A charge nurse is reviewing staffing assignments for the upcoming shift when two registered nurses call in sick. The unit has 28 patients with varying acuity levels. What is the most appropriate action for the charge nurse to take to ensure patient safety?
1Cancel all elective procedures and discharge stable patients early to reduce the patient census
2Contact the nursing supervisor to request additional staff and implement contingency staffing protocols✓ 정답
3Assign the remaining nurses to work double shifts to cover all patient assignments
4Redistribute patients among available staff without considering individual nurse competency levels
해설
Contacting the nursing supervisor to request additional staff and implement contingency protocols ensures patient safety during unexpected shortages. Other options compromise safety by canceling procedures, overworking staff, or ignoring competency levels.
Analysis of the Clinical Scenario
This question tests your ability to apply leadership and management principles during a staffing crisis, a high-frequency topic on the NCLEX-RN under the "Management of Care" category. The core of the scenario is a sudden, unplanned reduction in nursing staff on a unit with a significant number of patients. The priority is to ensure patient safety by mobilizing resources and following established organizational protocols. The concept of managerial agility is central here, defined as the proactive, adaptive, and timely response of a nurse manager to unforeseen challenges in a dynamic healthcare environment [1]. An agile manager does not simply react with short-sighted solutions but uses a systematic approach to stabilize the situation.
Rationale for the Correct Answer
Option 2 is the most appropriate action because it directly embodies managerial agility. This concept involves the ability to "respond effectively to emerging challenges" by making timely decisions and leveraging available resources [1]. Contacting the nursing supervisor is a critical first step that activates the chain of command and accesses a broader organizational view. The supervisor can implement contingency staffing protocols, which may include calling in per-diem nurses, reallocating float pool staff, or authorizing overtime in a controlled manner. This action is proactive and systematic, focusing on increasing resources to match patient demand, rather than making unsafe compromises with existing resources. It demonstrates a key dimension of agile management: the capacity to sense a problem and mobilize a response that maintains care quality [1].
Rationale for Incorrect Answers
Option 1: Canceling elective procedures and discharging stable patients is a drastic measure that falls outside the charge nurse's scope of authority and immediate capability. Such decisions require collaboration with the medical staff, hospital administration, and careful patient assessment to avoid unsafe discharges. This action is a reactive, macro-level solution, not an immediate, unit-level adaptive response characteristic of an agile nurse manager [1]. It fails to address the immediate staffing gap for the patients who remain on the unit.
Option 3: Assigning remaining nurses to work double shifts is a dangerous and short-sighted solution. This action ignores the evidence that nurse fatigue leads to errors, decreased vigilance, and compromised patient safety. It is a non-adaptive, rigid response that prioritizes filling a schedule over the well-being of both staff and patients. Managerial agility is not about forcing a static plan to work under new conditions; it is about adapting the plan to the new reality [1]. This option represents a failure to adapt effectively.
Option 4: Redistributing patients without considering individual nurse competency is a direct violation of the standard of care. Safe delegation and assignment are fundamental legal and ethical responsibilities of the charge nurse. This action disregards patient acuity and the skill mix required for safe care, creating a high-risk environment for adverse events. An agile manager's response is not just timely but also appropriate and grounded in professional judgment to ensure high-quality care [1]. This option shows a complete lack of that judgment.
References (research sources)
[1]
Managerial agility in nursing: a concept analysis.Research articleGougjehyaran HG, Maleki RN, Sahebihagh MH. (2025) · DOI: 10.1186/s12912-025-03710-9
Clinical Practice Guide: Managing an Acute Staffing Shortage
When faced with unexpected call-ins, the charge nurse must prioritize patient safety through systematic resource mobilization rather than reactive, short-term fixes. The following steps outline the safest, most effective approach.
Immediate Actions
Activate the Chain of Command: Immediately notify the nursing supervisor or house manager. This is not a sign of failure but a professional responsibility to access additional resources and organizational support.
Assess Current Resources: Quickly evaluate the acuity of all 28 patients and the competencies of the remaining on-duty staff. This data is critical for the supervisor to make informed decisions.
Implement Contingency Protocols: Work with the supervisor to execute the facility's staffing plan, which may involve calling in per-diem nurses, requesting float pool staff, or offering controlled, voluntary overtime.
Actions to Avoid
Do not mandate double shifts: Forced overtime leads to nurse fatigue, burnout, and a significant increase in medication errors and patient falls, directly jeopardizing patient safety.
Do not independently alter the patient census: Decisions to cancel procedures or discharge patients early are outside the charge nurse's scope of practice and require physician collaboration. Premature discharge can lead to adverse outcomes and readmission.
Do not ignore nurse competency: Redistributing patients without matching nurse skills to patient acuity creates unsafe assignments. A novice nurse should not be assigned a highly unstable patient without appropriate support.
Key Safety Principle
The goal is to increase resources to match demand, not to force existing staff to absorb an unsafe workload. Managerial agility means adapting proactively by leveraging the system's full capabilities, not just reacting to the immediate gap.
Managerial Agility — The proactive, adaptive, and timely response of a nurse manager to unforeseen challenges, involving systematic mobilization of resources and adherence to protocols.
Contingency Staffing Protocols — Pre-established organizational plans to address sudden staffing shortages, which may include calling in per-diem nurses, using float pool staff, or authorizing controlled overtime.
Chain of Command — The formal line of authority and communication within a healthcare organization, which should be activated during a crisis to access broader resources and support.