How Do You Make Patient Assignments on Your Unit?

  1. 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?
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  2. 14 Comments

  3. by   barefootlady
    The unit has X amount of patients, there is X amount of nurses, divide and assign. Nothing else is taken into consideration.
  4. by   RN-PA
    There was a staff meeting this afternoon and we talked about these patient assignment concerns. It seems that day shift, in particular, is part of the reason for management wanting to try assigning differently. Some nurses never want to budge from "their" rooms, so this new method will get the full-timers to rotate every month to a new area on their unit. Also, by having the previous shift make assignments for the incoming shift, they know the patient mix and acuity, and will hopefully make assignments more fair.

    The good thing is that our director said if this doesn't work out after a week of trying it, they'll scrap it.
  5. by   KK92RN
    ok well it depends on what part of the hospital you work in. every floor does it different and some do the previous shift makes the next assignment. i don;t know which one is better
  6. by   adidas99
    we divide by north and south hall.
    Last edit by adidas99 on Jan 29, '07
  7. by   ragingmomster
    I would think that a higher patient load with RN/LPN team would work well in your unit. I am lucky that LPN's are permitted to take patients with PCA and epidural or my work would be severly limited.

    We have had times when one nurse might get 7 patients on day shift and have a CNA commited to working only with her while another nurse may get only 3-4 and have no CNA at all. This seems not to work out, and I see more of this happening when the charge nurse is lazier or doesn't care about acuity and is not willing to take the time to think about the best way to split things up.

    If you are describing a pod shaped unit, why not assign one nurse to one pod if it is workable, and an RN/LPN team to cover two pods when there is a PCA that the LPN can't handle. Our CNA's are usually assigned to work with specific heavier patients, at least one from each nurse and a good charge nurse lets the nurse pick which patients she will need help with.

    12 hour nurses may get a slight change in their assignment after the first 8 hours, when staffing shifts, but 4 hour nurses just get what they get. 4 hours seems to work for them, and their place is to fill in the blanks. We don't work around them, they work around us. -

    Hope my story helps!
  8. by   Tweety
    Quote from barefootlady
    The unit has X amount of patients, there is X amount of nurses, divide and assign. Nothing else is taken into consideration.
    We divide and assign too. But a nurse can sometimes have a patient in room two and another in room 22 if it's fair. We have no cripped nurses, and they can walk a few feet. Our rooms near the nurses station right now have trached, total care, wound vaced patients in them. To simply divide by room #'s isn't fair.

    Fortunately though we have charge nurses that are aware of the acuity.

    Sorry, I can't help the original poster, but the only fair way is by acuity. Sometimes you can go by districts and it not matter, but sometimes you might have to jump a room.
  9. by   barefootlady
    Sounds like your unit is trying to assign patients fairly and take into consideration the skill level of nurse and care required by patients. I don't understand crippled nurse remark, please explain.
  10. by   hospicemom
    Quote from RN-PA
    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?
    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.
  11. by   RNKPCE
    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.
  12. by   Tweety
    Quote from barefootlady
    Sounds like your unit is trying to assign patients fairly and take into consideration the skill level of nurse and care required by patients. I don't understand crippled nurse remark, please explain.
    Sorry, I just now read your question. I'll answer even if you don't see it.

    Actually that was very sarcastic. It's a remark I make when a nurse whines about an assignment I made "I have to go from one end of the hall to another". Granted it's not easy, and not desirable but it's fair for acuity. I usually joke "well, last time I checked you weren't crippled, I think you'll do just fine". Perhaps not politically correct, and no offense to the handicapped intended.
  13. by   RN-PA
    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
  14. by   hospicemom
    Quote from RN-PA
    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....
    Charge nurses dont really matter in the Mesh system.....I am working tomorrow and will get a copy of it.....Ill post it up here tomorrow evening for you

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