Nurses pulling rank on assignments

[remotefuse]

So Ive been working in the ICU for about 4 months now, and am still getting used to the this new environment and how the nurses work together.

Well there was a very sick patient that had been deteriorating for several days now. Very complicated pt that was assigned to someone with a lot of experience in ICU, but only in this unit for about 2 years.

Well I overheard this nurse asking the charge if she was going to have the same assignment for the next day, and the charge replied, "you should as long as someone doesn't pull rank."

I thought that was sooo weird. This nurse had been doing a good job at taking care of the patient for 2 days. Why wouldn't she get the same pt back?

Is this someone you guys come across at all? I would be pissed if I was taking care of the same assignment for 2 days, and had to switch for my 3rd.

[Horseshoe, BSN, RN]

When I floated to various other ICUs (regular staff RN cardiac ICU, not float pool), they always gave me the easiest assignments. They were just so glad I was there, they wanted to show their appreciation.

[Swellz]

Making the assignment really is an art, as llg said; sometimes difficult decisions have to be made and assignments have to be changed. But "pulling rank" is just not a valid reason in my book. I would hope the charge nurse would be able to and choose to stand up to someone trying to pull rank.

[llg, PhD, RN]

None of those are legitimate reason except perhaps the orientee. I am an experienced ICU nurse.

That doesn't make you right. I am an experienced NICU charge nurse. So we are equal on that score.

My point was that it is wrong to automatically assume bad things about the charge nurse who decides not to give the nurse the same patient she had the previous night without knowing her reasoning as to why she might make that decision.

[Wuzzie]

My point was that it is wrong to automatically assume bad things about the charge nurse who decides not to give the nurse the same patient she had the previous night without knowing her reasoning as to why she might make that decision.

Who did that?

[llg, PhD, RN]

Who did that?

Some of the early responders to the OP.

I entered the thread because I disagreed with the people who were automatically thinking that the OP and her friend were working in a bad unit, with a bad culture. I was trying to stick up for the Charge Nurses, who often have to choose between competing rationale for who gets a particular assignment and who doesn't.

[Wuzzie]

Some of the early responders to the OP.

I entered the thread because I disagreed with the people who were automatically thinking that the OP and her friend were working in a bad unit, with a bad culture. I was trying to stick up for the Charge Nurses, who often have to choose between competing rationale for who gets a particular assignment and who doesn't.

Got it. I guess I interpreted it differently. Having worked in a unit where huge egos were in play it wasn't unusual for a senior/popular nurse to "pull rank" and take an interesting/sick patient from someone who had been caring for them (sometimes even their primaries) just because they weren't happy if they weren't always assigned the sickest kid in the unit. It was often easier for the charge nurse to capitulate to their demands rather than deal with the fallout or they were best buds. I found these nurses to be insufferable. They literally thought they were The Best Nurse In The Whole Entire World and let everybody know it. Plus they had no interest in helping less experienced nurses grow, for obvious reasons. So when I hear "pull rank" I don't interpret that as a charge nurse making good decisions for the unit (I've had to make some unpopular re-assignments in my time) but somebody having a hissy fit because they don't like their assignment. If that's the case then it is the culture of the unit but not necessarily the fault of the charge nurse who probably just wants to get his/her shift over with the least amount of drama. FTR: it never happened to me so my observations aren't based in bitterness they're just what I have experienced. YMMV.

[BSN16]

Is this someone you guys come across at all? I would be pissed if I was taking care of the same assignment for 2 days, and had to switch for my 3rd

Also sometimes nurses will have the same patient for 2 days and not get them back on the 3rd for a multitude of reasons.

Our biggest issue is rooms. We try make assignments that are in close proximity to each other. so if a admit comes in over night, it might make more sense to have a certain nurse take different patients. Another factor is some patients have stuff going on the requires a specific nurse who has been trained to take that patient.

Ex. If nurse A had patient A last night, but comes back later that night on CRRT, and nurse A doesnt know how to run CRRT they will obviously be switched.

[llg, PhD, RN]

Got it. I guess I interpreted it differently. Having worked in a unit where huge egos were in play it wasn't unusual for a senior/popular nurse to "pull rank" and take an interesting/sick patient from someone who had been caring for them (sometimes even their primaries) just because they weren't happy if they weren't always assigned the sickest kid in the unit. It was often easier for the charge nurse to capitulate to their demands rather than deal with the fallout or they were best buds.

I agree with you about that. There should be a good reasons behind the assignments -- not just caving in to prima donna behavior. Sometimes, there are good reasons -- and sometimes, there are not.

[kaylee.]

Yes this is true that many situations can arise that would warrant an appropriate change in assignment.

In response to some PPs suggesting that the situation in question is not apparent...

There is not ambiguity regarding the context of the OP. The CN used the expression "pulling rank". In context of the workplace this has a specific meaning: using one's "rank" as a means to get a desired goal. This implies that the favor is given based on rank alone, independent from other reasons.

The fact that the CN said this seems catty, and it is suggestive of a negative work environment.

[foggnm]

Some people like getting their assignments back and some people like mixing it up. Generally seniority is not used as a decision point for assignment making, but experience might be if a patient had declined and the nurse previously taking care of them wasn't quite experienced for the new/worse condition. When I worked in a trauma ICU I had a patient that was very sick and declined and the next day one of the more experienced nurses took my assignment. I think there were considering putting a Swan in the patient which I didn't have experience with, but I can't remember the details exactly. I was a little offended, but in retrospect it was probably a good decision by the management even though it took away my learning opportunity. Honestly there are all kinds of little petty things that happy working in the hospital. You have to learn to just let it go and take care of yourself. The complaining that goes on around patient assignments is one of many nursing nits. I could probably add that to the list of 'reasons I no longer work in the hospital.'

[Wuzzie]

Some people like getting their assignments back and some people like mixing it up. Generally seniority is not used as a decision point for assignment making, but experience might be if a patient had declined and the nurse previously taking care of them wasn't quite experienced for the new/worse condition. When I worked in a trauma ICU I had a patient that was very sick and declined and the next day one of the more experienced nurses took my assignment. I think there were considering putting a Swan in the patient which I didn't have experience with, but I can't remember the details exactly. I was a little offended, but in retrospect it was probably a good decision by the management even though it took away my learning opportunity. Honestly there are all kinds of little petty things that happy working in the hospital. You have to learn to just let it go and take care of yourself. The complaining that goes on around patient assignments is one of many nursing nits. I could probably add that to the list of 'reasons I no longer work in the hospital.'

I think that should read that "seniority shouldn't be used as a decision point". The second bolded part highlights a bigger problem. You should have been allowed to have that experience. Your clinical educator, CNS, resource nurse, charge nurse or somebody should have buddied with you for the Swan insertion and monitoring so you, too, would be educated and able to take other patients who had them. That was a major lost opportunity to advance your clinical expertise and if it had been me I probably would be a little bitter about it. This is how prima donnas (thank you LLG for reminding me of the term) are made and it isn't good for the unit OR the patients.

[Julius Seizure]

That was a major lost opportunity to advance your clinical expertise and if it had been me I probably would be a little bitter about it.

After all, when the unit experts retire or move on to other jobs.....who will take care of those complex patients then? Hopefully, if you aren't allowed to keep your patient when they become complicated, you are at least being offered other opportunities to learn or at some point there's gonna be a problem. I've seen that happen on floors with a lot of new grads and a dwindling number of experienced nurses, especially on night shifts. Swan-Ganz lines have to be monitored and CRRT's gotta be run at night, too.