Nurses How Do You Deal With Biased Patient Assignments?

[All4NursingRN]

So I currently work in a non-walk in/appt only outpatient clinic with a staff of 7, 3 RN's 2 NA's, and 2 Clerks, with a census of about no more than 30 patients a day, 10-15 on average-most days.

I've been there for about 1 year and I am the newest RN there. I notice that I consistently receive the heaviest patient visits (those requiring EKG's, technical or special phlebotomy techniques, and assisting with procedures)

One of the RN's (who creates the patient assignment for each day) consistently takes lighter patient loads that never require any of the above, and in the beginning of my employment I noticed that she also very rarely assigned the other RN to heavier patient visits.

I never noticed in the beginning but eventually I started to question why I was the only RN up and down in the clinic, working the floor with the 2 NA's with patient after patient, assisting the medical staff while the other two RN's were frequently sitting down on the computer checking their email, surfing the web only periodically getting up to do vital signs on a patient or a simple in and out (under 5 min) medical procedure. Meanwhile I'm setting up for biopsies, assisting with biopsies, doing post biopsy care, drawing blood, and etc...

The nurse who creates the assignment is the charge nurse, who by the way never wanted the position, said she doesn't have the personality for it, and comes close to tears everytimes she ''percieves'' things are not going her way with management, has threatened to leave and has admitted to me that she wanted to leave many times but needs a job to pay the bills so she stays.

She said that when she was offered the charge nurse position (before I was hired) to oversee 2 NA's and 1 other RN at the time they told her that she was not to assign any patients to herself and that as charge RN she should be an ''overseer''.

The problem is nursing management (1 manager and 1 DNS) who are both extremely lax, ignore medical staff (MD's NP's) and nursing staff concerns and etc.. have never spent any time on the unit to observe what actually goes on and who does what or who doesn't do what etc.. etc.. they also never look at the daily patient assignment and don't realize how little there is to do on the unit at times with the average of 10-15 all medically stable patients a day. There is little oversight thus they don't realize that there is very little for a ''charge nurse'' to do. Even the charge nurse herself admits there is no need for a charge RN when we already have a manager on at the same time and our nursing staff is only 5 people.

I have politely mentioned to her that I do not think it's fair for a charge nurse in this facility to have a 0 patient load and sit there on the computer all day, texting, etc.. and she agreed so she said that she would never sit there all day doing nothing and said in her defense that she has always taken a few patients each day.

My issue is that she always, not sometimes, but always takes the easiest patient loads, those patients only needing vitals signs and needed to be placed in an exam room for the NP or MD or quick in and out treatments, while I run up on and down doing EKG's, assisting with bigger procedures, and more technical visits lasting up to 2-3 hours.

I think she uses what our manager (who btw has never spent a day on our unit to see what goes on word that she as charge RN shouldn't take patients to get out of doing tasks she doesn't like. She has admitted that she is not good at phlebotomy so she doesn't want to do it if she doesn't have to and doesn't like doing EKG's and assisting with procedures.

Since when is it ok to say that if you don't like doing something you can assign it to someone else EVERYTIME?

The first 3-4 months of my employment there she never drew anyone's blood, never assisted with any procedures at all, she assigned me to do all the RN tasks and assigned away all the rest to the na's, and I watched her day after day sit at the desk on the computer???? But being new I wanted to make a good impression and not complain.

Recently she found out how upset I was about the assigments. She then told me that because I was better than her and the other RN at drawing blood it is only fair for her to assign me to the blood draw visits because she is not comfortable drawing blood, and that I am better at doing EKG's and that certain NP's, MD's like working with me more, but that she can still help me whenever I get too busy??? So that means that because I work well I should do the heaviest tasks? While she sits there on her phone, on the computer, getting up every now and again to do a light task?

What would you do about this?

[ukjenn231]

My opinoin: this happens almost everywhere. "Lazy" people in charge, someone gets the worst assignment every day. I do float pool so I'm used to the heaviest assignment. I think that if you are able to get your work done, then just take the opportunities to improve your skills and I am sure the patients will appreciate your attention and care. If you actually can't get the work done, then maybe you should try to delegate more or ask for help from other nurses who aren't busy. If you're drowning, be specific about what you need: "Hey (charge nurse): I'm busy doing xyz, can you please get an EKG on this patient?" (BTW, how is anyone better than others than doing an EKG? Either you know where to place the leads and tell the patient to sit still, or not).

Good luck, it sounds like a crap situation but know that you are polishing your skills, making a difference for patients, and developing the most awesome time management skills and all that will help you for the rest of your career :)

[nurseprnRN, BSN, RN]

Behavior modification. This is going to take a few months, but you can do it and you'll be really happy with the end result.

