Daily assignments -- how are they made?

[SoundofMusic]

It seems that on some days, I get the "easy" low stress patients. Other days, I get the worst assignment combination out of anyone. I have to wonder sometimes if it isn't the doings of the charge nurse on night shift. I KNOW one of them really dislikes me, and it seems everytime she's on, I get the crappy assignment. Then I'll see her "favorites" handling sometimes less than four "easy" patients and sitting on their behinds all day because they are far less busy.

I seem to sometimes get the same group they hand to the float nurses also.

Am I imagining this or not?

Do they realize that if they are intentionally punishing you w/ bad assignments that this is a safety concern? I had the other day: 1 heparin drip, 1 high demand total care patient (w/ so-called 24/7 caregivers at the bedside who were calling me into the room every 10 mins) , 1 suicide risk, and 1 high falls risk w/ a 5th admission also a high falls risk. I simply CANNOT be in 5 places at once w/ unsupportive techs. My new admit fell and of course, that creates additional time and work in terms of documentation, not to mention, a safety risk for the patient.

Is it possible to document this, or to bring it up w/ the managers?

[roser13, ASN, RN]

In my experience, charge nurses do their best to level out the high/low acuity patients so that no one nurse is overwhelmed. I also think that a good charge looks at each nurse's strengths/limitations and assigns accordingly. Could a vindictive charge make it tough on someone? Sure she could. There will always be those who abuse their power.

I would think that it would be next to impossible to document something like this, unless you can show relentless, night after night unfair assignments. You also say that sometimes you have a relatively light, easy assignment, so I don't know that you could prove being anyone's target.

Complaining to the managers unless you're 100% certain would probably not be very productive either. Seems to me that your best bet would be to enlist the help of those nurses who are "sitting on their butts" while you have high acuity patients. And why are your techs "unsupportive"?

[nevb]

At my hospital we listen to report pre shift, it is normally taped but if it gets busy the previous shift will give a verbal report.Then we split the assignment so it is as evenly split as we can get it. Whoever was there the day before usually takes their patients back unless it means someone else would get several admissions. We split the discharges and transfers, heavy/diifcult pts, crazy families and pts going for procedures/or. This is a telemetry/ step down unit with a 4 patient ratio. We have two halls and two reports with a charge nurse but they have a full assignement and everyone works together as much as we can. I would want things to be done differently. The way we do this assignement really builds a sense of team playing, IMO, since it is fair from the start everyone jumps in to help when things gets a little hairier than expected. Since everyone had a say in who they were assigned no one feels like they were scr***d. This good because we all take turns taking the bad pt someone steps upp and say " I 'll take one for the team tonight" so no one always gets the pt from hell! Some days the pts are all bad but since it split fairly you at least know next time has to "betterish"!

[Straydandelion]

I have never worked at a place another shift's charge nurse made the daily assignment for the next shift. There can be things going on the next shift including acuity that is not seen on nights unless acuity is well documented (and sometimes the acuity can just raise for that shift due to procedures etc.), I don't see how this can work well at all. It seems like the day charge should make assignments for her/his shift.

[Psqrd]

On my unit we do the assignments for our shift. I having worked with the nurses on a regular basis take into account whether the nurse had a bad assignment the night before as to not give them heavy patients again..I also consider isolation as I try an spread them out so one nurse does not have all the isolation patients. I also consider the nurses ability...I try not to dog out floats as it can be tough enough on a floor that you don't know where everything is and I don't want our nurses to get dogged when they go to their floor...

I'm not sure but maybe your charge did not know how heavy those patients were and if that is the case I would bring it up with them to make sure they don't pass that assignment on.

The other thing that needs to be addressed is the lack of teamwork on your floor...no one should be sitting on their duffs while you run crazy...if this is going on then I would definately bring that up with charge and if nothing happens then take it up with your manager.

The other thing to consider is of course is your perception that you are the only one with a bad assignment. I have had nurses come to me and ask why they got such a bad assignment...In one situation I explained that everyone had bad assignments as it was just a heavy floor that night...it was quickly confirmed by another nurse walking/running by who asked if she would like to trade assignments...she got the picture.

Alot goes into it...in fact I consider it to be the biggest challenge of being charge and always feel guilty when someone gets the "bad" assignment. I had to the day shift assignment once (i work nights) as the charge was going to be late and I have to tell you I don't envy them with all the discharges and admits from surgery or cath lab...that one is a total crap shoot sometimes.

