You have just taken over the nurse manager job on a medical-surgical unit. The nurse manager who was previously in the position left abruptly 2 weeks ago. An alternate nurse manager from the telemetry unit next door has been filling in to help with staffing but has provided little management and supervision to the unit. When you walk around the unit throughout your first day of work and settle into reviewing the paperwork on your desk, you notice several issues that need to be addressed:
The day nurses are choosing the patients for the night nurses, and the night nurses are choosing patients for the day nurses. Some nurses have extremely light loads, while others have extremely heavy loads. The nurses are choosing patients for their friends without consideration for staffing, patient load, and quality care factors. When you inquired about the prior staffing assignments system, the nurses replied, “Whatever it was, it was never enforced. So, we took over.”
HCAHPS survey scores are extremely low in several categories, including “Your Care From Nurses” and “Your Experiences in this Hospital.”
