Small Community Hospital You are a 3-11 pm team leader on a medical unit of a small community hospital. On leaving the report room, John, the day shift team leader, tells you that Mrs. Jackson, a terminally ill patient with cancer, has decided to check out of the hospital “against medical advice.”
John states that he has already contacted Mrs. Jackson’s doctor, who expressed his concern that the patient would have inadequate pain control at home as well as undependable family support. He feels that she will die within a few days if she leaves the hospital. However, he did leave orders for home prescriptions and a follow-up appointment.
Small Community Hospital Essay Paper
You immediately go into Mrs. Jackson’s room to assess the situation. She tells you that the doctor told her that she will probably die within 6 weeks and that she wants to spend what time she has left at home with her little dog, who has been her constant companion for many years. In addition, she has many things to put in order. She states that she is fully aware of her doctor’s concerns and that she was already informed by the day shift nurse that leaving “against medical advice” may result in the insurance company refusing to pay for her current hospitalization. She states that she will be leaving in 15 minutes when her ride from home arrives.
When you go to the nurse’s desk to get a copy of the home prescriptions and follow-up doctor’s appointment for the patient, the unit secretary states, “The hospital policy says that patients who leave against medical advice have to contact the physician directly for prescriptions and an appointment, because they are not legally discharged. The hospital has no obligation to provide this service. She made the choice—- now let her live with it.” The secretary refuses to give a copy of the orders to you and places the patient’s chart in her lap. Short of physically removing the chart from the unit secretary’s lap, it is clear that you have no immediate access to the orders.
You confront the charge nurse, who states that the hospital policy does give the responsibility to the patient. She is unsure what to do and has paged the unit director, who appears to be out of the hospital temporarily.
You are outraged. You feel the patient has the “right” to her prescriptions because the doctor ordered them, assuming she would receive them before she left the hospital. You also know that if the medications are not dispensed by the hospital, there is little likelihood that Mrs. Jackson will have the resources to have the prescriptions filled.
Five minutes later, Mrs. Jackson appears at the nurse’s station, accompanied by her friend. She states she is leaving and would like her discharge prescriptions.
Small Community Hospital Essay Paper Assignment
The power struggle in this scenario involves you, the unit secretary, the charge nurse, and organization politics. Please answer the following questions with a great deal of thought and on the basis of what you read in your text and any other sources you wish to cite:
- Does the unit secretary in this scenario have informal or formal power? Discuss your rationale for your answer.
What alternatives for action do you have?
What are the costs and/or consequences of each possible alternative?
- What action would you take?
The University of North Carolina at Greensboro
School of Nursing
Nursing 472 Leadership and Management in Nursing
Discussion Forums (20%) (SLO 1, 2, 5-7)
Purpose: The purpose of the Discussion Forums is to allow you to have conversations with your class about real-life scenarios that often occur in acute care settings and what the nurse leader’s role is in addressing these situations.
Small Community Hospital Essay Paper Directions
Each student is required to post an initial thread in response to the provided prompt for each Discussion Forum. Each thread must be at least 300 words (excluding salutations and references) and should be supported with at least two (2) scholarly references. Discussion Forum threads should include all key components. Major points should be supported by course readings, current (within 5 years) literature, and pertinent conceptual or personal experience examples. Scholarly references are articles found within the nursing literature that have been peer reviewed. Examples include; Journal of Nursing Management, Journal of Advanced Nursing, Journal of Nursing Administration, Critical Care Nursing. Articles from online web sites such as WEB MD, Mayo Clinic, Centers for Disease Control, or blogs do not provide scholarly articles. The web sites may be accurate, but they are not peer-reviewed. If using an online web site, make sure there is an author who is credentialed. If you are not able to find that on the web site, you probably should not use that as a reference.
In addition to the initial thread, each student is required to reply to at least two (2) group member’s threads. Each reply must be at least 150 words (excluding salutations).
Proper use of current APA formatting for references, correct grammar and spelling, proper sentence structure, evidence of critical thinking, and a robust discussion supported by evidence is expected. Responses that do not contribute to the content of the discussion will be disregarded (e.g., “I agree”, “You did a great job”, or “I have nothing else to add” are examples of responses that do not contribute to content).
Initial threads are due by 11:59 P.M. on Thursday of the assigned week and replies are due by 11:59 p.m. on Sunday of the same assigned week. Failure to post initial thread by Thursday will result in a 15 point deduction. Late discussion board postings will not be accepted and will affect the grade. Students are highly encouraged to post more than the minimum entries and to post early. The final discussion board grade is an average of the graded forums throughout the semester.
DISCUSSION FORUM GRADING RUBRIC
Thread Points
All key components and questions of the discussion board forum are answered in the thread. The initial post is submitted on time.
30
Major points are supported by course material, personal experiences, and thoughtful analysis. At least 300 words (excluding salutations and references). The initial thread should include at least two (2) scholarly references which are cited in appropriate APA format.
25
Proper grammar and spelling are used consistently
10
Replies Points
Major points are supported by course material, personal experiences, and thoughtful analysis. At least 150 words (excluding salutations and references). At least two (2) replies to two different group members posted within group discussion.
25
Proper grammar and spelling are used consistently.
10
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