P2

[Tait, MSN, RN]

I sit down at 0300 each morning with every nurse on the floor (three plus me as I carry a five patient team as well) and get report. This includes the following and any other pertinent information:

Discharges

Procedures

Accuchecks

Level 4 (heavy patients)

Drips/TF/TPN

Isolation patients

DNR

I then sit down with my grid sheet and for approximately the next hour mark down all the oncoming staff. Divide up patients they had the day before (if they are returning), then heavy patients, isolation patients, D/C's (attempting to give no one more than two D/C's if possible), and procedures (no one needs two LHC's and a whipple). I also factor in "heavy" patients, those being needy, pain seeking or family issues.

Then I use a grid to divide the nurses into "teams" and balance appropriate nurses to PCT's so that the PCT's aren't overloaded with a heavy team of Q2 turns or isolations as well.

Then I cross my fingers and close my ears in the morning.

It is often impossible to make the assignment perfect, because everyone has their own idea of what it should be, and that changes daily due to "traffic, tots and tantrums" of the day.

This being said, there are a lot of nurses who will make an assignment per favoritism, hate, pecking order or just out of their butt. It's just something we deal with.

Best of luck,

Tait

*PS. If this coming across as a bit crabby it is because I am still appalled over the "nurses baking cookies" thread. Ugh.

[loriangel14, RN]

Where I work the assignment is done by the outgoing staff for the next shift of that time slot.E.g. days staff makes up the assignment for the next days shift, evenings for the next evening shift etc. Usually it is the charge for that shift that does it but anyone can do it really.Quite often the shift will change the assignment in report anyways, it's not written in stone. if someone looks at their assignmnet and thinks it is too heavy or they have had the same bunch a lot lately they can ask to change it. We try to spread out the heavy pts( or those with pain-in-the-butt families)while still keeping each nurse working in rooms that are close to each other. I agree with the previous posters, no one should be sitting around if they had an "easy" assignment. We are team oriented where i am and it is understood that if you are done your pt care (on days especially) you go and ask if anyone needs help.We don't even sit down and chart if the others are still washing and dressing people.We are have about half rehab beds so our pt care involves getting everyone up and down several times a day and getting people dressed.Team work is a must.

[Fiona59]

Our assignments are written by the night crews and there are two nurses who charge that are notorious for writing craptacular assignments.

Float staff get lighter loads because they don't want to scare them off coming back. Some nurses are running from one end of the unit to the other for their assignment.

The favourite excuse is "well, I know you can handle the load" as they dump some staff with a fresh ICU transfer, a quad, and two ORs on Call. Life is good this weekend.

[Psqrd]

I am sure I am not the originator of the term "Jenny Craig" assignment of one patient at one end and another patient at the opposit end of the unit but I love the term.

[dskrninpa]

I have to agree with the other posters. Assignments are not easy to make. No one is ever going to be happy. Acuity has to be taken into account as well the experience of the nurses on the floor (mainly if there are floats or newbies). Charge nurses generally put thought into the assignment, and need the feedback of other nurses on the floor (a good charge will ask, but volunteer if not asked) to alter the assignment based on changes in a particular patient's status or a "mistake" in the present assignment. Admissions and discharges also factor in.

[diane227, LPN, RN]

Every place that I have worked has a different way of making assignments. Unfortunately, you will find people from time to time who play favorites and who give their buddies less work to do. I think that is very sad and it makes for a very stressful, unhappy work environment.

I currently work on a 34 bed med, surg, ortho floor as the 3-11 charge nurse. We have changed the way we do our assignments because we work a mixture of 12 and 8 hour shifts. The day shift charge nurse does the assignments for 3-11. She gives the 12 hour people their same patients for the remaining 4 hours of their shift and then assigns the other patients to the 8 hour staff coming on to take over for the 8 hour people going off. It sounds confusing but it works really well. When I get to work, usually at least 15 minutes before the start of my shift I get a quick over view from her (post ops, admits, transfers, discharges, isolations, patients with sitters etc) and I look over the assignment for myself and make changes if needed. I try to assign patients based on several things: current work load of that staff member, where I have the appropriate bed type, and type of patient (transfer, admit, isolation etc). I don't give people more than one admit if I can help it during the shift because it is so time consuming. I have a good relationship with the staff on my shift and they tell me when they need help. Of course I have a couple of people who complain no matter what, but that is another discussion all together.

[CASTLEGATES]

I think they tape each staff member's name to different stairs then throw all the papers of the patients in the air down the stairs and whatever papers land on your step are yours for the shift.

This seems to be the acceptable standard industry wide!