making assignments

Specialties Med-Surg

Published

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.

we split up based on acuity. something we have tried and like is that we all take an extra patient or two and free up one nurse to do admission and discharges. that nurse usually keeps the admissions as they come and if there are none or like only one ot two she helps the rest of the staff by hanging blood, doing dressings, starting iv's (we don't have an iv nurse/team) it seems to work out pretty well.

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Specializes in ICU/ER/Med-Surg/Case Management/Manageme.

I have to agree totally to Daytonite's comments about assigning nurses patients in close proximity. I'd much, much, much prefer to have 5-6 patients with higher acuity but grouped close together than even 4-5 patients spread out hither and yon! Our unit has a floor plan obviously not developed by anyone involved in patient care. It's like a maze...you can get lost in there. (Wish I knew who it was so I could personally drag him/her in there for a 12-hour shift!!) Many days I've been assigned patients on all four "halls," and by the end of one of those days, I'm so exhausted I can hardly make it to the car. Worse, I never feel that I've given good care. The days that my patients are grouped, regardless of acuity, are generally much easier. Even if the shift is tough, I can at least have the satisfaction of knowing I delivered decent and safe care.

I also liked liljsmom02's idea of the admission/discharge nurse. In fact, I'm forwarding that info to my nurse manager...something we may be able to test on our unit.

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Specializes in Transplant, homecare, hospice.

This sounds like how some of the team leaders do it on our floor. We don't have have LPN's working with us to help, but we do have techs. Anyhoo, the big arguement on our floor is a team leader from the previous shift will assign patients by the room number and clump them together, not realizing that one nurse may have 3 or 4 high acuity patients. And the others don't. It's not far and it's overwhelming. I would prefer to have a mix of high and low acuity and have them spread out. I've had one too many nights that I've cared for more than one or two high acuity patients and never got a lunch or break, barely sat down, needed extra support to finish my work, and left crying after staying for an additional hour or so....(making my shift 13 to 14 hours....just to come back that night). Personally, I don't think it's fair to assign patients this way. What a quick way to burn someone out.

This is done so frequently on my floor and mixed with the politics, it has been pure heck. We have lost over 6 nurses since I've started on my floor last year. I think that's sad.

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Specializes in Transplant, homecare, hospice.
we split up based on acuity. something we have tried and like is that we all take an extra patient or two and free up one nurse to do admission and discharges. that nurse usually keeps the admissions as they come and if there are none or like only one ot two she helps the rest of the staff by hanging blood, doing dressings, starting iv's (we don't have an iv nurse/team) it seems to work out pretty well.

What kills me is that some team leaders on my floor are great about this...but then a couple are clueless...why is that? It's sooo frustrating. To battle it, I have to go to my own teamleader and cry for help if I'm drowning, and then tell the day time team leader to not give me the same combination on the next night. I usually work 3 days in a row....and 3 days of all high acuity patients kills me....I sleep my entire time off. It's crazy!:o

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I don't envy you having your assignments made by the previous charge nurse. If you have to live with the assigment and your staff, you should be making the decisions.

I like to assign my nurses geographically. You can't answer call lights and be there for the little things if your are off in another part of the unit. If too many high acuity patients are in one area, they might need to be moved to improve assignments. Also, as possible, they should be dispersed around the floor as they are admitted. I realize this can be difficult, but all things are possible.

Assigning admissions and postops is a problem on those days when you start with a low census and end up with double the patients you started with. Everyone has to realize that the charge nurse is trying to be fair and give the patient the best care possible. If you have a charge nurse who is not being fair with assignments, it needs to be brought up to the manager. If the manager can't see that part of her team in undermining unit morale, you might want to find another unit.:)

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