I am wondering how patients are assigned in your PACU. Currently, we have a nursing assistant assigning patients, they go around the room and no matter what is happening to your patient if you are next you are next....even if the next nurse has 0 patients.
I have an issue with a nursing assistant running a critical care operation...thoughts?
Thanks for your input.
We all just take turns. We are a level 1 PACU, so we have a Primary and a Secondary RN per patient. We function in teams for the day, so both nurses will take turns being primary and secondary RN. As far as the CNA goes; we do not have a CNA in the PACU. No one is really deciding who is getting the next patient coming out from the OR except the nurse-teams. It’s really hard to hide the fact that you’re sitting there picking your nose while another RN team is taking patient after patient.
There are two issues
Can a CNA assign patients? Yes, a CNA with knowledge of the whos and hows of how a PACU's functions can assign better than a charge RN whose an idiot. (I've have some of those, and some extremely competent CNA's.)
Are your patients being assigned appropriately? No, if the only criteria is who's name is next on the list.
Perhaps you can get fellow nures to agree to present the issue at a staff meeting. Do not imply a CNA shouldn't be doing it. Simply that the assignments need to take into consideration the acuity level of the nurses current patient before assigning them another patient. Not just base it on whose name is next on the list.
We just take turns... but if your still busy with the last one and someone else's bay is empty... you get skipped (there may be some slight harrassment about "milking the clock" from fellow nurses).
If everyone has one patient then we see where we are when the OR calls turn over. Is someone about to discharge to phase 2 or inpatient?? Is someone's patient less critical??
We try very hard not to give a nurse that is still managing an airway (even an OPA) or that has a child a second patient. If everyone has one and the new patient coming is a very critical/ a child... the Nurses who's patient has the highest aldrete will take over another high aldrete scorer to free up someone to be one on one with the new patient.
So it's pretty fluid... it's where communication and team work factor in.
Often no one has assigned.. everyone has looked around and someone will shout out, over here, I can take another.
We have one tech, but she does not make assignments, she helps set up patient monitors, ted hose, SCD's, pillows, ice packs, she posts cardiac strips and does a lot of chin lifts and jaw thrusts so we can finish our assessment and get that first charting done. She also cleans the bays between patients and transports when needed. She works Monday through Thursday and I miss her on Fridays.
We also just take turns & no one ever takes a 2nd pt if there is a nurse free, nor would we expect them to. It's unneccessary stress on the nurse & potentially unsafe.
I second the notion of bringing this issue up in a staff meeting. We keep a log book for pt admissions to pacu which also records the nurse; that is how we keep track of whose turn it is.