Fair Patient assignments - Page 2

We based it on acuity.

I'm in charge orientation right now, and let me tell you making assignments is much harder than it looks. A lot of the time if you have a hard assignment, the floor might just be really heavy, and everyone has a crappy assignment.

When I am making assignments I am thinking about how stable the patient is first. Then I look at if they have feeding tubes/trachs/Q2hour T+P's. If they are back-breaking patients, confused on bed alarms/1:1's, or needy I try and spread that evenly as well. Then I ALWAYS make sure that discharges on the day shift are going to be evenly distributed. Other things go into play as well like neediness, psych issues, and location.

I only worked charge a few times (at night) and was never fomally trained before hand. Before any time as charge I would think that some assignements made by other charges were unfairly heavy compared with others. I quickly realized that making assisngments is far from scientific. A charge nurse can put a ton of time into it, and still there is a nurse that get "screwed."

A couple of things went into the assignments I made:

1. Try and limit the amount of discharges a particular nurse has (plus for each discharge, that likely means an admission). Also try to spread out pts that had to be taking by a nurse down to a procedure (for example, an RN had to take a pt down to cath lab holding or preop holding)--having to take 4 pts off the floor thoughout the day would really make it difficult on that nurse.

2. Try to split up PIA pts and/or pts that were heavy (i.e. tube feeds/meds, multiple incontinent episodes, etc.). I would talk to the night shift nurses to see how their assignment was, do pts need to be split up, etc. Some nurses were always complainers about their assignment, even if it was the easiest assigment on the floor. Others would never say anything even if they were 'dying.' Sometimes I had to take these recommendations with a grain of salt.

3. If the oncoming nurse was there the day before, I would try and give him/her some pts back (although I would take parts 1 and 2 into account before making the assignement--I would not just 'blindly' give someone his/her pts back from the day before).

4. Try to maintain some sense of geographic reasonableness to the assignments. On this particular unit it was quite a walk from the rooms on one end to the rooms on the other end. While this will go below the other factors in making assignements, it can be very difficult for a nurse to have pts in rooms on opposite ends of the unit.

5. Realize that no matter how the assigments look, certain nurses will b***h about the assignements no matter what. One will say, "I may have 5 rooms right in a row, but 3 of the patients are heavy/needy/PIAs." Someone else will say "WTH, I have rooms on all ends of the unit!"

We work a balance between acuity and #s. We pretty much get to pick our own patients on our assigned wing, which is nice. If we have some pts who are a higher acuity, they may go to the more experienced nurse on the wing or to the nurse who's taking fewer pts.

At my clinical hospital, it was all assigned with no input from the nurses.