How does your unit handle this assignment situation ?

[melanie1126]

Just curious as to how others are handling this scenario....

I work on a very busy tele unit in a large teaching hospital. My guess is it's a typical tele unit, high turnover rates b/c of higher levels of acuity with higher patient ratios than ICU. Many of our patients end up having to transferred to the unit b/c of change in status, or they were moved out of the unit before they were ready in order to free up beds and have to be sent back. We often work short staffed due to these issues.

Anyway, long story short, last night I had a patient experiencing respiratory distress and I worked with him for about an hour pushing lasix, getting resp tx's, stat xray, ABG, getting MD to come up and eval, twice. I ended up transferring him to the unit and b/c he was one on one for so long, I was way behind with my other patients. Of course this happened right after shift change, so i was left scrambling to pass meds, assess and chart. Everyone was busy b/c we were working short with no tech, but a short time later, the charge nurse gave me a new admission b/c I now had one less patient than everyone else so my number was up. This happens all the time on my floor. I saw that other nurses were sitting down to chart, basically caught up and I, who had been slammed since shift change and was now playing catch up, had to take a new admission just to make the numbers on the assignment board "fair" b/c I was down by one patient after my transfer. Is is better to assign a new admission to another nurse who is not struggling but will end up having an extra patient , or is is better to assign to a nurse who is slammed, but the ratio will be even? It is sometimes obvious to me that the workload is the same or even more for nurses with less patients but my floor doesn't really take this into consideration. Has anyone come up with a system for assigning that works better without slamming a nurse who's down and not making the other nurses feel dumped on by having to take on a higher number patients?

[Sun0408, ASN, RN]

Did your charge nurse have pts? If not, she/he should have gotten the new pt settled and started the admission paperwork for you will someone else put in the orders while you caught up with pt care. That was how we did things when I was on the floor. Also team work was huge on the floor, we helped each other. No one sat until all pt care/needs were met... Usually around 2 am we all were at the nurses station charting.

[loriangel14, RN]

Oh definitely that new admit should have gone to someone else.Even numbers or not,you were swamped and way behind.That has happened on my floor before and what they do is have another less busy nurse do the admission but then the patient gets added to the assignment of the person that gets them due to numbers.Or at least one of the others would have chipped in and helped.An admission wouldn't have been given to someone already scrambling to catch up.

[0402]

Where I worked previously, they would have done what happened to you. Where I work now, I have seen different things. I once had the charge nurse (no pts of her own) do the admission for me and then give me the pt (I was able to catch up a little while she was doing the paperwork, and I really, really appreciated when she did that). Another thing I have seen is, sometimes, we have to give a pt to another nurse and then take the admission. So, someone who already had one more pt than you, would give you a pt that's already admitted and then they get the admission. The other night, everyone had the same # of pts, but then one nurse had to deal with some pt freaking out and then leaving AMA, so then she had one less. When an admission was assigned to the floor, I gave her one of my pts (I had the block of rooms next to her), and then I did the admission, because she had already done one, and I had not.

[LynnLRN]

I think it is pretty common to give the pt to the RN with less pts. Especially if your cap is 5 pts, they would never give a nurse 6 and keep another one at 4.

In the situation you talk about where the other nurses are just sitting around and you are as busy as you say it's time to ask them for help. They should understand. I know when I was in charge and had to give a pt to a nurse who was understandably busy I would always say I'm assigning this patient to you but I will help you with it.

This is the type of situation where teamwork is so important. "All patients are everyone's responsibility" right? That's the theory where I worked anyway.

[cna23]

Did your charge nurse have pts? If not, she/he should have gotten the new pt settled and started the admission paperwork for you will someone else put in the orders while you caught up with pt care. That was how we did things when I was on the floor. Also team work was huge on the floor, we helped each other. No one sat until all pt care/needs were met... Usually around 2 am we all were at the nurses station charting.

I agree' if we ever get slammed, our charge nurse usually do the new admit so everybody else isnt trying to play catch up. i personally dont think you shoukd have been given that amout of stress, if eveybody else was sitting down charting, they couldve picked up a little bit of the slack. but i guess thats how alot of the nurses are, every man for themselves, when we are in the same profession, and should work together as a team. or maybe thats just my way of thinking.

