When they're giving out assignments . . .

Nurses New Nurse

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Do you think they put us new grads with the more challenging assignments on purpose? The easier ones? The busier ones?

I just can't figure out for the life of me why I am always running around like a chicken with my head cut off when at many of the nurses on staff have half the day to sit in the nursing station and just shoot the breeze. What exactly IS their patient assignment?

I've always got the hard core patients it seems. Is this being done on purpose?? LOL -- sure seems that way. :confused::chuckle

How can I find out? I guess I could ask my general preceptor about it.

Specializes in Rodeo Nursing (Neuro).

On my unit, while I was orienting, an effort was made to give me the sort of cases I "needed" to see. Once I was on my own, I tended to be given easier assignments, to the extent they were available. Out of 5-6 patients, I might get one who was a bit tough, but also a couple who needed very little care. I think this was mostly a matter of kindness, but I'm sure my CNs also realized they were putting their licenses on the line, too.

Over time, the assignments got more difficult, and one morning, as I was charting at 0900, I overheard the nurse who followed me telling the dayshift charge (who makes the nightshift assignements) that it wasn't really fair to give me such a difficult assignment while I was so new. The CN replied, "I know, but I don't have anyone else who can handle them." (The alternatives were a nurse who was even newer than me, or one who started when I did and was eventually terminated.) She did end up reassigning one of my patients who was not too complicated, medically, but had a tendancy to run the halls, naked and confused. Then, too, the others had lost the element of surprise, so I was much better able to keep up with them the following night. Plus, I had the knowledge that at least somebody thought I wasn't the worst nurse on the floor. Hooray!

The trend continues that new nurses are given assignments they at least have a chance of handling, which means some of us old-timers have to take a little harder assignments, occassionally. The goal, though, is to make the assignments as fair as possible, and they usually are. Even so, they can get pretty tough.

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In ICU, the newer nurses are often given the more stable patients.

The trade off is that more stable patients can keep you busier as you deal with demands, meals, getting them up etc.

Two awake demanding or confused patients are more work than one intubated, sedated less stable patient.

On some floors, the charge nurse takes a patient assignment. In that case, the charge nurse takes the lightest assignment.

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Specializes in Psych.

I wish they would put some consideration into acuity when making assignments. On my floor, it's simply divide the number of patients by number of nurses and give each one a block of rooms together. Last shift I ended up with 6 stable walkie talkies, only had to push pain meds for a couple all night. The nurse next to me had two of her 6 going south and one was very demented and kept getting up out of bed. I helped her get him back in bed every 10 minutes. They had just taken him off 1/1 because they are trying to d/c him to SAR and can't do that if he's 1/1. So they SHOULD have taken that into consideration and given her a smaller assignment but that's just not done where I work. The only exception is vents - then they decrease your assignment by 1. This is one of my biggest complaints about my unit (it's not a bad unit, especially for Med-Surg).

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Specializes in ICU/ER.

You have Vents on a med surge unit and they only decrease your assignment by 1? Holey smoke. Our vents are 1:1. in an ICU setting. We have no vents on MS.

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When I first got off orientation here I would regularly get "3 baby" assignments, one night I even had a "4 baby" (set of trips and a single). Granted they were "feeder/growers" and two were on pump feeds but it was still a handful. Now a year later 3 is a walk in the park, I watch the new grads just off orientation run around like crazy with two babies. We have one that won't tell us she hasn't eaten lunch and we have to force her off the unit.

It's all about time managment, my preceptor taught me the "work your butt off for the first rounds" rule, that way if your night goes to h-e-double hockey sticks you dont have to worry about falling behind. As of yet I have not had to stay after report to chart..knock on wood.

It will get easier.......

Liz :D

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

You need to advocate for yourself if you feel you're being treated unfairly in the assignments. But I also agree that as a new grad you're going to be "running around like a chicken with your head cut off" for a while yet, no matter what assignment you get.

It's also unfair to presume that other experienced staff are doing nothing for half of their shift. If they truly are, that's not a mentor to aspire to.

Good luck and hang in there, and be your own advocate because if you don't speak up for yourself, no one else is going to.

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Specializes in Psychiatric NP.

Morettia2,

That is some really great advice! I was wondering do you have a copy of your report sheet I could see?

I have been working a little bit over a year now and the nurses are finally realizing that they can't keep dumping things on me for my shift. I think the next shift has started to respect me more because I make a point in saying during report what all I did so that certain problems with the patients would be resolved for their shift(like medicating the patient for pain so they don't call within the first hour of their shift, or hanging a new bag of fluids so it doesnt run dry before they make first rounds, things like that) It does seem that some of the nurses who have been around for a long time are annoyed that we just graduated and are able to take on the same responsibilities as them(when they've worked for maybe 10-20 yrs.) But if you get to know them, maybe they'll treat you differently. Or the other thing is I point out the bad patients that I have to my charge nurse so she knows when I've really tough assignments and when that happens several times in a row I point it out again to try to get it changed for the following day. But it's true, some floors the charge nurse give newbies and floaters the worst assignments because they don't know you whereas they don't want the other nurses they know well to be upset at them. Anyway I'm still struggling with the problem because there have not been any new nurses on our floor after me(wonder why?) But things have gotten a little better as I speak up for myself more often. Good luck!

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Specializes in CTICU, Interventional Cardiology, CCU.
Morettia2,

That is some really great advice! I was wondering do you have a copy of your report sheet I could see?

