I've been a nurse for over year working nights, and for the last year I always wonder what the day shift charge RN with no patients does. When I come in for patient assignments, it honestly looks like half the time they just throw the numbers up there in dividing patients without putting any thought into it. At the start of a shift, a nurse shouldn't have the least # of patients with a new admit that hasn't gotten there yet leaving them open for the one of the next admissions, which happens a lot. A nurse starting the shift, shouldn't have 5 patients with the new admit who hasn't gotten there while others have 4 patients and no new admit. Those are 2 issues on my floor, which are obvious that should be easily fixed. The bigger issue I notice is that people either wind up with a cake group full of walkie-talkies or a heavy group full of crazy ETOH patients, just plain crazy/needy patients, or patients that are actually really sick and require extra care. I've spoken with some of the night charges and nurses who have been there for a while and have heard that it's impossible to sometimes get the full picture of the pt load with 30 pts. I say that's fair enough, and I also say there can be some basic acuity rating you ask the nurses to give you to divide the patients up evenly. I've seen the acuity rating discussions on here, but most of them are in regards to getting more staff. We use a matrix and the matrix seems to be just fine when we have patients divided fairly. My question is: Does anyone utilize some sort of unit based acuity rating strictly to divide up patient's fairly? Some nights are beyond frustrating when I'm running my butt off and not wanting to beg for help while I see others sitting around.
