A charge nurse notes that a staff nurse delegates an unfair share of tasks to the assistive personnel (AP) and the nurses on next shift report the staff nurse frequently leaves tasks uncompleted. Which of the following statements should the charge nurse make to resolve this conflict?

A. Administer an analgesic PO: Administering an analgesic by mouth may not provide immediate relief for the pain at the insertion site of the IV catheter. Oral medications typically take time to be absorbed and reach therapeutic levels in the bloodstream, which may delay pain relief. Additionally, oral analgesics are not specifically targeted to the site of pain and may not adequately address localized discomfort associated with IV insertion.
B. Administer a local anesthetic: Administering a local anesthetic, such as lidocaine, is the most appropriate action to alleviate pain at the insertion site of the IV catheter. Local anesthetics block nerve impulses in the area where they are applied, temporarily numbing the site and providing rapid pain relief. The nurse can apply a topical local anesthetic cream or spray directly to the skin around the insertion site or infiltrate lidocaine into the subcutaneous tissue near the catheter insertion site to minimize discomfort for the client.
C. Request a prescription for placement of a central venous access device: Requesting a prescription for a central venous access device, such as a central venous catheter or peripherally inserted central catheter (PICC), is not indicated solely based on the client's report of pain at the insertion site of the IV catheter. Central venous access devices are typically reserved for clients requiring long-term intravenous therapy, frequent blood draws, or administration of vesicant or irritating medications. The decision to insert a central venous access device should be based on the client's specific clinical needs and the assessment of venous access options by the healthcare provider.
D. Remove the catheter and insert another of a different size: Removing the IV catheter and inserting another of a different size solely due to pain at the insertion site may not be necessary and could cause additional discomfort and trauma to the client. The nurse should assess the insertion site for signs of complications, such as infiltration, phlebitis, or infection, before considering catheter removal and replacement. If the IV catheter is appropriately positioned and functioning well, the nurse should focus on managing the client's pain at the current insertion site using appropriate interventions, such as administering a local anesthetic, rather than immediately removing the catheter.

A. Requiring staff nurses to demonstrate competency by passing a medication administration examination: While competency assessments are essential, initiating this as the first strategy may not address the root causes of medication administration errors. It's important to first understand the specific factors contributing to errors by reviewing the events leading up to each error before implementing competency assessments. This allows for a targeted approach to addressing gaps in knowledge or skills related to medication administration.
B. Providing an in-service on medication administration to all nurses: While education and training are valuable components of error reduction strategies, providing an in-service as the first step may not address the underlying system issues contributing to medication errors. Education should complement other interventions aimed at improving the medication administration process, such as system redesign or standardization of practices.
C. Developing a quality improvement program for nurses involved in medication administration errors: Implementing a quality improvement program for nurses involved in errors is important for learning from mistakes and preventing recurrence. However, developing such a program should be informed by a thorough analysis of the events leading to errors. Without understanding the root causes, it may be challenging to develop effective improvement initiatives.
D. Reviewing the events leading up to each medication administration error: This strategy is the most appropriate initial step. Conducting a detailed review of each error allows the committee to identify patterns, common factors, and system issues contributing to medication errors. By understanding the specific circumstances surrounding each error, the committee can develop targeted interventions to address root causes and prevent future errors. This approach aligns with the principles of continuous quality improvement, focusing on data-driven analysis and proactive problem-solving.