I have been working a little bit over a year now and the nurses are finally realizing that they can't keep dumping things on me for my shift. I think the next shift has started to respect me more because I make a point in saying during report what all I did so that certain problems with the patients would be resolved for their shift(like medicating the patient for pain so they don't call within the first hour of their shift, or hanging a new bag of fluids so it doesnt run dry before they make first rounds, things like that) It does seem that some of the nurses who have been around for a long time are annoyed that we just graduated and are able to take on the same responsibilities as them(when they've worked for maybe 10-20 yrs.) But if you get to know them, maybe they'll treat you differently. Or the other thing is I point out the bad patients that I have to my charge nurse so she knows when I've really tough assignments and when that happens several times in a row I point it out again to try to get it changed for the following day. But it's true, some floors the charge nurse give newbies and floaters the worst assignments because they don't know you whereas they don't want the other nurses they know well to be upset at them. Anyway I'm still struggling with the problem because there have not been any new nurses on our floor after me(wonder why?) But things have gotten a little better as I speak up for myself more often. Good luck!

I will send you my report sheet that I use. I have to get if off my computer. I am using my fiance's laptop.

OH good news for ME! I was charge nurse agian for the second time in 2 weeks and this is the first 2 times ever for me to be charge. I am am 1 month from finishing my first year as an RN.

So I checked all the charts to make sure all the orders were entered for the other nurses(it was the weekend and we had no unit clerk so what ever the day shift missed I picked it up, eventhough I had a 4 pt. assignment my self, made sure that the other nurses were ok, and not overloaded, and wanted to know of any problems that could be resolved with phram, Doc's, pt's ect...

I started my shift rounding ALL of the pt. rooms introducing my self, told the pt. who their nurse was and gave each pt. a quick assesssment, and I mean quick.

If the nurses were having a problem I was making all the calls for them so they could get thir work done, without trying to find out what MD to call, called respiratory for TX's for the nurses pt's, called pharm. for the nurses, if the meds were't in the pyxis or in the pt. specific drawer. I know how much it stinks trying to find out what MD to call for the specific problem, waiting by the phone for a MD to call, or who ever to call.

I also made sure that my nurses got a break. I said, "tell me what has to be done, and how can I help." WOW the power of just ASKING IF SOMEONE NEEDS HELP, can make a nurses night. And every nurse got a break, along with the CNA's and the Tele Tech. They said it was the first time in years that has happend where they all got a break. I didn't have a break I didn;t care just seeing the entire floor staff with smiles and working as a team and lauhing and happy made all the difference, I neve see that on my floor it is rare.

I figure if you are in charge you are in charge of the floor, pt's, nurses, CNA's and the rest of the staff, you are in charge for a reason. Yea it's an extra doller an hour, wooptie do, but if my nurses and staff were happy for one night and not miserable like almost every night we work. I know I did a good job.

PLUS I just wanted to run the floor the way I have always wanted it to be run.:yeah:

THANK GOD for the first time in one year WE HAD NO ER Admitts that night. I made sure all the pt's had ID bands with a new tag on the band, b/c SO I got to do the assignments, and I did a GREAT JOB. All of the day shift nurses were shocked how I asked if they were OK with their pt. assignment, and if they wanted to change pt. assignments to pt's that have had in the past to make it easier for report. I told them I had looked at the last 2 weeks of pt. assignments and tried to see if they have had the pt.'s they recieved(that's if it's one of the pt's that's been on my floor for 1-2 weeks which is rare).

None of the day shift nurses had a single complaint, only good things to say. There were 5 day shift nurses, and each nurse had 4 pt's. Which is good for the weekend. I ALSO made sure that no one was getting pulled, so that's why I assigned each nurse 4 pt's.

We had 5 isolation pt's. Each nurse got and isolation pt. We had 5 complete care pt's, each nurse got one complete care pt. and each nurse got a walkie talkie pt. And the confused pt's I made sure were all moved to the rooms near the nurses station so SOMEONE can see them at all times, insted of being out of sight out of mind in the back of the unit which can equal falls and what ever else the confused pt's do which is ALOT. Also the reason I moved the confused pt's to rooms near the nurses station during my time as charge was all the confused pt's 1:1's were d/c'd by the md's b/c they were for d/c on monday, and it was the weekend so no one was watching them. If they are in line of sight at the nurses station I felt it was safer for pt's and nurses, b/c there was no one at the bedside watching them. So if you could see the pt. from the nurses station it would be better.

And I asked the nurses that got the confused pt's if they were ok with that...some nurses hate having confused pt's. I love getting confused pt's, as long as I don't have all of the confused pt's. which happens often to me. But the nurses that got the confused pt's I made sure that they had the pt. prevoiusly, and if they didn't I asked if they wanted to switch pt's with another nurse.

I made sure that no one got too much, you know what. Some of the assignments the charge nurses give are total crap. One night one of the nurses, including my self got all the complete care pt's.

I work interventional Cardiology/CCU Stepdown and we recently became the only stroke floor in the hosp( I have my opinions about the stroke thing b/c we arn't equipped but I will save that for another time) and It was interresting making the assignment for the day shift. But I wanted to make sure that they were happy with the pt's that they were assigned.

I was praised for how well things were run.

AND at 0600 we even had a rapid response. I took care of it like a pro. It was undercontroll in a matter of min. The RN, whose pt. it was, was so happy about how well the situation was handeled. The MD for the pt. was so pleased with how I handeled the situation as charge nurse, that he came down from the CCU and brought us all coffee, totally out of character for this MD.

Anyway, I hope that I get to do it agian SOON. Maybe I can bring some TEAMWORK and smiles back to my floor at night.:redpinkhe

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