Scenario
You recently started a new position as a nurse manager in a 28-bed oncology unit. One of the staff nurses who returned from bereavement leave one week prior has been assigned to care for an elderly client, newly diagnosed with stage IV pancreatic cancer. While you are visiting with the client, the nurse completes the assessment. During the client interview, the client requested assistance to set up hospice care, complete an advanced directive, and reach out to their estranged daughter. The nurse stated, "I can get you the paperwork for the advance directive, but I can't call your child for you; I do not specialize in mental health." The nurse leaves the room and asks to speak with you, stating, "I can't care for this client; I need my client assignment changed now or else I will go home."
As the nurse manager, you agree to change the nurse's client assignment and offer to assist the client with their requests. Later, you debrief the nurse regarding their reactions and decisions with this client and make recommendations regarding how the nurse could have responded differently. You write a summary of the events and debrief with the nurse.
Instructions
Compose a written memo of the situation and debrief for the employee's personnel file.
Include the following in the memo:
• Analysis of the cues impacting the responses of the staff nurse and the nurse manager.
• Description of how these cues influenced the clinical decision-making of both nurses, including supporting rationales and examples.
• Prioritized strategies the nurse could use for self-compassion and compassion toward others when demonstrating emotional intelligence, including supporting rationales, examples, and credible resources.
• Alternative responses more appropriate for the nurse and nurse manager, including supporting rationales, examples, and credible resources.
Analysis of Impacting Cues and Clinical Decision-Making
Staff Nurse Cues and Rationale:
The primary mitigating cue impacting the staff nurse's response was her recent return from bereavement leave (one week prior). The client's request—which involved discussing impending death, family estrangement, and overwhelming emotional burden—acted as a powerful grief trigger.
Influence on Clinical Decision-Making: The emotional cue led to a decision rooted in self-preservation and avoidance rather than clinical duty. The nurse's statement about "not specializing in mental health" was a cognitive rationalization used to mask the underlying emotional flooding. This reaction, while understandable given the recent loss, resulted in the abandonment of the holistic standard of care (failure to connect client to appropriate psychosocial resources, i.e., Social Work/Palliative Care), a direct breach of professional responsibility.
Nurse Manager Cues and Rationale:
The Nurse Manager's key cues were the immediate threat to unit staffing stability (the ultimatum to go home) and the urgent clinical and ethical needs of the client.
Influence on Clinical Decision-Making: The manager's decision to immediately change the assignment and take over care was driven by Patient Advocacy and Risk Mitigation. The rationale was two-fold: (1) De-escalation: Honoring the nurse's distress to stabilize the unit and prevent a staffing crisis; (2) Prioritization of Safety: Immediately attending to the complex, time-sensitive end-of-life planning needs of the client, which takes precedence over correcting staff behavior in the moment. The manager’s decision was justified in prioritizing the client’s immediate psychosocial well-being and maintaining unit operations.
Sample Answer
MEMORANDUM
TO: Staff Nurse Personnel File (
) FROM:
, Nurse Manager, Oncology Unit (28-Bed) DATE: October 19, 2025 SUBJECT: Critical Incident Debriefing and Performance Coaching - Client Care Assignment (Stage IV Pancreatic Cancer)
Incident Summary
On
, Staff Nurse
was assigned care for a newly admitted elderly client diagnosed with Stage IV Pancreatic Cancer. During the client assessment, the client expressed significant psychosocial and end-of-life needs, specifically requesting assistance with hospice setup, completing an Advanced Directive, and contacting an estranged daughter. The nurse responded by offering administrative assistance for the Advanced Directive paperwork but stated, "I can't call your child for you; I do not specialize in mental health." Immediately following the client interaction, the nurse requested a change in assignment, issuing an ultimatum: "I need my client assignment changed now or else I will go home." The Nurse Manager agreed to the assignment change and subsequently assumed care and coordination for