# Situation: On the evening shift, a 30-bed adult medical ward has 28 clients. The staff are the charge nurse, a registered nurse (RN) with 6 years of medical ward experience, an RN floated from the operating room who has never worked on a medical ward, and one trained nursing attendant. Which client should the charge nurse assign to the floated nurse?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629856  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: On the evening shift, a 30-bed adult medical ward has 28 clients. The staff are the charge nurse, a registered nurse (RN) with 6 years of medical ward experience, an RN floated from the operating room who has never worked on a medical ward, and one trained nursing attendant.

Which client should the charge nurse assign to the floated nurse?

## 보기

1. A woman admitted an hour ago after vomiting blood, now receiving blood
2. A woman with leg cellulitis on intravenous antibiotics, stable and afebrile **✔ 정답**
3. A man who had a stroke 12 hours ago and needs hourly neurologic checks
4. A man with diabetic ketoacidosis on an insulin infusion and hourly glucose checks

**정답: 2**

## 해설

Assignments match client acuity and complexity to the nurse's demonstrated competence. A nurse floated from another specialty should receive stable clients with predictable care that uses general skills such as intravenous antibiotic administration. Clients who are unstable, newly admitted, or need specialized frequent monitoring go to nurses experienced on the unit.

## 심화 해설

The charge nurse should assign the floated operating room RN to the client with leg cellulitis who is stable and afebrile on intravenous antibiotics.

Why this client fits the floated nurse

A nurse floated from the operating room brings strong general skills in sterile technique, intravenous line management, and monitoring for medication reactions. What this nurse lacks is unit-specific experience with medical ward workflows, rapid clinical deterioration patterns, and high-frequency neurologic or metabolic assessments. The cellulitis client requires exactly the kind of predictable, protocol-driven care that a competent RN from another specialty can safely manage: ongoing IV antibiotic administration, site observation, and vital sign monitoring on a stable patient.

Assignment decisions should match client acuity and complexity to the nurse's demonstrated competence, not simply to licensure status. The floated RN is a registered nurse, but competence in the operating room does not automatically transfer to managing unstable medical patients or performing hourly neurologic assessments. Key point! Floating does not reduce the nurse's accountability; it changes which clients are appropriate for that nurse's current skill set.

Why the other clients are not appropriate

The other three clients all require either immediate stabilization, frequent specialized monitoring, or both. These are precisely the situations where unit-specific experience and rapid access to unit resources matter most.

| Client | Why not the floated nurse | Appropriate assignment |
| --- | --- | --- |
| Hematemesis on blood transfusion | Newly admitted and actively bleeding; requires continuous assessment for transfusion reaction, hemodynamic instability, and possible rebleeding | Charge nurse or experienced medical RN |
| Stroke 12 hours post-event | Needs hourly neurologic checks; early deterioration from cerebral edema or hemorrhagic conversion requires rapid recognition and escalation | Experienced medical RN |
| Diabetic ketoacidosis on insulin infusion | Hourly glucose checks, insulin titration, and monitoring for hypokalemia and cerebral edema; high-risk metabolic management | Experienced medical RN |

Unstable clients, newly admitted clients, and clients requiring frequent specialized monitoring should be assigned to nurses with demonstrated competence on that unit. The charge nurse retains accountability for making assignments that protect patient safety while also supporting the floated nurse's ability to practice within a reasonable scope of familiarity.

The underlying principle: equitable assignment

Research on nursing assignment structures emphasizes that inconsistent or unfair assignments contribute to unsafe care situations and nurse dissatisfaction . When assignments are linked to patient acuity, workload becomes more balanced and nurses report greater satisfaction with the standard of care they can provide . Tools such as the Perroca patient acuity tool and unit-based acuity assessments have been developed specifically to make assignments more equitable and transparent .

Watch out! Do not interpret "stable" as "unimportant." The cellulitis client still requires skilled nursing care, but the care is predictable and uses general competencies. The goal of assignment is not to give the floated nurse the easiest client, but the client whose care demands best match that nurse's current demonstrated skill set.

In this scenario, the charge nurse must also consider the trained nursing attendant's scope. The attendant can assist with activities of daily living and basic observations, but cannot independently manage IV antibiotics or perform neurologic assessments. The floated RN, by contrast, can manage IV therapy independently, which makes the cellulitis client a reasonable and safe match .

## 임상 시나리오

Floated Nurse AssignmentMatch acuity to demonstrated competence
Assign a nurse floated from another specialty to a stable client with predictable, protocol-driven care such as routine IV antibiotic administration. The cellulitis client is afebrile and requires general nursing skills.

Clients who are unstable, newly admitted, or require specialized frequent monitoring—such as hourly neurologic checks or insulin infusions—must be assigned to nurses with unit-specific experience.

CautionFloating does not reduce accountability; it changes which clients are appropriate for the nurse's current skill set. OR experience does not automatically transfer to managing unstable medical patients.

## 핵심 개념

- **Assignment** — The process of matching client care needs and acuity to the competence and experience of the nursing staff available.
- **Floated Nurse** — A nurse temporarily reassigned from their home unit to another unit, often lacking unit-specific workflows and patient population experience.
- **Patient Acuity** — The severity of a patient's illness and the complexity of nursing care required, used to guide safe staffing assignments.
- **Competence** — A nurse's demonstrated ability to perform specific skills and manage particular patient situations safely, which may not transfer across specialties.
- **Stable Client** — A patient whose condition is predictable and not deteriorating, suitable for assignment to a nurse with general nursing skills.

## 같은 주제 문제

- [Situation: The adult medical ward of a tertiary hospital reviews its medication safety eve…](https://mymerci.kr/pages/nclex_q.php?qn_id=629756)
- [Situation: The adult medical ward of a tertiary hospital reviews its medication safety eve…](https://mymerci.kr/pages/nclex_q.php?qn_id=629757)
- [Situation: The adult medical ward of a tertiary hospital reviews its medication safety eve…](https://mymerci.kr/pages/nclex_q.php?qn_id=629758)
- [Situation: The adult medical ward of a tertiary hospital reviews its medication safety eve…](https://mymerci.kr/pages/nclex_q.php?qn_id=629759)
- [Situation: A 78-year-old woman is admitted to the adult medical ward with community-acquir…](https://mymerci.kr/pages/nclex_q.php?qn_id=629760)
- [Situation: A 78-year-old woman is admitted to the adult medical ward with community-acquir…](https://mymerci.kr/pages/nclex_q.php?qn_id=629761)
- [Situation: A 78-year-old woman is admitted to the adult medical ward with community-acquir…](https://mymerci.kr/pages/nclex_q.php?qn_id=629762)
- [Situation: The quality committee of a 200-bed hospital notes that the adult medical ward's…](https://mymerci.kr/pages/nclex_q.php?qn_id=629763)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._