ARE YOUR PATIENT ASSIGNMENTS "FAIR?"

flashpoint · Sep 22, 2005

Here, it really depends on the charge nurse...we have one that assigns by acuities...one nurse may end up with three patients, while another ends up with five because their acuity total is the same...one plays favorites and gives the patients who are going to be the easiest and most fun to take care of to her "pets" and give the patients who spit, hit, and kick to the nurses she really doesn't care for...one gives the heavier assignments to the nurses who are the most efficient and manage a heavy load better, this same nurse gives admissions to the more efficient nurses regardless of acuity, regardless of number of patients, regardless of how many admissions they have already taken...when she is on, it pays to be a few steps behind...

So are our assignments fair? Often times, they are not, but it comes to the point where you know that depending on who is in charge you are going to get screwed...you get used to it and either work your schedule around that person or walk in expecting the worst...

Management is considering having charge nurses make assignments for the on coming shift...assignments would be "firm" unless there was a very good reason to make changes...if changes are made a form has to be filled out explaining the rationale for the change and "just because" will not be accepted. They say it will cut down on the favoritism and make report go faster...

SheriLynnRN · Sep 22, 2005

I just left my position, due to a military move, on a unit that made assignments in about the same way as you describe. I worked nights, so our ratio was usually 7 or 8 to 1. If four of us had eight and one had seven, the person with seven would get the first admission and then it would just rotate around. The better charges nurses would try to give admissions based on who seemed least busy. The most frustrating part of the whole thing for me was that we had two parallel halls with patients on only one side of each hall. If we were full, the charge nurse would give me rooms 1-7, give Susie 8-13, and give Mary 14-20. All with no regard to acuity. I gave up giving suggestions for a better way to do itafter I realized that many of my coworkers seemed to be too lazy to walk a little more to balance out the work load. Maybe my next unit will be better.

(Also, our assignments were made by the off-going shift. The charge nurse for our shift only had to deal with assigning admissions.)

Daytonite, BSN, RN · Sep 23, 2005

We RNs, when assignments were made and just before report, always decided what order the admissions would get assigned to. Some people wanted the first admission of the shift, others would take the second or the third. If you don't get a lot of admissions it might be smart to rotate the first admission of the shift (kind of like floating). This way we always had it in the back of our mind that we needed to be ready in case an admission came in. We were stepdown so it was not unusual to get more than one or two admissions a shift--especially during the nighttime.

There are always going to be times when no matter how hard the nursing staff tries to make the assignments as equal as possible that it's just not going to happen. First admission of a shift should ideally go to the person with the lightest assignment. The one with the heaviest assignment should be lower on the list. A patient who was a high acuity on one shift, suddenly becomes less of a problem on the next, and vice versa. You can't always predict these things. As you get more experienced you might be able to recognize when you are getting an overloaded assignment. Then, what you have to do is speak up and suggest a better patient distribution. It's hard to change horses in midstream, so you aim to make the assignments fair at the start of the shift.

If a patient contacts a doctor or is coming from a doctor's office, they don't necessarily have to go through the ER. The doctor can make the decision to make the patient a direct admit and call orders to the floor nurses if he knows the patient very well and knows exactly what he wants to have done for them. This happens all the time on the medical units. Direct admits always have a lot of orders, some of them stats, and take a lot of time to get settled and stabilized.

Hope that after you got home yesterday you found the time to do things you had to do for yourself in your own life. (I watched Martha Stewart's Apprentice--waited all day for it!) Sounds like you did every thing right. Sometimes you just have things that have to be followed up by the next shift. There will be things you have to do for the shift you follow at times. If you are worried about what the other nurses are going to think of you, I would recommend that you go to each of them individually and ask for feedback. It shows you are concerned about them and it helps build trust between you and them. Over time they will know what they can expect from you and you will know what they expect of you. This is how teamwork is built. "Have you felt like I've left you with any messes to clean up?" "Is there anything I'm doing that's making it more difficult for you?" And, "what can I do to help you get a better start to your shift?" Don't be surprised at some of the answers you get. Some of the nurses will be very helpful and will use that opportunity to actually tell you if you are doing things that are aggravating them (yeah, for them). There will be a few you'll run into that will take those opportunities to try to get you to do half their work for them before they come in! You have to use your common sense to decide when someone is not being realistic. However, take the chance to open up and ask for feedback and criticism because it will help you mold yourself to what is expected of you and make you a better nurse in the long run. Eventually, you will "bond" with some of the other nurses and develop a working relationship that will make things move along very smoothly on a day to day basis. I was always willing to give 110% as long as I wasn't being taken advantage of. Deliberately screw me over again and again and you won't get anything more from me than what I owe you.

