making assignments

[Lisbeth]

I work as a charge nurse on a med-surg floor and we are currently having discussions regarding patient assignments. We usually have the charge nurse on the previous shift make our assignments so we can all start work when our shift begins. Our floor is divided into four corners and usually the assignment consists of each nurse having a corner. If there are too many empty beds or admissions/postops in one corner, it will be split up. As charge nurse, I also have patients with an LVN, but I try to resource the other nurses and encourage team work. The dilemma is: do we assign the corner and have the nurse take the admissions that come with it, no matter what time they come, and the rest of the staff help out as needed; or do we assign only the patients currently in the beds, then assign admissions as they come in? Does anybody have any suggestions or experience with this? We have been doing it the corner way for years, and some new nurses are wanting changes, so I thought I'd look into it.

[Daytonite, BSN, RN]

If your assignments are always split into the four corners of the unit, why have the off-going charge nurse make the assignments? Just get her input as to any patients who are particularly "heavy duty" nursing care then let the oncoming shift work out little details and maybe swap a patient between them here or there. My experience over many years has been that if you don't give everyone the same number of patients with about the same nursing care needs, feelings get hurt and resentment builds, even though most of the staff realize that some patients require more care than others. I'm guessing that this is probably what's happening on your unit. As a former manager I don't like the idea of splitting up patient assignments so nurses have to be running all over the unit because their patients are spread to the four winds. First of all, it's not efficient. Secondly, the nurses end up being tired by the end of their shift from all the walking they have to do. I like keeping nurses assigned to patients in a tight geographic area. By geographically spreading out the patients, the nurses have to depend on the rest of the staff to answer lights and keep an eye on their patients when they are tied up in a room way over on the other side of the unit. The staff develop bigger resentments over this than when they think they have more higher acuity patients than everyone else. Problems will also develop because some people will not answer the lights of their colleagues and disagreements and resentments ensue. Pretty soon you have a bunch of nurses who are having difficulty getting along. Also, as a staff nurse I want to know what is going on with my patients even when another nurse has to answer one of their lights. I'm more likely to be aware of what's going on if my patients are in a tight geographical area.

The way we handled admissions was that we determined the order of admissions. The person with the lowest acuity of patients got the first admission, the second lowest acuity got the second admission and so on. The smarter nurses begin to realize that the smart thing to do is volunteer to take the first admission of a shift, especially if the admission arrives early in the shift. Then, you're off the hook for another admission during the remainder of the shift unless, in your case, you get hit with more than 4 admissions!

[achot chavi]

You are assigning your nurses according to location without regard to case-load, I always prefer giving assignments fairly so that each nurses workload is somewhat fair and they work together as needed. New assignements are handed out in such a manner as well and it works out for us . But each situation is unique and I would say try the new way temporarily and then evaluate the effectiveness. Sometimes change can bring out increases productivity and sometimes...havoc

[Thunderwolf, MSN, RN]

On our med surg floor, current patients and scheduled surgeries to arrive are part of that team's assignment....same for the other teams. ER admits are rotated if possible, but if a team has 3 discharges and 2 ERs come in...that team gets them (that team's census is down). Lastly, as a charge nurse, I make out tomorrow's staff assignment the day before. When I come in the next day, the assignment only needs tweeked a little. Works out fairly well.

[nursemaa]

There's no perfect way to make out assignments- if you group assignments geographically, someone may end up with more high-acuity patients than someone else. If you go by acuity, someone may end up running all over the unit. It's tough to plan for surprise admissions, because you can't be sure who's going to be discharged (although you can often guess). So it's hard to make sure everyone's assignment is "equal".

On our unit, the previous shift groups patients together, then the oncoming charge nurse assigns a group to each nurse. He or she may "tweak" the assignments if needed.

[Thunderwolf, MSN, RN]

Agreed. You can plan and organize it but need to be flexible as well. One day, one team's acuity may be higher than the other team's. Tomorrow, it could be reverse in acuity. It evens out. But, we all help as needed.

[Thunderwolf, MSN, RN]

I will say that I don't agree in the idea of splitting up teams just because its her or his turn to take the admit. Keeping teams together as much as possible improves the continuity of patient care and patient monitoring.

[nursemaa]

I will say that I don't agree in the idea of splitting up teams just because its her or his turn to take the admit. Keeping teams together as much as possible improves the continuity of patient care and patient monitoring.

Agreed. It's hard to appropriately monitor your patients if they're too spread out.

[Hopalong]

On our M/S unit I have rec'd a whole set of pts each day to provide for "continuity of care" for the noc shift. Usually I don't say much but sometimes we just rearrange it.

[Lisbeth]

Thanks for the great responses. We don't use "teams", I'm not even sure how they work. We try to take acuity into account, and we can do that at the start of the shift based on patients already on the floor. Unfortunately, we get so many admissions on our shift, each nurse can get up to 2-3 admissions each day. Some are post-op, some are from the ER, and some are admitted from the clinic, home, or other hospitals. We don't know how challenging these patients are until we admit them, and then it's difficult to change assignments. I would like to think that it balances out over time, so that one nurse isn't constantly getting heavy assignments.

[Thunderwolf, MSN, RN]

My team consists of 8 beds. I and the LPN had 2 discharges, 2 ERs, 3 fresh post ops, 2 pod#1, and 1 pod#2. This is not counting all the blood I hung today...or all the meds passed and treatments given. Average day on a med surg floor. But, with a strong RN and LPN team, it can run well. Just to give you my typical day.

[grinnurse, RN]

The way that it works on our unit is that we split the "halls". Generally, each nurse takes a certain end of the hall regardless of the acuity of patients. That same nurse generally works that same area all the time. The nurse with the lowest # of patients gets the first admit, and then it works its way down the line. I always volunteer for the first admit unless I have mostly total care patients, then I won't take ANY admissions. I usually start out with at least 6 and if I have heavy patients, I refuse to take more.