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?

[diane227, LPN, RN]

That might not be bad. We could draw straws. Flip a coin, or better yet, bribe the charge nurse, easiest assignment to the highest bidder. I worked in an ED once where the staff would pay one of the CNA's to do all the extra stuff they did not want to do like stock the trauma rooms. She made a lot of money off that group.

[BluegrassRN]

I'm night shift charge, 12 hours shifts. Charge nurse on nights makes day shift assignments, vice versa. Here is how I make assignments for our unit (med/surg, average census of 21):

First I print out a census and then ask each of the nurses which are their heavy patients, which pts might have procedures, and which pts will be going home.

Then I look to see if any nurses and aides are returning, and if so, which pts they had the previous day.

Then I make assignments.

It's not as easy as it sounds. I guarantee, if a nurse or aide had a pt one day, they will have that pt on subsequent days unless they request not to, or there are extenuating circumstances. I always try to divide up the heavy patients, as well as the ones who will be going home or who will be returning from procedures.

I never make assignments based on "who can handle it". Well, there is an exception to that. If I have a pt with a difficult *personality* then I will make an effort to not assign that pt to a new nurse. Also, if I have a critical pt or a pt who I have a very bad feeling about, I will make sure either the nurse is experienced, or that the charge nurse has a lighter load so that she can help the inexperienced nurse with this situation.

I really do try to look at the whole picture. I never ever make an assignment based on how much I like someone, or try to give someone I don't like a heavy assignment. That is just asking for karma to come and smack you upside the head. Any half-way decent charge nurse is not going to do that.

I'll add that the only time I float people out of order (we take turns floating) is if the staff is very inexperienced, and it is the most experienced nurse's turn to float. I think it is entirely unfair to leave a charge nurse with a bunch of newbies straight off of orientation--and it is unfair to the new nurses, too. Some of the nurses don't like it when I do that, but I think it is a patient safety issue, and I'm not willing to bend on that.

[chicookie, BSN, RN]

We get assigned by rooms. Rooms 1, 2, 5, 7 are one team of 6 patients, etc. So we get those patients if we are on that team regardless if all of them are high risk.

So all the charge nurse has to do is assign a nurse to that team and if I am working before I leave I see who is on the floor and either ask for the same team if I get a good nurse to relieve me or I ask for a certain nurses team just because that means when I get their team I won't have to run around like a chicken with its head cut off for the first part of my shift. There are 2 night shift nurses that I make sure I never ever get their teams. No way jose. They just leave it a mess.