Patient assignments - Are nurses assigned to empty beds - Page 2

I work in the ER, so it's a bit different. We get assigned a set of rooms- whatever patients are in those rooms or wind up in my rooms are my patients. Sometimes you have a heavier or lighter assignment depending on how the cookie crumbles, but the folks I work with are pretty good about recognizing who is struggling and needs help and pitching in. Patients are placed in different assignments somewhat by acuity (we have one really high to high acuity area, two medium high to high areas, and then fast track). If patient acuity changes in a major way (or they turn out to be way sicker than initially determined) they can be moved pending bed availability, but usually other nurses help with your assignment while you are getting the sick patient stabilized.

In our hospital (UK) the nurse is assigned a group of patients (beds 1-8 or whatever) and that is it. If there are empty beds in that assignment then they take admissions as they come.

Various hospitals have various methods. The nurse usually will follow the patient unless the patient is moved off the unit. Sometime the assignment is rearranged for ergonomics and efficiency for the nurse of the patient is moved to the end of one hall and her assignment is at the other.

Is this a home work assignment? What exactly is the assignment looking for?

In both hospitals I have worked in; yes a nurse can be assigned an empty room. Rooms don't stay empty for long. When I was a floor nurse, we had pods that had 6 pt room in each. One nurse was assigned that pod, didn't matter what the acuity was. Now in the ICU acuity is divided as much as possible as well as distance between rooms are kept in mind. Nurses are never given room 1 and room 10, too far apart. And yes, even in the ICU we are assigned empty beds. If we have an empty bed, we can beat we will get a code or rapid response off the floor or a new admit through the ED.

Assignments are not done by software. It is a hand written sheet with the pts name and the nurses name only.

At my hospital the nurses are not assigned empty beds. Our max nurse patient ratio is 5:1. If two nurses have 5 patients and another nurse has 4 patients, then that nurse is "open for the admit". If census is low, we will have nurses on call. If the three nurses all have 5 patients a piece. then we call in the on call nurse to take the admit. I work on a unit that has 15 beds of med-tele & 15 beds of progressive care. We often have to move patients to different rooms, and reassign the patients to different nurses. An example: A med-tele patient was previously in NSR, but has now flipped into afib. The doc orders Amiodarone drip, but this drip is not allowed to be administered on med-tele. This patient now requires a progressive care bed, and must be moved and reassigned. Likewise if a patient was in Progressive care, but does not meet the criteria anymore, then they will have to be transferred to a med-tele bed if another patient needs a PCU bed. This is to maximize profit, since PCU has additional charges. The actual room number assignment is in a program called "bed board", which I know nothing about since I am not a charge nurse. Our patient assignment sheets are written in pencil, and things are changed as necessary throughout the shift.

I work in a MICU. If we are not full, we are assigned a patient and an empty bed. We also determine who will get the first patient admission by looking at the acuity of the patients that the nurse(s) may have. We may also get pulled to another unit :P

Yes, it happens all the time. Family pitched a fit to get a private room for their child and at 2 am an admission with MRSA needs to come to the floor and there are no private rooms available. That means the patient who doesn't need a private room needs to move to make room for the admit. This was possibly the thing I hated most about working nights... bed changes that need to happen in the middle of the night and somehow it's YOUR fault that the kid in the ER has MRSA/is on contact and then the family is mad at you for the rest of the night for waking them up to move them into a private room. And then of course they don't get along with their new roommate who keeps the thermostat too cold. When a patient moves rooms, if they are still on the same unit, they keep their nurse. The nurse is assigned to the patient, not the bed.

To answer your original question...when I worked in the hospital, nurses were not assigned empty beds and they only staffed for the patients they knew about. So, on a 26 bed unit, if there were only 15 patients at 5pm, they canceled 2 night nurses and if you happened to get 10 admissions overnight, too bad for the nurses who have to absorb them. It could happen that you are assigned to a patient who is scheduled to be admitted but has not arrived yet but in that case, you are assigned to the patient not the bed... and if Joe Smith is scheduled to go into room 102B but when you get report you find out that he has C-Diff and needs a private, you will still be his nurse if he is admitted into room 105 (private room).

Everywhere I have worked, assignments are done on a shift by shift basis by the charge nurse. Assignments are much more and art than a science. Factors that go into assignments are acuity, which pts will be off the unit/have procedures during the day, what pts did a nurse have yesterday, etc. With all that taken into account, there is no given "formula" for making assignments. I have never been a unit that assigns empty beds at the beginning of a shift; however, if one nurse has few pts than all the other nurses on the unit, that first nurse can pretty much presume that if an empty bed is filled, it will be his/her pt. Of course, if that nurse has much 'heavier' pts than the rest of the nurses, than he/she may not get that admit. At that point, it is just up to the charge nurse to use his/her judgement.