Fair Patient assignments

[GoNightingale, BSN, RN]

Hi everyone!

I'm not a charge nurse and don't aspire to be. I am a telemetry nurse, but as everyone knows, we also take patients with other disease processes including stroke patients. Of course nurses that are not stroke certified are not assigned the stroke patients.

I have always been curious as to how the charge nurses (and/or whomever assigns the patient load for the next shift ) conclude or come to a conclusion as to what nurse is going to get what patients. Is there some kind of standard method. In some places I hear it's done in the level of acuity of the patient. In other places I hear they do it by keeping each patient load at close proximity to each other roomwise. Where I work I think they do it by trying to keep the nurse with the patients close to each other so she doesn't have to run around so much. On the other hand, I 've had nights that I have 6 total care patients or patients that require constant monitoring, or 6 patients with Peg tubes ( we allknow how long thattakes), etc. On patient loads like that, it seems like the patient load has not been evenly distributed.

If there are any charge nurses out there, I would enjoy hearing from you.

Thanks.

[canoehead, BSN, RN]

I've always found the "suck it up" policy to be the best one because it backs up my "choose your battles" philosophy in life.

Measure your complaints. You want to be taken seriously when you find something that is life threatening to the patient. If you can say that the patient care isn't safe, then speak up, and go up the chain of command, not complaining to coworkers. Make it count.

[Flo., BSN, RN]

We do it by patient acuity. However I often felt shafted because the patient that is quiet all night can turn into a night mare when the sun rises and vice versa.

[Crux1024]

Pt acuity and PIA level. We try to split up difficult pts so no one nurse is overwhelmed. Doesnt always work, but its nice if others are aware of your issues you may have or any special pt needs that may take up a lot of time. To a lesser degree was room location, but that would come second to acuity, always. Not far for one person to have all total cares or confused or walky talkys.

[That Guy, BSN, RN, EMT-B]

I dont say anything most of the time. Some nights I get dealt a soft hand, others a heavy hand. On the soft nights I make myself available to help out anyway I can as do most of the other nurses. Some nights just suck either way and "fair" is nigh impossible.

[LouisVRN, RN]

we do it by pt acuity. However you have to look at more than just the disease process - the walkie talkie that calls every 2 minutes is costantly complaining and demanding the doctor can be called is not a low acuity pt. I try to mix and match the ones with high acuity medical needs and those with high personal needs. However you also have to know your staff. A new grad I may give them a high medical acuity pt if I feel they will pay extra attention to detail and assessment or I may not thinking they won't notice subtle changes. It depends on their skill set.

[PatricksRNMommy]

I am a charge nurse and when I make assignments for the next shift I look at several factors:

1) Patient acuity - I try to split up "total care" patients as much as possible, as well as isolation patients, post-op patients, confused patients, and pt with cardiac drips as much as possible

2) Continuity of care - I almost always give a nurse back the same patients he/she had the night before (unless either the patient or the nurse request otherwise)

3) Nurse's Skills/Abilities/Certifications - For example giving a stroke patient to a stroke certified nurse, assigning the Spanish speaking only patient to a nurse who is fluent in Spanish, giving a critical patient to a very seasoned nurse, etc.

4) Proximity - Proximity of rooms is the absolute least important factor to me in making the assignment, but if there is a choice between assigning a nurse a patient closer to her other patients or one further away (assuming there is no good reason to assign the distal patient) I will assign the one closest to the other ones.

I try to balance the needs and safety of the patient with the satisfaction of the nurses as much as possible, but I have learned that there is absolutely no way to make everyone happy...

[msjellybean]

On my old floor, we assigned by acuity & potential for discharge/transfer.

On my new floor, the standard (which I do NOT adhere to when I'm charge) is: get report from as few nurses as you can. Which ends up easily with one RN having all the discharges. And really, is it fair to set one nurse up for 3 admits, when we're only a 9 bed unit? No. And also to go along with that, your acuity could be dramatically different than the other nurses. A while back, had I gone the standard route, one nurse would have had an average acuity of let's say... 8, while the other had an average of like 16.

[Bringonthenight]

Acuity. I'm also wondering what it takes to be "stroke patient" certified? I've never heard of this before, everyone i've worked with can be assigned a stroke patient..

[FancypantsRN]

I think they are referring to nihss certification. It's an online course you can take to get certified.

[Amanda.RN]

We based it on acuity.

[beckster_01, BSN, RN]

I'm in charge orientation right now, and let me tell you making assignments is much harder than it looks. A lot of the time if you have a hard assignment, the floor might just be really heavy, and everyone has a crappy assignment.

When I am making assignments I am thinking about how stable the patient is first. Then I look at if they have feeding tubes/trachs/Q2hour T+P's. If they are back-breaking patients, confused on bed alarms/1:1's, or needy I try and spread that evenly as well. Then I ALWAYS make sure that discharges on the day shift are going to be evenly distributed. Other things go into play as well like neediness, psych issues, and location.