[Double-Helix, BSN, RN]

In my unit, it would depend on the charge nurse and whether she wanted to do the work. The other day I had two patients, an asthmatic I was transferring to the general floor and a fresh post-op with a lot going on (NGT that I had to measure drainage and replace with IV fluid, several fluid boluses, a foley that I was measuring every hour due to low urine output, pain control issues requiring frequent intervention, multiple IV medications/drips. All in all she was probably the most complicated patient on the unit.

In contrast, the charge nurse (who is notorious for hating being in charge and only wanting to do her work, not help out) had one patient who was stable and being discharged.

As I was completing the transfer paperwork for my patient and getting him ready to move to the floor the charge nurse (who had already discharged her patient) told me that I would be the one taking an admission from the ER. I asked her why I was taking the patient when she didn't have any patients (our unit does not have a free charge nurse). She replied in a snarky voice that it was "so that she could supervise me." Since I didn't have the authority to push it any further, I took the admission and ended up leaving an hour late because of it. Oh yes, and the charge nurse left early.

Usually, though, we are assigned admissions based on the acuity of our patients, not ratios. So a person with two stable patients would take an admission before the nurse with a critical one. It just depends on who is in charge.

[Good Morning, Gil]

Just sounds like you don't have good teamwork on your floor, and that's something you can't really fix. You can't make other nurses be team-oriented if they're not, so the solution is to transfer to ICU.

You're not going to be able to make any changes on your floor staffing wise lol. You can try and speak your mind, see how that goes (and I actually mean that sincerely since if your mgmt is half decent, they will listen to you), but if nothing gets done, put in for a transfer to ICU. :). I work in ICU, and our teamwork is great. Like I said, can't make that guarantee for you in your ICU, but it's likely to be good b/c we have no choice but to help each other. No CNA's, total care, so for the ones that don't actually care about you and just think selfishly, they help you so that you help them. Works out wonderfully. (but I don't have this issue. Nurses are great on my floor, just saying that it's a foolproof thing in ICUs with no CNAs, non-team-oriented people are forced to be that way lol).

Best of luck to you!

[onetiredmomma]

You shouldn't have to ask for help, your coworkers should realize you need it BUT you also need to stand up for yourself: " I know I have fewer pts and will be glad to take an admit if I can get some help getting caught up. Can you please....." and tell your charge/ coworkers what will help you. Sometimes its hard to tell if someone needs help, but I have alson offered only to be told " oh I don't know what you could do I am so far behind." I can see another nurse giving up a pt and taking the admit but that seems to just add to the confusion, esp for the pts.

[Aurora77]

One of the other nurses or the charge could have gotten the patient settled in. That's how we handle it on my floor. I've done initial unofficial assessments and taken care of a pt until the actual nurse could get to them and I've had that done for me. Ideally there should be a lot of good teamwork. You can still be slammed, but the other nurses need to help you bear the load; that way nobody has too many patients and all the work still gets done.

I've found the best way to get others to help me is to offer to help them first. Now that my coworkers know that I'll do whatever they need within the limits of what they're comfortable with, I don't have to ask for a lot of help. It's just offered.

[NoviceRN10]

On my unit you would have gotten the first admit, no matter how behind you were. Numbers have to be even, that's just how it is done. Rarely is teamwork implemented, unless a patient is really in distress, and then another nurse may help you get things under control with that patient, but they wouldn't be doing any admits or anything like that for you.

[Meriwhen, ASN, BSN, MSN, RN]

Unless staffing laws/ratios mandate otherwise (meaning that they can't give another nurse that patient w/o violating those regs), I think it would be better to give the patient to another nurse with less acute patients who was more caught up on her work and could take the patient--or could at least start the admission. After all, it wouldn't be forever, just for the remainder of the shift--the original nurse could assume ownership of the assignment next shift. Or the charge nurse should have done it.

At least that's how I would have done it (and actually have done it) if I was charge. Granted, more often than not it was me doing the admit :)