Patient assignment v. actual patient load

meownsmile, BSN, RN · May 26, 2006

Patient acuity is not taken into account in my med/surg unit. The floor is split up into 1,2 or 3 teams depending on available mix of staff for the day. The CNA and LPN may have 6-8, the LPN may get 13 or so dropped on them, an the Rn's can count on 8-10 on normal days.

But i should say the situation you describe happens frequently where i work, but that is where working together with your co-workers comes in. If the nurse with the light load cant bring herself to go offer to help the nurse with the heavy load then you have real problems in your work environment. And i have to say,, turn around is fair play and the one who doesnt at least offer help, wont get much in return when the wind blows the other direction.

Its all about team work, and i dont mean just those on your assigned team, the whole of the workforce in the unit have to work as a team.

Ruby Vee, BSN · May 26, 2006

i work in icu, and patient acuity is sometimes -- but not usually -- taken into account. so i could have a heavy chronic patient with an insulin drip and q 1 hour glucose checks, dialysis and constant stooling and get a fresh post-op with the insulin drip, q 1 hour glucose checks, q 15 minute vs and i & o. if the post-op is stable, great. if not, i'm still stuck. meanwhile, 5 or 6 other nurses with lighter assignments are sitting in the break room yukking it up. some of them take it upon themselves to help out when they gave time, but not all of them. not even most of them.

WV_heart_RN · May 26, 2006

i work cardiac stepdown. it is primary care so we have no lpns or aides to help us. except an occassional pca for the whole floor. at night we have four teams with six to seven patients each. acuity plays no part in the equation.

it is a very hard night when you have all completes or the crazy crew. the only way toget through the night is working with each other. we try to really work together as much as we can.

it is not unusual for someone to do my blood draws or restart and iv for me while i am cleaning up a patient etc.

teamwork!!!!

HappyNurse2005, RN · May 26, 2006

I am in a cardiac surgery stepdown unit.

we do take into account acuity, b/c our acuity is often high. Our charge nurses will often ask "does any of your group need to be split up?" or "are your pt's good together?"

We don't want say, one nurse to have both of our vent patients. I've had our charge nurse one shift ask me if i was able to take another pt, or should she give it to someone else.

can't have one nurse with all the confused pts, dying pt's, pt's on drips, vent pt's, our pt with a trach who has massive secretions that need to suctioned, etc.

Yes, acuity is taken into account. We often have our nurses have pt's that aren't all in a row b/c of acuity. i like it just fine that way.

grinnurse, RN · May 26, 2006

At the hospital that I am leaving (thank goodness) there is no differentiating between accuity and numbers. For instance, yesterday, I started out with 6 patients 4 of which were total care (feeders, tQ2 etc, incontinent) pts with no help what so ever. No aide, not even enough staff to help with pulling pts up in bed!! I got the first admission which was an 89 yo male with R/O GI Bleed with a huge attitude that refused to give me any kind of health history and barely let me perform an assessment who 2 hours later developed CP and ended up going AMA with EKG showing bigemenies/trigemenies.

I am quite certain and hoping/praying that this is not the norm. Curious to see the posts on this subject.

PS-sorry for the venting-but thanks I needed it!!

Antikigirl, ASN, RN · May 26, 2006

OH I guess I am soooooooo lucky! Aquity is taken in big time in regards to nursing assignments, and many management meetings are done dependant on load, but typically occur once a shift to assure proper RN to PT care! The charge nurses at this hospital have been there for 10+ years typically and know a lot about this!!!

There are times when all heck breaks loose of course. I have gotten some caseloads that seemed so light and a total admit later in the day that all went to heck fast and wow! One time I had two surgical pts going in to surgery and one ambulatory pt who was going home..and an admit later. Easy right? One surgical pt went south and the surgery was cancled and boy that one was full time care, then my other surgical changed their mind and chose to go home (one discharge), the ambulatory one was too painful and declined leaving (long story but they HAD to leave because of insurance and the doc was less than kind to me...okay salt on a pretty good wound in progress doc..thanks!)...and my admit was a total admit with more paperwork than what I could do in 8 hours given the chaos that occured!

Thankfully my team helped me, and an administrator saw how flushed and flustered I was and had the charge nurse help me with my pts. Oh did I mention we didn't have a unit secretary or CNA that day! EEEEEKKKKKK that was heck! I went home and crashed!

But thankfully I was helped by other nurses, and the charge nurse (eventually). But wow...won't soon forget that day!!!!!!

LPN1974, LPN · May 26, 2006

Well, I only work in a facility for the mentally challenged, but acuity is taken into consideration in the work we do, and if the RNs who make the assignments/schedules, don't consider it, then we LPNs demand it.

It's not fair for one nurse to get stuck on one side with all the "extras". However, we do "float" our assignments, so I know that if I have the lighter side today, most likely I might have a heavier side tomorrow. So we are willing to help each other out.

If there's a procedure or some other task that one of us can take over to help out the swamped nurse we do it. It helps us all, and we do change up our assignments frequently. Change also keeps us up to date on all our clients, and keeps us from getting bored.

Not that this would work in every facility...I realize hospitals are much faster paced than we are. This is just the way we do our assignments.

Tweety, BSN, RN · May 26, 2006

We do both. Our assignments are primarily divided up in sections, and it isn't always fair. Usually someone will say something and it becomes known that a particular district is unfair and they divide them up. They try to dvide up the trached patients so one nurse is only caring for one trached patient.

The other day I told the night church who made my assignment. "Out of four isolation rooms on the floor, you gave me three of them, and they are all very tough patients." She apologized, saying the wasn't thinking.

I hate when assignments are made by district. When you change things you always get the invariable sourpuss who complains, "why do I have room scattered all over the place, I like my rooms all in a row."

MS._Jen_RN, ASN, RN · May 26, 2006

We divide by patient accuity. I would question the reasoning of doing otherwise. Especially if there are those who rarely help others working with you. Our unit is actually working on a research project involving the development of a patient accuity based staffing model. It would allow you to officially vary the staff # on the unit based on accuity rather than # of patients. This would justify (to administration types) the times that our unit is "overstaffed" when we are really just keeping our heads above water because the patient accuity is through the roof.

~Jen

TabyRN · Apr 26, 2008

Acuitity is not normally taking into concideration by supervisors, so if we have a floor full of total cares, we still noly get minimal staff. working night shift we are all usually given 5 pt's a piece, with no charge nurse, and covering LPN's depending on how many we have working that night. worse part is days gets angry if the baths aren't done.... (not an actual assignment for nights, but we try to help) and usually 1 RN gives charge report in am, this includes making sure your pt's are ready for days, the entire floor's worth of labs taking care of and any doc's called that needs to be. needless to say it can be a heavy load. :twocents:

NurseKatie08, MSN · Jul 25, 2008

I worked on a medical unit when I was a tech...I think they tried their best to take patient acuity into account, although generally the tech assignments involved the floor being split 2 or 3 ways (depending on how many techs on) and day techs given their ADL assignments within that section of the floor. All techs on all shifts were responsible for all call lights, even if it wasn't in your section of the floor.

As far as I could tell, the nurse assignments were based strictly on patient acuity, and if any of the nurses coming on were the primary nurse for that pt. Also things like isolation, and if the patient was on PD were taken into account (bc not all nurses on the floor do PD). Sometimes the nurses got all their pts in a row, sometimes they didn't.