear or unclear, precise or imprecise, specific or vague, accurate or inaccurate? Is it relevant or irrelevant, logical or illogical, deep or superficial, complete or incomplete, significant or insignificant, adequate or inadequate, and fair or unfair? Apply the critical thinking questions and review the research and best evidence at each step.

3) As more is learned about quality improvement, including the prevention of health care error or risk and using research fi ndings in daily practice, organizations must make shifts in how they practice. For example, organizations must recruit and retain a qualifi ed workforce, make quality improvements, and assess and reward performance. What can the clinical nurse do to improve quality of care, patient outcomes, and patient and staff satisfaction, and also minimize health care error? What are the contributing and inhibiting factors in your workplace in identifying errors and reporting them?

4) Dalen and Alpert (2008) maintain that the U.S. needs only to follow its own Medicare model to implement a viable national health care program. They state, “Medicare pays the private sector to deliver quality health care to more than 44 million Americans. Those who stick with traditional Medicare have free choice of physicians and hospitals. Nearly every U.S. physician and nearly every hospital in the U.S. has elected to participate in Medicare. The administrative costs of Medicare are only 2% compared to costs of 12% with for-profi t health insurers” (p. 55. Is a national health care plan the solution to our health care problems? What is the position of your state board of nursing and the American Nurses Association on this? Visit their web sites to compare their position statements.

5) As the nurse enters the room of a new postoperative patient with a radical laryngectomy, the patient begins to hemorrhage from his neck incision. The nurse applies direct pressure with one hand and calls for assistance. Help arrives and the patient is taken to surgery with the nurse still maintaining pressure on the hemorrhaging site. The patient lives and goes home a few days later. How does good leadership on a patient care unit ensure positive nurse-sensitive patient outcomes in an emergency? How can you develop your transformational leadership skills, such as belief in self as a change agent, belief in people, and being a lifelong learner to improve your ability to care for a group of patients and empower others to do so?

6) An adult patient with a history of alcoholism, 24 hours after gastric resection surgery, is complaining of pain rated as 9 on a scale of 1 to 10, with 10 being most severe. The nurse reviews the orders and prepares to administer morphine 2 mg intramuscularly. Before administration of pain medication, which assessment is a priority that must be completed by the RN? a) Bowel sounds and degree of nausea b) Respiratory rate and level of consciousness c) Heart rate and ambulatory status d) History of addiction to narcotics and potassium level

7) When Susan arrived on duty, what are some strategies she could have used to be sure she made the most of her early arrival?What factors should Susan and Maura consider when deciding how to prioritize their patient care assignment?

8) What type of team-building skills will help Nancy as she learns to work with the interprofessional team and coordinate the patient’s plan of care with a diverse group of health professionals?What resources are available to help Nancy learn and enhance her management and leadership skills?

9) What skills will assist Nancy as she begins her new role as a staff RN with many leadership and management responsibilities?Why is it important for the nursing staff to understand the mission and values of the organization to provide direct patient care?