A nursing supervisor is reviewing staffing assignments for the upcoming night shift in a medical-surgical unit. The unit has 28 patients, and the following staff are available: 2 RNs, 2 LPNs, and 3 nursing assistants. One RN calls in sick 2 hours before the shift begins. What is the most appropriate immediate action for the nursing supervisor to take to ensure patient safety?
1Redistribute the patients equally among the remaining staff members
2Contact the nursing supervisor to request closure of new admissions
3Call in an additional RN or reassign an RN from another unit✓ 정답
4Assign the LPNs to take on additional responsibilities typically performed by RNs
해설
When facing a staffing shortage that compromises patient safety, the priority is to maintain appropriate nurse-to-patient ratios and ensure adequate RN coverage for complex patient care needs. Options 1, 2, and 4 fail to address the immediate need for qualified RN staff.
This question tests your ability to apply principles of nursing supervision, delegation, and staffing management to ensure patient safety. The core issue is an acute staffing shortage where the unit has lost one of its two Registered Nurses (RNs) right before a shift. The supervisor must act immediately to maintain a safe nurse-to-patient ratio and ensure that legally and clinically appropriate care is provided.
Analysis of the Options
Option 1 (Redistribute patients equally): This is incorrect because it ignores the legal scope of practice differences between RNs, Licensed Practical Nurses (LPNs), and nursing assistants. A simple numerical redistribution could assign unstable patients or those requiring complex assessments to staff who are not qualified to care for them, directly compromising patient safety. Effective supervision requires matching patient acuity with staff competency, not just counting numbers [2].
Option 2 (Request closure of new admissions): While this might be a secondary action to control workload, it is not the most immediate action to address the existing 28 patients' safety with the current critically low staffing. The immediate need is to fill the competency gap left by the absent RN.
Option 3 (Call in an additional RN or reassign an RN from another unit): This is the correct answer. The loss of an RN creates a critical deficit in the unit's ability to perform nursing assessments, develop care plans, and administer certain medications—functions legally reserved for the RN. The nursing supervisor's primary responsibility is to ensure adequate, competent staff. Replacing the RN skill mix is the most direct and appropriate immediate action to safeguard patient care [2].
Option 4 (Assign LPNs to take on additional RN responsibilities): This is incorrect and unsafe. It violates the scope of practice as defined by nurse practice acts. LPNs cannot legally assume the independent assessment and care planning responsibilities of an RN. A supervisor's role is to ensure that delegation is legally sound and that staff are not placed in a position where they must practice beyond their licensure level [2].
Deep Dive into the Rationale
The correct action is rooted in the fundamental supervisory responsibilities of the Registered Professional Nurse. As the most qualified category in the nursing profession, RNs are mandated by their scope of practice to supervise other nursing categories during the provision of care [2]. This supervision is not merely an administrative task; it is a cornerstone of high-quality nursing care that must be integrated into daily operations to ensure patients receive optimal treatment and to minimize complaints and lawsuits [2]. When an RN is absent, the supervisor cannot simply delegate their core functions to an LPN, as this would constitute a failure in supervision and a direct violation of practice standards. The immediate priority is to restore the necessary RN-level competency to the unit, either by calling in another RN or by reassigning one from a less critical area. This ensures that the chain of command and supervision remains legally and clinically intact, directly addressing the root cause of the safety risk.
References (research sources)
[2]
Registered professional nurses' experiences regarding supervision of nursing care at selected hospitals of Limpopo province.Research articleRaliphaswa MR, Luhalima TR, Mafumo JL. (2026) · DOI: 10.4102/curationis.v49i1.2846
Clinical Practice Guide: Managing Acute RN Shortage on a Medical-Surgical Unit
When an RN calls in sick shortly before a shift, the immediate priority is restoring the RN-level competency to meet legal and clinical care standards. A simple numerical redistribution of patients is unsafe.
Immediate Action: Attempt to call in a per-diem or on-call RN. If unavailable, reassign a float RN from another unit with similar competencies. This ensures assessments, care planning, and high-risk medication administration are covered.
Scope of Practice Enforcement: Never assign LPNs or nursing assistants to perform tasks legally reserved for RNs (e.g., initial assessments, blood product administration). This violates nurse practice acts and endangers patients.
Acuity-Based Reassignment: If an RN is obtained, rebalance assignments based on patient acuity, not just numbers. Assign the most stable patients to LPNs under RN supervision, per state regulations.
Secondary Measures: After securing an RN, request closure of new admissions to stabilize the workload and consider activating the facility's emergency staffing plan.
Charge Nurse — A nurse responsible for a specific shift on the ward. They oversee staffing, patient assignments, routine problem-solving, and overall safety of both staff and patients.
RN (Registered Nurse) — A nurse who has passed the national licensing exam (NCLEX-RN) after graduation. They can carry out the full nursing process—comprehensive assessment, diagnosis, planning, intervention, and evaluation—and supervise other nursing staff (LPN, NA).
LPN (Licensed Practical Nurse) — A nurse with a practical nursing license. Provides basic nursing skills and care for stable patients, but works under the supervision of an RN and has a more limited scope of practice than an RN.
Nurse-to-Patient Ratio — The number of patients assigned to one nurse. An appropriate ratio is an important indicator directly linked to patient safety, quality of care, and nurse fatigue.
Scope of Practice — Scope of practice permitted by law and regulations for each nursing license (RN, LPN) or position (NA). Violating this is illegal and threatens patient safety.