See, you have already conditioned them to gradually shift all the skilled work over to you. At first it was because you were new, and now it's because you're better than anyone else. Ever hear the expression, if you want something done, ask a busy person? That's because we know how to make it happen. Now your job is to look at this situation with fresh eyes and see a terrific opportunity to condition them to reassume some responsibility, improve their skills, and make the whole clinic better. Pipe dream? Too big a goal? Read on.

Ukjenn has a good suggestion-- when you are getting swamped, ask one of your colleagues to do one specific, time-limited task-- one EKG, one set up, one assist-- because you are in the middle of doing (whatever). Thank her for her help, smile, and get her a coffee or something that doesn't take too much out of you. If it's the charge nurse who doesn't like what she does and is starting to feel her skills eroded, so much the better. You will be gradually getting her to the point where she will expect you to ask for help and someday she will ask you first what you need help with! Lather, rinse, repeat, once a day for four weeks. At the end of each week, bring in a box of doughnuts or something nice, with the throwaway line that you appreciate the help and what a great job Joan did with that old lady on her EKG or whatever.

Then, you start asking your charge nurse if you two can sit down for five minutes and look at the day's schedule and identify where the bottlenecks are going to be so you can plan where you'll be likely to need some backup. You're teaching her how to be a charge nurse!

Next you start the same plan with one of the other nurses-- once a day, ask for specific, time-limited assistance. Thank, treat, positive reinforce. Couple of weeks there.

Maybe by now you're starting to break up some old habits. Keep at it. One day in staff meeting when everyone is there, ask if it might be useful to have special preferences recognized. "Like, I'm pretty good at phlebotomy now. How about I do your draws if you do my EKGs?" or "Dr. Jones and his group can be a challenge sometimes, but I'll do all their biopsies, and you guys can cover the clinic while I keep them out of your hair." Or whatever works.

What's gonna happen here is that in a year you will have some great leadership skills, the staff will be offa their duffs more, your charge nurse will have acquired some skills back, and when she has finally had enough, they'll ask you to be the charge nurse. And the place will run more smoothly. And the management and the docs will love you. It's a process and it will take some time to gradually condition them all without their knowing it, but you can do this.

[Anna Flaxis, BSN, RN]

I would take her at her word and ask her for help when I get too busy.

[thenursemandy]

I think greentea gave some good advice.

Is it fair that your manager is on the computer half the day? No

Is it fair you get the heavier load? Maybe Not

But, you are NOT the manager. She is. You should keep the peace and fulfill your duties. If you don't like how she operates apply to be manager, do what GREENTEA suggests or move on.

[BlueDevil,DNP, DNP, RN]

I had a job like this once. There were two of us doing this sort of thing, along with some infusions, but no one liked the other nurse. She was unpleasant, abrupt, missed a lot of sticks and people began asking for/waiting for me. So I would be super busy, with as many as 30 patients in a day, while she would take care of 8-10. We were paid the same thing, and I did 3x as much work.

The only satisfaction was going home at the end of the day knowing I'd done my job well, that people I'd worked with respected my effort and appreciated the value I'd added to their day. Sometimes that just has to be enough, because the world, after all, is not a just place.

You can try greentea's advice (it is excellent). It will either work or it won't, and you can either learn to live with the situation or not.

[kcochrane]

As a charge nurse I'm going to come from that perspective. I always took a lighter load with easier patients. Why? Because most times I had other things I had to do in addition to the patients I had. Most times I couldn't see my patients quickley, so I needed ones that were stable. I'm sure things differ with regards to an acute setting versus a walk in clinic. But she is the one that will utimately be responsible for things running smoothly. If you as the charge nurse are taking care of patients that take up all your time, things will get out of control. As someone else mentioned...take her up on her offer to help out. That is another reason my load was lighter. But for the others to also get a lighter assignment, doesn't seem fair. And yes it does sound like she isn't really charge material. I agree with the above poster, to know you did the best job possible should give you some satisfaction. But in the long run you need to decide if you can live with this. In a lot of cases it doesn't get fixed. Good luck!

[jadelpn, LPN, EMT-B]

I agree, it does seem unfair that the charge nurse doesn't take patients, but that is the norm most everywhere. However, if the poop hits the fan, and she still sits and watches, that is when I would have a complaint about it to the manager about patient safety.It is a really good thing, I think. that you are getting so much clinical experience. This will also be a really good experience for any future endevours you may have. That you are getting hands on is much better than not getting any, and not being able to do these things. When you have difficult sticks, complex patients, and procedures, get really really good at it. Make yourself indipensible. You will be respected for your clinical competencies, your ability to prioritize with multiple patients, your ability to set up a biposy situation, your grace under pressure. This will benefit you in the long run. Believe me when I tell you that when a practioner asks for your assistance because "you are the only one who can do it correctly" they remember these things. They support you, speak well of you--and you never know what doors will open because of it.Look at it this way--you are given this assignment because you can handle it. Because of your clincial skill. Because of your abilities. And that is worth its weight in gold!!