Nurses pulling rank on assignments

calivianya, BSN, RN · Feb 1, 2017

Really? You triple the travelers and floats first - the ones who bail you out of staffing clusters? What a s show of a unit.

I agree! That's why I try not to... but the person who oriented me to charge said, "Always triple them first!" And most charges will automatically triple them first. I think that's a good way to get people to quit contracts and stop coming to our floor, so I try to treat them as well as I can.

How does this answer the OP's question?

It doesn't directly, but it does point out that pulling rank is only one of many factors to take in, so even if someone gets bumped, it may not be due to pulling rank.

Ruby Vee, BSN · Feb 2, 2017

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.

If someone is precepting, they may need that assignment. For instance, one of the things we have to check off on our orientee's skills list is LVAD. If the patient has an LVAD and my orientee needs that experience, we would get dibs (or "pull rank") on that assignment. An orientee that is at the end of her orientation may just lack one or two experiences to complete their skill's list, so the orientee that is closest to the end of the orientation without checking off that particular skill, device or experience is the one who will get the assignment, regardless of who had the patient yesterday.

Sour Lemon · Feb 2, 2017

I agree! That's why I try not to... but the person who oriented me to charge said, "Always triple them first!" And most charges will automatically triple them first. I think that's a good way to get people to quit contracts and stop coming to our floor, so I try to treat them as well as I can.

I'm not in ICU, but we commonly give unfamiliar floats and travelers a slightly heavier assignment. It's not to be mean or unappreciative, it's because the regular employees need to be more available to help. People who are new to the unit are logically less familiar with it and less able to help with all the "extras" that come up in a shift ....or even routine things. Once they're fully oriented and able to contribute as much as regular staff, things should be more even.

Julius Seizure · Feb 2, 2017

I'm not in ICU, but we commonly give unfamiliar floats and travelers a slightly heavier assignment. It's not to be mean or unappreciative, it's because the regular employees need to be more available to help. People who are new to the unit are logically less familiar with it and less able to help with all the "extras" that come up in a shift ....or even routine things. Once they're fully oriented and able to contribute as much as regular staff, things should be more even.

I can at least see that reasoning a bit. But when the charge comes up to you and cockily says "I'm tripling your assignment. That's why you make the big bucks." Well, that's harder to find reasonable.

JustaGypsy · Feb 2, 2017

Really? You triple the travelers and floats first - the ones who bail you out of staffing clusters? What a s show of a unit.

If they already have the easier assignments, and the incoming

g patient is on the easy side, makes sense to me.

Wuzzie · Feb 2, 2017

I can at least see that reasoning a bit. But when the charge comes up to you and cockily says "I'm tripling your assignment. That's why you make the big bucks." Well, that's harder to find reasonable.

It's all in how you say it isn't it? That's why I interpret nurses "pulling rank" as far removed from a charge nurse making unpopular assignment changes for the good of the unit.

remotefuse · Feb 3, 2017

ICU's are staffed with "strong personalities". The ability to pull rank says a lot about the culture of the unit.
The patient would benefit most, from continuity of care. I would never let another nurse take over my assignment.
Sounds like you need to get ready for that scenario.

That's the feeling I had as well.

remotefuse · Feb 3, 2017

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.

This is a good argument. However this pt was a 1:1 on CRRT so the nurse assigned stayed at the bedside the majority of the time.

Rocknurse, MSN, APRN, NP · Feb 3, 2017

That's poor management if that's allowed to happen. We would have the choice of getting the patient back unless we specifically requested not to. Sometimes you need a break from certain patients. Other times, as they became more stable, nurses with more experience might be asked to take a sicker patient because their skills were needed, or perhaps because a less experienced nurse actually needed the experience of a sick patient. Regardless of the reason it should be based around communication and certainly not because of "rank". Sometimes assignment making is a mystery but usually there are good reasons for changing assignments. Rank is not one of them.

whatdayisit11to7Nrse · Feb 3, 2017

Pulling rank seems highly immature, and not in the best interest of the patients. Haven't worked too long in this field but in my young nurse life i have yet to see this happen.

firemedic12, BSN, RN, EMT-P · Feb 4, 2017

Pull rank? What rank? Show me an official seniority list and we'll talk about rank. Until then they should shut up and do their job. We have an issue with the same thing and I let the perpetrators know it's not going to fly with me.

Creamsoda, ASN, RN · Feb 4, 2017

Really? You triple the travelers and floats first - the ones who bail you out of staffing clusters? What a s show of a unit.

Ha no kidding! "unspoken rule" or not. What crap way to treat people who are helping your staffing issues. In my unit, theres a tripple rotation book. So when your trippled you put your name down so it doesn't happen to you every shift. Doesnt matter if you are from the lowly float pool or traveler. Never mind an experienced ICU nurse with >10 years behind her and working in the same float pool for the last 7 years. Do these people not understand that when you are floating...a lot of the time EVERY unit decides to pull this unwritten rule garbage. So every day when you float to a unit you get the horrible assignment. I think my hospital is pretty good about not doing this and seeing our floats for what they are. Great nurses who are there to help your unit in a bind. So why abuse them?

To answer OP's question..."pulling rank", I dont think that's a thing for the most part, ive never seen it. We staff to how our nurses skills will best suit our particular patient and units needs at the time.