I am a new grad RN, and have been at my first job for four months. On my floor (post-surgical/ortho, with overflow of medicine patients), we have a pretty spread out floor, mostly private rooms, and is divided up into a north and a south side. Patients are not assigned with an acuity in mind. They are blindly assigned as a room number by the charge nurse, who also happens to take patients. The various RNs who take charge and make out the patient assignments factor in the previous day of trying to give nurses the same patients they had the day before. We have LPNs and RNs on the floor working, and the patients are usually divided up equally among the RNs and LPNs, with no regard to the level of care they will need. For instance. RNs cover the LPNs because LPNs (per policy) DO NOT hang IV piggybacks, push IV drugs, hang the first IV bag of fluids, call doctors for any problems the patients may be having and take verbal or telephone orders, take phone report for an incoming patient (from recovery, the E.R. or another floor, even if it is going to be assigned to the LPN), listen or chart lung or heart sounds, or take off the orders in the computer. Ultimately the RN is responsible for the patient and should do an assessment on the patient, as well as the LPN. Sometimes an RN may have to cover 2 patients from one LPN, and another from another LPN. With assigning patients this way, one can either have a very good day, or a very BAD day.
For instance, let s say I have a couple of stable patients and a couple of patients going downhill, that is work enough. Now, let's say that you are covering LPN's patients who came from recovery as a fresh post-op who needs IV push morphine q1h, another needing IV antibiotics, another who has Blood pressure requiring a phone call to the doctor, another with blood sugar of 50.......you get my drift.
My suggestion to my manager was that we should (like the medicine floor below us), assign patients based on acuity and factoring in if this is a patient requiring RN tasks (hanging piggybacks, calling docs because patient is taking a turn for the worse, etc.) It could be done by the previous shift just updating the charge nurse ( on a piece of paper) if the acuity is a 1,2, or 3, and some basic info on what the patient is getting, needing. Also, I pointed out that since the charge nurse takes a lesser assignment to be available "to help," that the RNs and LPNs patient assignment should not be divided equally, since it is apparent that the RNs are doing things that the LPNs cannot do. Please do not let this turn into a RN vs LPN thread, as that is not my intention, I am just stating the fact that the RNs are responsible for more. My manager said that the nurses on the floor see that 20/5= 4, and that is the way the floor nurses have always assigned patients. So, shot down with that one. As far as assignment by patient acuity, she said that another nurse was already working on that (she was on military leave at the time). When that nurse got back, she said that she was looking into to maybe coming up with something, but hadn't even started. To make matters worse, another new grad RN had previously proposed the acuity assignment of patients and had presented our manager with a proposal and a system that she worked out. Our manager told her that it was a good try, but the military leave nurse was coming up with something. So, as you can see, months later, we still don't have a system for assigning patients other than charge nurse makes it out randomly assigning patients according to their room number.
Fast forward to the present. Sorry this is so long. I have been working for the last three days with the same patients. I know them and their issues very well at this point. One has high b/p, low pulse, s/p ileus issues. Another has foot debridement dressing changes and pain management issues, the other has high blood pressure and blood sugar (low and high) issues. I have had to call the docs numerous times on two of these patients and have tended to them just fine.
I am fine with having patients spread out, as I don't mind walking. Our charge nurse for today (who is a part-timer, maybe works 2 days a week--I am there five days a week), does not like to walk, and makes her patients very close, all within 2 feet of each other. We are both assigned to work on the south side, with me covering patients on the north side. She has not worked on the floor in several days, while I have been there for the last 3 days with the same patients. Her LPN-covered patients were very stable, by the way, mine were not. She assigned herself TWO of my patients, since they were right next door to her's! Meanwhile, she assigned me a patient I did not know, also one door down to my patients that she assigned herself. Then, she has me walking up the hallway a few doors up to my other new patient.
So, I speak up. I state that due to continuity of care for the patients, that would like the same patients that I had. She said that she didn't want to be spread out (but she spread me out!) She was not even spaced that far apart. By the way, no other nurses who were present backed me up. They all remained silent, even though they have had this happen to them many times. She put up a fuss, but I persisted, and she reassigned my patients back to me.
When my patients had issues, I was able to come up with a plan, call the on-call doctor, and with my knowledge of what I had done previous days, collaborate effectively with the doctors.
The tone was definitely set for the night. One of the day nurses, who happened to be working this PM shift took me aside later in the evening and said that I was too outspoken, and since this was a very cliquey shift, I was setting myself up to being fired. She said, "Watch your back."
Now, it is true that I am outspoken, and I will stay that way. I see that we have very few of those nurses, and I do not want to cower down so that certain nurses can bully others. I feel that if this is not the floor or hospital for me, then I want to know before my first year is up, anyway.
My question to all of you out there is: Do others out there feel that they must not speak up for fear of retribution or backlash? I think it is a shame that when patient care is at stake, that a nurse is made to feel like he or she must just remain silent and not stick up for himself or herself. I have seen this behavior with another charge nurse who makes out a cushy assignment, while overloading the other RNs, and hiding out so that it is hard to find the said RN when it is time to ask for help.
Any thoughts....?
