Curiosity: Charge nurse how do you determine assignments

[love-d-OR]

I have heard people say they have to look at the skill mix, but exactly what does that mean? If nurse A and nurse B have the same skill mix who gets what patient? and if nurse A has more skills than nurse B, then how is nurse B menat to learn if she/he is never exposed those skills. There are some nurses on my unit that always get very critical 1:1 and others and others that rotate from getting really sick 1:1 or 1:2 assignments. I have heard some of the nurses complain that they did not appreciate the fact that every time they came to work they had a 1:2 assignment and xyz always had the interesting 1:1 with all the monitors, gtts and other invasive lines.

So to cut it short, what is it like making an assignment. What goes into the thought process? :thnkg:

[nrsang97, BSN, RN]

I base the day assignment to the skills of the staff for the day. If I have a new RN just off orientation then I will give them the stable 1:2 assignment, I will give the experienced staff RN the harder 1:1. However if I think they could use the new skills of having the 1:1 after some time then I give it to them with exerienced nurses around them so they have some backup and someone to ask questions to. So I deffinately look at the skill set of who is on for that day. There are a few I really don't want the sick sick pt to go to because they will not be able to handle it appropriately.

I too did wonder for a long time. If I am not charge they will give me something interesting. One night the Day charge gave me the GOL pt at my ANAM's insistance instead of giving the experience to another nurse who had less experience, but is none the less a great nurse.

[diane227, LPN, RN]

Skill mix means the number of RN, LPN, Tech, CNA for your particular shift. The charge nurse has to evaluate all the patients that are present and make the assignments based on the needs of the patients and the staff she has to care for them at the certain place in time. You also have to take the skill levels of the staff into consideration.

In addition, as a director you have a position control sheet (in most places) where you have worked out your mix for each shift. This is based on how many hours you are budgeted per patient. In the ED it is calculated hours per patient visit. On the floors it is different. You are allowed a certain number of hours per pt day.

An FTE (full time equilivent) is a person that works 40 hours a week, 80 hour a pay period assuming that your pay period is two weeks. When you have vacant positions you know what skill level you need to hire based on your position control sheet. Your FTE of a certain employee varies according to the FTE that they are hired for. For example, you may have an employee that works 4 - 8 hour shifts per week. This makes this employee a 0.8 FTE.

There are times when I assign certain nurses to certain patients based on the needs of those patients and the skill levels of a particular nurse. I am not going to assign a brand new LPN to three or four fresh orthopedic post op patients.

I hope this helps.

[meandragonbrett]

We look at what's going on with the patients in the unit. Meet with the current **** and find out if their assignment is good or bad...why or why not? Then also look at staffing. Who is a better multi-tasker for the busier assignments. Who is experienced with sicker patients. Who's newer and needs to be pushed out of their comfort zone with a more unstable patient, etc.

[nurseeB]

When I do staff assignments I try to take into consideration the acuity of the patients and the skill of the nurses. I don't want to overload a nurse with 3 or 4 involved patients and give another nurse 4 independent, barely need any care patients (otherwise known as walkie talkies...is this a common phrase everywhere?) Although during my agency nurse time, there were charge nurses who would deliberately assign the worst patients to the agency nurses and they would also get the first admission too, but that's another thread.