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?
Jun 10, '04
we divide by north and south hall.
Last edit by adidas99 on Jan 29, '07
Jul 20, '04
Quote from AngieRN29
at my hospital we run it by the MESH system...we classify each patient witha number...for example a new surgical may be a 3....someone who does everything for himself and requires little nursing intervention may be a 1....someone on the flip side who has tubes and is a full assist may be a 5.....we take all the patients on the floor and divide up the POINTS..that way the nurses all have pretty much the same load...noone should have all 4s when one nurse has 3-2s and 2-1s.....of course,RNS will be expected to take some of the higher acute patients.....which will give her less of a load, but when the patient meshs at a 5...its like taking care of 2 patients. it works for us anyway.
Quote from batmik
Assignments are done by the off going charge but can be switched. They first look who was working the previous day and try to give that RN his/her patients back. We also have an acuity system 1-5, we never have 1 or 2's (light) most are 3 and 4's with rarely ever a 5. We try to divide up the 4's equally as well as the discharges. As we know not all 4's are alike. Some patients are 4's because they just came back from the cath lab, some are confused, some are total care, 1st day open heart, some are isolation. We try not to give any one RN more than one isolation. We only have 4 iso rooms so this isn't too hard. We are straight 8 hour shifts and no lvn/lpn so it makes it easier. We never do it by room, mostly by acuity.
I like the sound of both of these acuity rating systems. Do either of you have anything in writing describing your systems that you could write out here or email me that I could present to my managers?
Another problem is that we have no charge nurses....
Last edit by RN-PA on Jul 20, '04