Leadership in Clinical Practice

Clinical Scenario 1:Aarya is a graduate nurse working in Westeros Aged Care. On this particular afternoon shift the wing she is responsible for has been very busy. She is responsible for fifty residents in Winterfell Wing. She is leading a team of one Enrolled Nurse and six carers. The GP is coming to review Mr Lannister around 1800 hrs as he has been complaining of a rash on his back. His family voiced their concern three days ago and have expressed concern as it has not been reviewed as yet. Aarya called the GP surgery at the start of the shift (1500 hrs) and Dr Greyjoy has agreed to come after his surgery closes for the day.

One of the residents is on a PEG feeding schedule due to finish at 8pm, five residents are on regular 4 hourly observation (vitals) as they have been noted to be having flu like symptoms; there are two residents who are on insulin and need to get their BGL checked before dinner, and their  insulin administered.The morning RN handed overto her that one of the residents, Mrs Snow, was out for lunch with her daughter, thus her IDC could not be changed which was due that day. There are five simple dressings and two complex dressings to be done for the shift. The care manager has requested a continence assessment for the new resident, Greg Clegane, who arrived 3 days ago and is having some trouble settling in.

Also due is the three monthly care plan review for two of Aarya’s residents, Edward Stark and Ted Littlefinger. Halfway through the shift one of the carers complains of feeling unwell, thus is allowed to go home. Aarya needs to complete two medication rounds in her shift; 1700 hrs and 2000 hrs inclusive of four residents on S8 drugs. After dinner (approx. 17:40 hrs) Aarya gets a call from one of the carers that Mrs Targaryen has been found on the floor of her bedroom and has a laceration to her head.

Clinical Scenario 2:Jade is a second-year postgrad registered nurse who usually works in ICU but has been sent relieving to the Surgical Ward at The Busy General Hospital as ICU is quiet. She has commenced an early shift, and has been allocated eight patients with Olive, an experienced Surgical Ward EN. Ebony is the team leader for the shift. Ash is the ward AIN, and he is floating for the whole 30 bed ward. Jade is also allocated the supervision of Hunter, a supernumary third year student RN on the sixth week of his 8-week internship on the Surgical Ward. Their patient load is currently:

Bed 1- Kay White, 38 yo female: day 2 post appendicectomy. Type 1 diabetic on free fluid diet

Bed 2- Mark Black, 59 yo male: day 1 post op total knee replacement, buzzes needing to open bowels

Bed 3- Jan Green, 79 yo female: day 3 post hemicolectomy with ileostomy formation. Her stoma is not functioning, and the stump looks to be very dark through the stoma bag.

Bed 4- Jock Grey, 69 yo male: medical outlier awaiting a bed on the Respiratory ward; exacerbation of COPD; due for regular nebs, spo2 is 92% on 2L/O2. He buzzes complaining of chest pain.

Bed 5- Pippa Blue, 48 yo female; day 1 post-mastectomy for breast cancer, bellovac drain in situ which is nearly full of haemoserous fluid. She will be allowed to go home once she has been seen by the breast care clinical nurse consultant (CNC).Bed 6- Tanya Pinkstone, 26 yo female; Day 8 post MVA, fractured sternum, preparing for discharge tomorrow, needs a check CXR today

Bed 7 – Tom Purple, 72 yo male day 10 post total knee replacement, needs to be ready for QAS transfer to private rehab hospital at 0900. He needs staples removed and basic wound dressing applied, discharge paperwork to be completed including last set of vital signs and discharge medications to be arranged with pharmacy.

Bed 8 – Stacey Yellow, 62 yo female; Day 12 with settling acute pancreatitis, heavy drinker and smoker who wants assistance to go outside for a cigarette. Her discharge planning is complex due to her difficult social situation – she has recently been evicted from her government housing and has no family support.