Critical Thinking & Prioritization
Someone calls in sick, and the unit is in full capacity and acuity is high. What is your first step as charge nurse?
Assess each nurse's assignment acuity and redistribute assignment, call staffing for coverage (OT vs straight time) Use the OT decision making tool if necessary.
You’re short one HCA today. How can you best support your team?
Reassign workload fairly (ensure HCA's that are there are splitting the third hub), prioritize patient safety tasks, and help with key tasks.
Two nurses are arguing at the desk. What’s your best immediate action?
Step in, de-escalate, and move conversation to a private space.
You overhear a nurse making a judgmental comment about a patient. What’s your response?
Address it directly and privately, remind of professionalism.
What’s the first thing you do during a code?
Call for help, start compressions (if a code blue), delegate roles, contact MRHP.
You have multiple competing priorities with one new admit arriving, a patient wanting to discharge, and two call lights going off. What should you prioritize first?
Respond to the call lights — immediate patient safety.
A nurse refuses an assignment, saying it's “unsafe.” What should you do first?
Assess the assignment, discuss concerns, and adjust if valid.
A physician yells at a nurse in front of patients. What should you do?
Intervene professionally, support your nurse, and address the behavior privately.
A family demands patient info but doesn’t have permission. What do you do?
Protect privacy; explain Personal Information Protection Act restrictions, if family continues to press offer them to obtain information through health records (give them the phone number).
You hear a bed alarm and a crash from the nursing station. What are your next steps?
Go directly to assess the patient, call for help if needed, assess vital signs, neuro vitals, inform family and MRHP, enter worklist tasks for post fall vitals, ensure RLS is entered.
The lab calls with a critical potassium result. What is your next action?
Notify the primary nurse and provider immediately, ensure patient safety
A nurse from Hub B calls in sick leaving the hubs unbalanced. How can we reconfigure the care hubs to be more balanced in a way that is fair.
Move a nurse from C hub up into B hub so that each hub has 3 nurses, create new borders for the care hubs so that each hub has a balanced acuity that equals 1/3 of the total unit acuity.
A nurse repeatedly ignores your requests for updates. How do you handle it?
Address directly, clarify expectations, and offer support if overwhelmed.
A nurse wants to leave early because their assignment is “done.” How do you handle it?
Explain to them that nurses have a duty to provide care to their patients until the end of their shift and that they must remain for the duration of their scheduled shift.
A nurse freezes during an emergency. What should you do as charge nurse?
Step in calmly, assign clear tasks, debrief afterward.
During shift change, a patient becomes unresponsive. What should the charge nurse do first?
Call a code and direct team actions, support the bedside nurse, and inform the MRHP.
You need to assign a new admit but everyone is busy. Who do you choose?
The nurse with the lightest current load/patient acuity, not just fewest patients
You overhear gossip about another staff member. What’s the charge nurse’s role?
Stop unprofessional behavior, model respect, redirect conversation
You see a nurse documenting before performing a procedure. What do you do?
Address immediately, ensure accuracy, report if necessary. Remind the nurse that the purpose of documentation is to report on what you have, not what you are going to do.
A patient with a recent stroke suddenly becomes more lethargic and difficult to arouse. What should you do first?
Perform a bedside neuro assessment and call for a code stroke — potential stroke evolution or bleed.
You find multiple delayed med administrations by one particular nurse on the MAR after multiple patients called saying they're waiting for their meds. What is your best next step?
Assess for patient harm, investigate system cause, and coach staff appropriately.
Is there something going on in this nurse's assignment that you weren't made aware of, did the nurse not realize they were assigned these patients?
Two nurses are behind on charting; one is helping others. How do you address it?
Acknowledge teamwork, assist nurses with some tasks so that they have time to complete their documentation, or find nurses from other hubs who may not be as busy to delegate some tasks to if possible.
A nurse calls you out in front of others. How should you respond?
Stay calm, don’t escalate, address privately later to resolve conflict.
A nurse reports feeling unsafe due to a patient’s aggressive behavior. What’s your role?
Ensure staff safety, call security (if necessary), and follow workplace violence protocols (mysafetynet). Ask nurse to enter a VAST score on the patient and enroll patient into Behaviour Safety Program, create a care plan alongside the bedside nurse that identifies possible triggers, ways to de-escalate behaviours.
A patient with a C4 spinal cord injury suddenly becomes flushed, sweaty, and hypertensive. What is your priority action?
Sit patient upright, check for bladder/bowel impaction, or other potential causes — treat for autonomic dysreflexia.