Question: Reorganizing to Accommodate a Change in Staffing Mix You are the head nurse of an oncology unit. At present, the patient care delivery method on the unit is total patient care. You have a staff composed of 60% RNs, 35% practical nurses (LPNs/LVNS), and 5% clerical staff. Your bed capacity is 28, but your average daily census is 24. An example of day-shift staffing follows:

? One charge nurse who notes orders, talks with physicians, organizes care, makes assignments, and acts as a resource person and problem solver

? Three RNs who provide total patient care, including administering all treatments and medications to their assigned patients, giving IV medications to the LVN/LPNs' assigned patients, and acting as a clinical resource person for the LVN/LPNs

? Two LVN/LPNs assigned to provide total patient care except for administering IV medications Your supervisor has just told all head nurses that because the hospital is having difficulty recruiting nurses, it has decided to hire nursing assistants. The nurses on your unit will have to assume more supervisory responsibilities and focus less on direct care. Your supervisor has asked you to reorganize the patient care management on your unit to best use the following day-shift staffing: three RNs, which will include the present charge nurse position; two LVN/LPNs and two nursing assistants. You may delete the past charge nurse position and divide charge responsibility among all three nurses or divide up the work any way you choose.

ASSIGNMENT: Draw a new patient care organization diagram. Who would be most affected by the reorganization? Evaluate your rationale, both for the selection of your choice and the rejection of others. Explain how you would go about implementing this planned change.