Who decides which patient you'll be assign to?

[RoadRunner]

I just had a "discussion" with the dayshift staff nurse about the patient-nurse assignation. I wonder what you think of it...

I work nightshifts in a 24 beds ICU. Our ratio is 1:1 or 1:2 for medical, cardiosurgery and trauma patients and 1:3 for cardiology patients. All those patients are on the same floor, in the five rooms of the ICU. So, the staff nurse decides which room I'll be in and the choice of which patient(s) I'll take care of is mine within this room. If I was there yesterday and my patient is still there too, he'll be my patient. The remaining patients are assigned by a draw among the rest of the nurses, onless one wants a particular patient or don't fell able to take charge of one (ex: new nurse with very unstable trauma...)

Now, this staff nurse was horrified by this "drawing" thing stating that it was very unprofessionnal and unrespectful for the patients.

But we never did this in an unrespectful way (we don't draw patients in front of them!)

Our staff is very young (3 years or less of experience as nurses) or "old" (10 +). This way of assigning permits that very heavy patients are not always taken care of by "old" nurses, that confused or unpleasant ones are not always taken care of by nurses who just can't say no, and that every nurse can take care of the wide diversity of patients the unit has, not just the ones who "interests" her/him the most. It's like an unwritten rule but it has been working well ... and I personnally don't see it as a bad thing.

What do you think?

[renerian, BSN, RN]

OUr charge used to do it and it went by the acuity not the location which was kind of a pain if people were at one end of the hall and the other end.

renerian

[whipping girl in 07, RN]

More than once I've been pulled to the floor and gotten an assignment down three halls (and there are only three halls!). Seems to me you have to take acuity and geography into account, so you're not run ragged. Also, sometimes the neediest patients aren't the sickest or have the most procedures.

[SmilingBluEyes]

More often than not, we decide collaboratively. OB works a bit differently than med-surg that way I guess. It depends on census and what we are the mood to deal with. Often, If I am willing to take care of labor, I don't have to do postpartum or GYN surgical care. Vice versa...if doing couplet care or GYN, I am not doing labor. WE usually voice our preferences and very rarely have problems with this. Of course, changes in census (namely, new admits) change things and usually the nurse with the lightest load takes the first admit. I like working this way.