Assignment politics/rites of initiation

Playing senior nurse's advocate (although I am also a new nurse). Is it possible that it just feels like you get the more complicated patients. Perhaps the assignment was split for the next shift because it was after your horrendous shift that it was realized.

I had a pt. that should have gone to the unit, but because day shift had a dedicated charge who took care of my patient from 3-7, the trauma resident never knew how much care he required. As a result my other patient in that room (a stabbing victim) went nuts because he was jealous of all the attention my other patient was getting. Imagine how much care my other 5 patients got while I took care of an old man postop spine fx rx surgery how was desating from severe atelectasis... It was a horrendous night. BTW, the patient went to the unit a few days later and looked pink and healthy when he arrived there (I happened to be there as a barcoding resource). I'm thinking, he's critical now, but he wasn't when I had him??!!?? Sometimes it depends on who is on and what they decide.

If it is politics you need to have proof, which is pretty tough. And even then, not sure what would be done about it. If you feel you are getting an unsafe assignment though, you need to open your mouth.

BTW, where in PA are you? I work at Lehigh Valley Hospital - Cedar Crest.

Good luck!

Your perceptions may well be accurate ... I've noticed a couple of charge nurses who have, at times, seemed to make it their mission to find out "can she handle it?" Never mind patient safety & quality of care ... Where I work this is the exception more than the rule, but I have seen it happen.

Having said that, I will also say that with additional experience, things get *somewhat* easier. I used to find an active chest pain patient nearly overwhelming ... now that same patient scenario seems much more routine.

The ICUs where I work assign 2 patients per nurse for non-vented patients. A vented patient is automatically a single assignment. Seems more cut & dry than the way your assignments are handled, and very different from my "world", where I may have an intubated patient as well as 3 others.

(((Hugs)))

As long as you're sure your assignments are worse and you're not just having normal new grad disorganization, you should take your concerns to the one making the assignment.

When I was a charge nurse I was mindful of making fair and equal assignments. I was even accused by old timers of taking it too easy on the new grads when their orientation ended. A good charge nurse knows the skills of the nurse, and knows the acuity of the patients and should be fair and consistent in making assignments.

If there are any rites of initiation schemes for new grads, I didn't get that memo.

Good luck. You have to advocate for yourself, or you will be taken advantage of. I'm not talking about going to the manager, but going to the source - whoever makes the assignments. As long as you don't complain it's going to keep happening.

You have to advocate for yourself, or you will be taken advantage of. I'm not talking about going to the manager, but going to the source - whoever makes the assignments. As long as you don't complain it's going to keep happening.

When I did talk to the charge who made the assignments, she told me it was a "ballsy" thing to do. I had been assigned to two vent pts. One was a head bleed with q1h orders for EVD draining and propophol weaning to stop. For 3 days I had the same assignment. On my day 1, he pulled his foley despite wrist restraints. I got a urine splash in the eye from that one as turned in that direction at the same time he pulled. On day 3, he pulled his foley again, this time requiring a urology consult. After a couple of days off, I wanted to make sure I didn't get him again. It was a frustrating and unsafe assignment and I needed something different. I thought he should have been singled but I'm a rookie so I kept that thought to myself. I did call the night before my next shift to request that I not be assigned to that pt. again. The next day I got a 10 minute talking to by the assigning charge as to her rationale. Well, OK. But the point was that requests by the staff just weren't made.

Hm. It must be nice to be in charge with the attitude that the staff can't make assignment requests! Good grief. She must not put her panties on the same way the rest of us do.

Anyhow. I've been learning to charge since february. And my karma is such that if it crosses my mind to be less than fair (and occasionally it does, I'll admit) then the assignment I give myself can turn into a really, really busy night. So I'm trying to be fair. In doing, I've had nobody with less experience than me, since I am part of the crop that graduated last year. So I try to split up total care patients, pre-procedure patients, and just plain PITA's if possible. It isn't always possible to give good assignments, sometimes the best thought-out assignment can go straight downhill no matter what you do.

Also, since I'm a baby (experience wise) and making assignements often for people with the same amount of experience as me, I have begun to notice that people's abilities vary. I pay attention to how long they take to chart, how long they spend yakking at 2 am, etc. Some folks will spend the same amount of time talking and reading magazines no matter what the assignment, then be behind on charting and stay an hour late to finish. Some work their butt off and have the "dark cloud" following them such that their seemingly OK assignments give them heck and/or crash frequently, and I just try to help out 'cause I've been in that boat often enough.

Our unit has a semi-informal tradition of the charge nurse finding out who the nurse had the night before, if she knows any of the patients, etc. Some people we just don't give to the same nurse several nights in a row unless they want them back or show a really good knack for dealing with them. I'm a think-out-loud type person so as I'm making assignments people can hear what my rationale is and voice any objections. The only objections I've ever had were from a float nurse and it really got on my nerves. So I can understand your charge nurse maybe experiencing some irritation but for the love of pete, giving you the idea that you can't make requests is a little high-handed.

Organization, by the way, is what allowed me to live through my rough nights. The scribbling of times and briefly what I did or the patient did, on my brain, saved my butt more than a few times when I had no time to chart until way close to the end of a shift. My notes may have been brief on those nights but by gosh they were complete. I have this maniacal drive to get out of work on time no matter what happens... some mornings I swear we leave treadmarks.

When I did talk to the charge who made the assignments, she told me it was a "ballsy" thing to do.

Unfortunately, in order to advocate for yourself, you're going to be labeled "ballsy" and a whole lot more. That's one of the dynamics that make people afraid to confront the source of their frustrations. Still that's better than being treated unfairly and given potentially unsafe assignments don't you think? If you continually speak to the charge nurse without results, there is a chain of command to follow. Of course in the end sometimes we have to speak if out feet as we walk out the door to something bigger and better.

I have also noticed this, Kat. If there are an odd number of patients I always to get the extra one, and one of our classmates in CCU regularly gets the toughest patients on the unit. She also struggles with nobody being there for her when she could use a hand, even though everybody knows she's new, and needs support. Her 'initiation' is particulary painful being in CCU, like you. Honestly, I don't think anybody really cares we're new grads. You sink or swim. Nobody bumper-padded my first night alone. Instead I had more patients than the nurses on our floor typically gets, and the expectations were that I could manage it. Every night since then I have had at least the same number of patients, many times more than everyone else, and always the ones with GCS's of 14, climbing over the side rails, and pulling out trachs.

Kathy-

This happened all the time on the floor I used to work on. I finally got tired of beating my head against a brick wall and transferred. Most of the time it was more of everyone (ie. the charge nurses) being so busy and playing catch-up (The floor needs a major overhaul in how things are run.) that they really didn't pay attention to the division of patients. Other times they had to give their friends the hook-up. There was a group that all started around the same time and if you weren't part of the clique, you got no consideration. Their excuse was "Well if you think it's bad now you should have been here xyz years ago and we had to do this and this and this." Kind of like the old grandfather telling the story about when he was a kid he used to walk 5 (10,20) miles to school barefoot in 3 (8,10) feet of snow, up hill both ways and he was thankful. :trout: Just my observation.

I'm beginning to think that there are elements of a few things going on. Sometimes it's about giving me exposure to more complex scenarios. Sometimes it IS politics and other times it's just the luck of the draw and a question of geography. The past couple of weeks, my assignments have been more manageable. Maybe too I'm becoming more comfortable as an RN. Hard to say.