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?
Oct 7, '02
We work off of PCH scores. The nurse who was the caregiver on the shift prior (PM's for me) determines the patients acuity by how much nursing care, acuity of care, etc was provided and is still needed. Each intervention is given a certain amount of points, for example, Pain intervention = 0.5 points, 1-5 med trips = 1.0, 6-10 trips = 2.0; Simple dressing change = 1.0, moderate dressing change = 2.0, etc; Patient feeds self = 1.0, fed by staff = 2.0, and a host of other interventions like IV drips, PCA's, the ability to ambulate self, etc..... (I'm sure my scores are not correct - just giving you an example). They enter the information in a system that fields are prompted, and a PCH score is generated. A normal PCH is around 10.4, a high one can be around 24.5, low 7.4. The higher scores usually are when a patient is assigned a CNA as a sitter in place of restraining them.
With the scores, the assignments are generated. Everyone is given a fair share of patients from low to high acuities.
As a LVN, I'm usually assigned a higher PCH score and extra patients because a RN covers my IV abx's and initial assessments with care plan if I have an admission. I try to take extra patients to free up my RN's from having to do patient care on their assignment AND cover me.
By the way, since its impossible to make everyones assignment the same total PCH score, the person with the lowest score accepts the first admission, second goes to the person with the second lowest score and so on.
Its not perfect, but its the fairest we've got so far. When it doesn't work is when nurses try to manipulate the system so patients with actual high PCH's look like they are low care, and get assigned to an unsuspecting nurse who also has to take the first admission or more patients, AND possibly cover a LVN. This usually happens when the assigning nurse is attempting to "hook up" a "nurse buddy" who is coming on shift, or dog someone they have it in for. Rare, but still happens.
Last edit by rebelwaclause on Oct 7, '02