Assignment of breaks and lunches

[D.R.A.]

Hello ladies and gentlemen:

I am a day shift charge on a med-surg unit. We have only 21 beds. Our pt census averages 12-14. There are times when we have 6 or fewer, and times when we have 17-21. It varies greatly.

We typically staff three nurse aides when we have 10 or more patients. One of them leaves at 1400. I would call this staffing arrangement a walk in the park. We staff 2 nurses and for 12 or more we staff three nurses. We have an additional nurse who acts as an admission/discharge expediter, as well as doing skin assessments, and care planning.

My dilemma is that the aides have routinely been allowed to break and lunch together. So no aides are on the floor during lunch or breaks. I don't feel comfortable with this. The nursing staff has been allowed to do the same.

The aides do not take patient assignments. They are all responsible for all the patients. This makes it easy for no one to take responsibility in my opinion.

I'd like some advice here. What are you doing. What works best in your experience?

Thanks in Advance.

[Spika RN]

I had this problem once, what I had them do was split up the patients each aide was responsible for say patients room 1-10 the other one rooms 11-20 they could work together if they wanted but I made a decision they are responsible for those patients, and they could not be on break T the same time had be be someone to help and cover

[D.R.A.]

Thank you. I see you have CNA experience. That lets me know that you made a reasonable decision based on both your nursing judgement, and experience as an aide. I appreciate your input. I also fully agree with you. My proposal is the exact same.

[Spika RN]

Ok first I would like to say sorry for missing spelling stuff, I have dyslexia so it get hard some times. Second thank you for the complement yes I did make off both those criteria. UT I have also seen before I became charge that one aide said I thought she'd did it and other said they thought she'd did it so yea that was like a what the heck point. Always be fair with the assignment too sometimes if I have 2 aides and 2 nurses I just have the aide with the nurse works good if they get along., some patient for aides can be just as heavy as for the nurse.

[wheeliesurfer]

It is a HUGE liability if all of your nurses break for lunch at the same time, as that leaves YOU exposed if a patient codes/crashes and you are the only provider capable of helping to provide emergency care until the Rapid Response/Code Team comes to assist you (if you have one)! If you have two nurses on, I would break one and then the other, and if you have three I would break two and then the second break you can take your lunch. I would try to keep it so that there are two nurses on the floor at a time as much as possible for emergency treatment if necessary. Not only to care for the RR/Code, but also to help cover basic care for the rest of the patients on the floor.

[Sam J.]

A unit having 12 patients that has 3 CNAs and 4 nurses doesn't sound, on its face, to be a walk in the park.

It sounds more like a ride in a gilded, horse-drawn carriage through Central Park, complete with caviar and a a bottle of Dom, that begins and ends from a deluxe suite at the Ritz-Carlton?

[MrChicagoRN, RN]

We had a similar problem on a medical floor.

ended up making a sign up sheet for lunches so only a certain number could go at once.

IIRC, we had overlapping times so, for example, the noon person could spend some time with both the 1145am and the 1215 persons.

[loriangel14, RN]

We have breaks 1 & 2 for coffee and lunch. Half the nurses and aides go on first break and half go on second. If you work 2 days in a row (or more) you go on the opposite break you were on the day before.

[D.R.A.]

We had a similar problem on a medical floor.

ended up making a sign up sheet for lunches so only a certain number could go at once.

IIRC, we had overlapping times so, for example, the noon person could spend some time with both the 1145am and the 1215 persons.

I have proposed this plan as well. I love that idea.

[D.R.A.]

A unit having 12 patients that has 3 CNAs and 4 nurses doesn't sound, on its face, to be a walk in the park.

It sounds more like a ride in a gilded, horse-drawn carriage through Central Park, complete with caviar and a a bottle of Dom, that begins and ends from a deluxe suite at the Ritz-Carlton?

Don't let the sound fool you. What I failed to add was that half the staff usually calls in. So we over staff in hopes that we will end up with what we need. And of the staff that shows, they are lazy, don't do their work, or take an entire day for 3 aides to give am care. And don't have time to toilet the patients and answer calls because they are 'too swamped.' They are too busy to turn the patients properly, and take frequent, lengthy breaks. Oh, and they are insubordinate most of the time. Still sound like a cake walk?

[D.R.A.]

Oh, and we have a HUC who plays charge nurse. Gives orders to clinical staff, and tries to make pt assignments, and police nursing care. Yeah, its quite a huge disaster.

[D.R.A.]

And our policy book....well it might as well be empty. There's nothing in it! Wanna know what the facility policy is on something, just make one up and go with it! Yes, this is a true story. This is happening.