The 0700 board: six patients, one assignment
The whole page as a simulated chart shell with tabs reading ASSIGNMENT BOARD, HANDOFF NOTES, ORDERS, and STAFFING, the board tab active, six zebra-striped rows in monospaced type, no severity color anywhere, and a blank acuity gutter down the left for the reader to mark.
ASSIGNMENT BOARD · HANDOFF NOTES · ORDERS · STAFFING
| Room | Age | Diagnosis | Day | Last documented concern | Pending task | |
|---|---|---|---|---|---|---|
| ☐ | 201 | 68 | Bowel resection, post-operative | 1 | No flatus since surgery; abdominal firmness increased at 0400 | Dressing check |
| ☐ | 202 | 74 | COPD exacerbation | 3 | Speaking in full sentences at 0600 per board entry | Hallway ambulation |
| ☐ | 203 | 59 | New-onset atrial fibrillation, admitted overnight | 1 | Lightheaded when sitting upright at 0530 | Telemetry review, vital signs |
| ☐ | 204 | 45 | Pulmonary embolism, resolving; awaiting discharge | 4 | None documented this shift | Discharge teaching, new oral anticoagulant |
| ☐ | 205 | 71 | Total hip arthroplasty | 2 | Tolerated first ambulation yesterday without incident | Second ambulation |
| ☐ | 206 | 83 | Community-acquired pneumonia | 2 | Unwitnessed fall two nights ago; hourly rounding since | Hourly rounding, toileting |
HANDOFF NOTES · night shift
- 201 asked for the head of the bed up several times overnight; states the abdomen feels tight.
- 202 needed to pause mid-sentence to breathe at 0600 and was using neck muscles to inhale.
- 204 slept well, family arriving at 1000 for teaching.
- 205 walked to the chair without help at 2200 and back again.
STAFFING
- One RN. That is you. Six patients.
- One LPN/LVN, two years on this unit, competent with dressing changes, enteral feeding, and catheter care.
- One assistive personnel, floated from another unit this morning, has not worked on this floor before.
Tasks
- Rank all six rooms in the order you will lay eyes on them.
- Assign the dressing check, the second ambulation, and the discharge teaching.
- Name the one pending task on this board that cannot be delegated to anyone.
Answers
Ranking: 202, 201, 203, 206, 205, 204. Room 202 goes first because the handoff line contradicts the board. The board says full sentences, the narrative says pausing mid-sentence with accessory muscle use, and the narrative is the newer and more specific observation. That is rung one. Room 201 is second: increasing abdominal firmness with no flatus on the first day is unexpected and could be an early obstruction or bleeding. Room 203 is third: new atrial fibrillation with positional lightheadedness is unstable but already under telemetry and a plan.
Assignment: the dressing check goes to the LPN/LVN. The second ambulation on room 205 would normally go to assistive personnel, but this person floated this morning and has no demonstrated competence with post-arthroplasty ambulation on this unit, so it fails gate three. Give the walk to the LPN/LVN or do it yourself, and give the float hourly rounding and toileting on 206 after a direct orientation.
Cannot be delegated: discharge teaching for the new anticoagulant. Initial teaching is RN work in every state.
Margin noteread staffing before you read patients.
Watch outthe LPN/LVN row is a scope claim. Scope of practice is set by your state Nurse Practice Act and by facility policy.
Takeawaythe float changed the assignment even though no patient changed.
→ BOOK 07 · P9 for the anticoagulant monitoring value this exhibit references but does not print.