Assignment of isolation pts

[delphine22]

Another thread on pregnancy got me thinking: Does your unit avoid assigning isolation pts to pregnant nurses? On the face it makes sense, but really, shouldn't they be using the same precautions we all do? What's the difference between a pregnant nurse and one with a newborn at home? Or an immunocompromised family member?

Separate but related question: Would you assign a contact pt and a neutropenic pt to the same nurse? I had a floor do that to a float nurse. Again, nurse should be taking all precautions anyway, but it just seems stupid to me if it can be at all avoided.

Finally (I guess I should have made 3 topics): Does your unit keep the isolation pts on a separate part of the floor, or refuse to take most isos all together, depending on your normal pt population? I've seen some surgical floors refuse isos, and we keep them far away from the OHS pts on our floor. But the same nurse may take care of both. Or in some hospitals, not.

[ICURN3020]

Separate but related question: Would you assign a contact pt and a neutropenic pt to the same nurse? I had a floor do that to a float nurse. Again, nurse should be taking all precautions anyway, but it just seems stupid to me if it can be at all avoided. Finally (I guess I should have made 3 topics).

In response to topic #2 I have been assigned a neutropenic patient with a contact patient before. Upon realizing it, I went to the charge nurse and stated my concerns. I reasoned that even though we take all precautions available, why put the immunocompromised patient at unnecessary risk? I wouldn't want to be that cancer (or whatever) patient and know that my nurse was also assigned to someone with a raging infection that could, if transmitted, easily kill me in my current state of health. My assignment wasn't changed.

I work in an ICU with a usual patient load of 2, sometimes 3 patients per nurse. Here's the issue on my unit...there are certain nurses who become angry if their assignment does not put their patients directly next to each other. For example, they get mad if they are assigned rooms 6 & 9 or 14 & 18 versus rooms 5 & 6 or 20 & 21. This means extra work (walking) for them. It's ridiculous if you ask me...unless they have some disability that makes it difficult to walk or one patient is more critical and needs to be kept a closer eye on (although in this case they could be made a 1:1) room locations should be irrelevant. I've had rooms 6 & 20 before - both ventilated patients mind you, and yes it kept me hopping, but I didn't throw a hissy fit 3 year old performance because of it.

The complainers tend to be the staff that have been around many years and I think they intimidate the sometimes younger, newer charge nurses into doing what they want to avoid a confrontation.

My argument is (and I have brought this up many times to no avail) is to take patient acuity into consideration when making the assignment. It's no fun to have two super busy, critically ill patients and never get to sit even for a minute and then see your co-worker down the hall with two "easy" patients (non-ventilator, no dressing changes, no tubes coming out of every orifice, etc.) walking around leisurely chatting (yes, they should offer their help to the swamped nurses, but there are those that don't). I'm tired of feast or famine!

[blondy2061h, MSN, RN]

Every patient on my BMT unit is neutropenic. Many of them also develop infections requiring isolation. So literally almost every time I work I'm taking an isolation patient and a neutropenic patient. The only thing they won't do is send my unit a suspected TB patient.

[ICURN3020]

Hissy "fit" / staff that "have" been around

I hate autocorrect and it won't let me go back to edit!!!

[tnbutterfly - Mary, BSN]

I edited your post for you.

[HouTx, BSN, MSN, EdD]

(I teach HR legal issues in management classes and this comes up frequently) ..... Pregnancy is not a disability, therefore they are not entitled to any special accommodation. Managers who do this are actually creating greater HR liability for their organizations. All staff need to comply with universal precautions. If a pregnant nurse feels that she is not capable of performing the job due to personal feelings about safety, she needs to request a change of job or go on FMLA. BTW, teratogenic substances' threat to reproductive capability is the same for women and men.

[anon456, BSN, RN]

We assign based on acuity rather than isolation status. We don't give pregnant nurses the patients who might harm them or their baby: chicken pox, CMV, TB and such. And we don't give them any patients who are on tobramycin. Our unit has a LOT of patients on isolation. It's the nature of the unit.

[icuRNmaggie, BSN, RN]

I have worked with a few pregnant women and women trying to start a family who assumed they should be exempt from taking the cdiff, MRSA, VRE , meningitis and suspected TB patients. They were shocked when I said yes you will take them there is no danger if you use correct isolation technique.

Varicella is teratogenic so I can agree with no shingles or chicken pox patients during pregnancy. I have also had a certain pregnant female refuse to take bariatric patients and expected others to take her patients on transports. I am not putting up with that kind of workload for nine months while they shop online for baby things and facebook.

Houtx said it best, it's not a disability.

[duskyjewel]

Ugh....I worked with a pregnant VSS nurse on a telemetry floor. Twenty times a shift we'd all hear, "I can't go in THAT room! I'm *flutter* pregnant!" It disgusted everyone on the unit, except apparently the charge nurses who let her get away with it. And she had done the same during her first pregnancy, so why should she expect different? At the same time, there was an aide who worked full time until they sent her to L&D in the middle of her shift. There was a lot of grumbling about how she never refused contact patients, and as a mere aide, would never be given that luxury anyway.

Women like that VSS set women back every time they open their mouths.

[anon456, BSN, RN]

I have worked with a few pregnant women and women trying to start a family who assumed they should be exempt from taking the cdiff, MRSA, VRE , meningitis and suspected TB patients. They were shocked when I said yes you will take them there is no danger if you use correct isolation technique.

Varicella is teratogenic so I can agree with no shingles or chicken pox patients during pregnancy. I have also had a certain pregnant female refuse to take bariatric patients and expected others to take her patients on transports. I am not putting up with that kind of workload for nine months while they shop online for baby things and facebook.

Houtx said it best, it's not a disability.

Nope, we give the pregnant nurses the VRE, MRSA, c.diff and such patients. Just not the ones I mentioned above. If in doubt wear all protective gear including eye shields and wash your hands because you just never know. And that goes for all of us.

[PacoUSA, BSN, RN]

On my unit, pregnant nurses are never assigned to TB patients, but still assigned to any other iso.

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[firstinfamily, RN]

I worked in ICU when I was pregnant all three times, our facility had at that time policies specific to pregnancy and isolation patients. I never took any hepatitis, or shingles patients or HIV, MRSA was not known at the time. My co-workers were very supportive of me and would help me positioning etc. No it is not a disability but it does a lot to your body and shouldn't we try to take care of each other when we need it??? Thankfully I was in a good place during all of my pregnancies. I think it should be taken into consideration,and yes, men are affected also, although I am not sure exactly how!!