The nursing director and clinical manager of our 65-bed med-surg unit are trying to come up with a plan for patient assignments. We are divided into two units, East and West, and have a mixture of staff: RN's, LPN's, and PCT's (aides), and have nurses working 4, 8, and 12 hour shifts. There's also a mixture of full-time, part-time, and casual (or pool) staff. We don't have charge nurses and patient assignments in the past have been generally based on the room layouts (I would have rooms 301-303, the next nurse, 304-307, etc.). Sometimes an RN has to take a patient with PCA or continuous epidural and we'd have to pick up a different room or swap patients with an LPN. If the empty beds are in "my" area, I would receive less patients and be available for transfers, post-ops, and admissions.
I think management is trying to make assignments that are more "fair" and based on acuity, but the physical layout of our 2 units could make it difficult. (I work 3-11 and one time, because of a 12 hour nurse keeping her rooms until 7 p.m. and various empty rooms, my assignment was spread among three different med carts and up and down two different hallways. Pretty confusing.)
Some of the new plan so far:
Managers want RN's to stop what they're doing at 0600, 1400, 1800, and 2200, and make assignments out for the next shift based on the following criteria: "Continuity of care; 1:1 coverage and the assignment of a relief person; RN's must care for patients with PCA/epidural/insulin drips; activity in the hospital (based on a bedboard review of possible ED or transfer patients); hemodialysis patients; patients with restraints (?)". Also, LPN's can't be assigned the same patient group for 24 hours. An RN must take the patient for at least one shift or do all the LPN's patient assessments in addition to their own patients.
And, to confuse you even MORE, the RN who has to make the assigments for the next shift will be chosen based on their room number assigment, not whether they know the mix of patients on the floor or not. (If I have rooms 302 or 303, I make the assignments.)
Can anyone help me come up with a better-- less confusing and time-consuming-- but "FAIR" way to make patient assignments?
