A nurse is caring for a client who has cancer the client’s adult child asks the nurse for information about the client’s treatment plan. Which of the following responses should the nurse make?

a. A client is refusing care from assistive personnel of the opposite gender:

This situation involves the client's right to refuse care based on personal preferences or cultural beliefs. While it requires attention and respect for the client's wishes, it may not pose an immediate risk to patient care or staff safety.

b. No transport assistance is available to take a client to physical therapy:

This can be resolved by contacting the transportation department or finding an alternative solution, but it is not a critical issue that requires immediate attention.

c. Two nurses had a heated disagreement about a scheduling issue:

While workplace conflicts should be addressed to promote a positive work environment, a heated disagreement about a scheduling issue may not pose an immediate threat to patient care. However, if the disagreement escalates or affects staff morale, it could impact unit functioning and require intervention.

d. Three staff members have called to say they will be absent:

This situation has the most immediate impact on the overall functioning of the unit. Staffing shortages can affect patient care and safety, so it is crucial to address this issue promptly to ensure adequate coverage and maintain the quality of care.

a. Alert the infection control department:

While the infection control department plays a role in ensuring proper infection prevention practices, directly alerting them may not be the most immediate action to take. The charge nurse should first address the issue internally before escalating it to other departments.

b. Discuss the issue with the AP:

This is the most appropriate initial action to take. Speaking directly with the assistive personnel allows the charge nurse to clarify the correct protocol, provide education or retraining if necessary, and address any misunderstandings or lapses in adherence to facility policies.

c. Reinforce facility protocols at the next staff meeting:

While reinforcing facility protocols is important, waiting until the next staff meeting may not address the immediate concern of the observed failure to follow protocol. Direct communication with the individual involved is more effective for addressing the specific incident in a timely manner.

d. Notify the unit manager about the incident:

Notifying the unit manager about the incident may be necessary if the issue persists or if further action is required beyond the initial discussion with the assistive personnel. However, it may not be the first step to take when addressing an isolated incident.