Good luck. You're doing awesome! It sounds like you've made some great strides since your first posts. I'd love to know what ever happened with the situation you were having with the nursing assistants.

SmilingBluEyes · Sep 23, 2005

Where I work, YES they are. We are rather democratic about such things, and if the load is too heavy for one, adjustments are made. We work as a team almost ALWAYS. I love working this way. Would not have it any other way.

NessaNurse · Sep 23, 2005

Are you in Peds? or Adults?

hosenhag_310 · Dec 4, 2008

I agree it hard making assignments fair , esp the CNA. They are the ones to fuss. I am trying to make this alittle easier on my unit ( LTC) for making assigments. I would like to make a set assigment based of staff avail so all I have to do is pull out the assignment based on number of CNA. Staff are unhappy waiting for there asignments after report , so I thought about a set assignment would make it easier for CN .Does anyone use this method

loriangel14, RN · Dec 4, 2008

Our assigments are always pretty fair. The RNs and the PNs get the same number of pts(no CNAs). We listen to the taped report and afterwards we quickly discuss each pt. The charge always reminds us that we are expected to help the gals that have the really heavy people. We work as a team so no one gets the short end of the stick. No one is allowed to sit if others are working.

NursingAgainstdaOdds · Dec 4, 2008

Ours are not particularly fair. As has been mentioned, the assignments are made based almost entirely on room number and total number of patients. Some people really complain if all their patients aren't in the same block of rooms. We are a medical/telemetry floor, so sometimes this does occur to have the telemetry and medical groups balanced-out where they need to be. As a fairly new CN, this alone presents a pretty significant challenge sometimes. Myself, and other nurse-minded CNs, will try to balance it out somehow if one nurse has an extremely challenging patient or patients. The reality is, the unit just does not have enough staff to really spread it out as we would like. We have no choice.

For many challenging patients, keeping them safe and their needs fulfilled is a team effort. Many nurses on my floor do not see it this way, but there are many who do as well.

I was covering patients for a nurse on lunch recently, who stated just prior to leaving "they're all fine, they shouldn't need anything". Four minutes later, I'm in a room of hers, with a patient sobbing uncontrollably because her pain was out of control, her sopping-wet dressings were dragging on the floor behind her. I quickly went and retrieved her IV pain medicine, but upon returning discovered she had no IV. I started an IV, gave her pain medicine, changed her dressings to both LEs (bilateral cellulitis) and helped her back to bed. She was not an easy stick, and I was quite busy with my own 7 patients, but this was clearly necessary, eh? Upon her return from lunch, the patients primary nurse yelled at me for starting an IV in the AC (she had no continuous fluids, just intermittent ABX and pain meds) and for applying the wrong kind of dressing to the LEs (what is wrong with Kerlix and gauze, I didn't figure out).

Another nurse I work with will answer my call bells if I'm tied-up, and come ask me where my MARs are, so she can give pain meds or whatever to patients who need them. She's the first one in the room when a PA goes off, and will always help me when I'm up to my elbows in stuff you really don't want to be up to your elbows in. I adore working with her, because it is such a team environment. She has taught me a lot about what it means to be a great nurse.

Sorry to hijack! I think overall, with the challenges we face and the way the system is set-up - the most important thing is to work together to take care of these patients. :nurse:

RedWeasel, RN · Dec 8, 2008

Sometimes I feel like I get the harder patients because I can 'handle' it. Just because most of the other nurses on my shift are more recent graduates. Sometimes that is fair, sometimes it isn't. It is kind of a compliment too though. The thing is the other girls are just as competent as I am. Maybe I just need to say something more often.