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?

[melanie1126]

Thanks for the replies. I've gotten several good ideas that I'm going to bring up to the nurse manager. I didn't want to make it seem like I was the only one on the floor working b/c that certainly wasn't the case. All of the other nurses were busy, they were just finishing up their meds and sat down to chart and get chart checks done quickly b/c we had 7 empty rooms and we ended up filling all of those by the end of the night. It's just that I was the one who was slammed. It's a difficult floor, there are very few "easy" nights so usually we are all feeling like we are just keeping our heads above water. The team work on my floor is so/so. There are some who are really good about pitching in and others who only want to do their own thing. Our charge nurse on nights takes a full load, on day shift they don't take patients but sadly on night, yep, full load. I wish that acuity went into making the decision about assignments, and often it will as far as the order patients are assigned if everyone has the same #, but if you are down one, your getting the new admission no matter what other variables are in play.

[beeker]

On my floor it seems to depend on who you are working with. There is a good group of people that pitch in and help each other when someone falls behind or gets sicker, but some nights it is the every man for himself crew. So on my floor you would have gotten the admit due to numbers, but if there was a good crew you'd have had a lot of help. I remember who helps me and who doesnt so I can repay the favor.

[beckster_01, BSN, RN]

Your unit sounds EXACTLY the same as mine as far as acuity goes. The difference is that when a patient is having issues like that, the charge nurse is expected to be elbow deep in their care, helping you carry out new orders, making sure your other patients are okay, etc. This way you hopefully don't get too far behind overall. If it was me, I probably would get the next admit, and I would probably be busier than the rest of the nurses, but no one would let me get so far behind that the quality of care suffers.

As far as teamwork goes, make sure that on your good days you make a point to help other nurses, even if it is a simple med pass, or helping organize their tele strips. I can almost guarantee that even if teamwork isn't in your unit culture, next time you are swamped one of your co-workers might remember that time you went out of your way to help them and it could generate some good things for you. :)

[SHGR, MSN, RN, CNS]

Sometimes we had a nurse that would float to different units and just do admissions. The orders, the admit paperwork, etc. because that really is a one-on-one until the person is settled in. Then when the patient was good to go, they would be considered part of the regular floor assignment. It was only on the PM shift and a total win-win for everyone.

[wooh, BSN, RN]

My unit/shift, you'd get the patient, but you'd have all of us helping you with it. Patients come to the floor, we've generally got 3-5 nurses in the room. Someone doing vitals, someone getting supplies, someone doing the admit paperwork, someone checking orders...

But we work together REALLY well. I used to feel guilty when I'd get the help, but we all do it for everyone. That's just how we are. :)

In your position, I'd ask for help. "Can someone get me this? Can someone call whomever to let them know the patient is here?"

[Creamsoda, ASN, RN]

I think thats how its usually done, but I think as a courtesy to you, you should be allowed to catch up, then take the admit. and ask your coworkers for help, like passing routine meds if they're not busy.

[dreamingofbeing]

I stayed on a floor exactly like you are working in for 2 years before I just couldn't do it anymore. I cried on my way to work, at work, and on my way home from work. The last straw came when I had 8 patients one day and within the first hour of my shift all at the same time one patient had a bloodsugar of 20, another had a BP of 68/32 and was symptomatic, one pulled their PICC line out and was bleeding everywhere, and one was coding. Yeah no one offered to help and my charge kept calling my Ascom phone telling me about the abnormal rhythms on the monitors and that so and so had their call light on and needed something. I knew at that point my sanity was worth more than anything and began aggressively searching for another job. I was out of there less than a month later within the same system but at a different hospital doing a job I have found that I love in Interventional Radiology.

[Maggie09]

I stayed on a floor exactly like you are working in for 2 years before I just couldn't do it anymore. I cried on my way to work, at work, and on my way home from work. The last straw came when I had 8 patients one day and within the first hour of my shift all at the same time one patient had a bloodsugar of 20, another had a BP of 68/32 and was symptomatic, one pulled their PICC line out and was bleeding everywhere, and one was coding. Yeah no one offered to help and my charge kept calling my Ascom phone telling me about the abnormal rhythms on the monitors and that so and so had their call light on and needed something.

And that, ladies and gentleman, is why so many nurses are dealing with depression, anger, regret, sadness, and absolutely hating their jobs.

I can say without a doubt tele is one of the absolute toughest places to work. I started there for my first few years of nursing, and towards the end I hated every minute of it. Many times the patients were ICU material, but the ICU was full. Thus, you ended up with multiple patients who have the potential for going down the drain. But, by golly, you'd BETTER make sure they all were bathed (even the walky talkies), fluffed and puffed. and heaven forbid the CNAs get off of their cell phones and quit rolling their eyes long enough to pitch in.

It blows my mind that day shift charge nurses never (and I mean EVER) took an assignment, but the night shift nurses had a full load. It makes no sense. The charge nurses on days didn't do jack, but they were more than happy to tell the staff nurses how poorly they did their work.

Ok, so that's my rant. This topic just hits a nerve with me. M/S and tele patients are so much sicker than people realize. Even sometimes the ICU and ER didn't understand how high the acuity could be in those departments. And the lack of support from management and charge nurses...Lord have mercy.

I'm sure these experiences aren't the case on every tele floor...and I know there are some good, decent, hardworking charge nurses out there.

My experience in tele made me want to get the you-know-what out of Dodge. Hence why I moved to the ED. Much better teamwork, more exciting, and in a lot of ways...less stressful. Don't stay somewhere that makes you completely miserable unless you absolutely HAVE to for other reasons. It's not worth the stress, tears, and frustration!

[imintrouble, BSN, RN]

The person with the least pts gets the new admit. It would have been nice if one of your fellow nurses would have volunteered to take the pt, when they could see how your shift was going. We are good to each other that way.

On the other hand, where I work, no nurse ever does an admit entirely by themselves.

[beckster_01, BSN, RN]

Quick question for those who claim lack of support from charge nurses etc., do you have specific nurses that ONLY do charge, or do you rotate through the job?

On my unit, every nurse who has been there for more than a year is oriented to charge nurse, and we are rotated through the role. There are some who are charge more than others, either because they function well in that role or they don't mind it. There are some who HATE being charge, and are usually only it on night shift (yes, on MY unit the night charge serves solely as a resource nurse, and helps settle the new patients). I think this works because, new grads aside, every nurse understands what it is like to be a charge nurse, and what it is like to have an assignment. It promotes teamwork, and keeps animosity between charge and those with an assignment to a minimum.

What happened to dreamingofbeing would NEVER happen on my floor. We would have the charge, management, and I wouldn't be surprised if our floor's DON was on the unit to help out in that situation.

[dreamingofbeing]

When my situation happened I was on day shift and there was 2 people that did the charge nurse position. One charge nurse was awesome and would help out with whatever she could this happened to be the day the other charge nurse worked and she was one that didn't believe in leaving her desk. The night shift had different charges that were not only expected to play that role but also carry a full patient load which was anywhere from 9-10 patients. I'm not sure how it is there now as this was 3 years ago but I can't see much changing since they still have the same manager and a very high turnover rate. Most of the people I stayed friends with have moved on to different areas of the hospital and say they are much happier.

[hecallsmeDuchess]

On my unit, we utilize 'traffic light signals' and we are supposed to put a light up depending on what was going on with our patients. Green meant you were good and caught up, Red meant you needed help and quick. You don't have to run around asking for help, just put your sign up and help will materialize. We are assigned patients more by acuity than by numbers, sometimes the charge helps but it actually depends on who's charging. More days than not, charge nurses do not have an assignment so they walk around offering to help and helping...