Patient assignment v. actual patient load

[irish_std/n]

I am just wondering how each of your facilities handle division of patients. what happens if the patient load is unequal...do you get help or are you left to tough it out? I am currently working on a general surgical divided to to two sides and futher divided into sections 1, 2, 3, 4, with each having 6 beds, some days I may have one section with all 6 beds full of 'heavies' with the staff nurse opposite me having 3 beds empty with independant pts or the opposite (with me having few pts and the staff nursing being swamped)and so on... These are the days where I really feel like I'm not being paid enough!!

Are patient assignments divided strictly by pre decided bed/room numbers or is pt load taken into account?

[loriangel14, RN]

Where I work day shift you typically get 4 pts and they try to take accuity into consideration.Sometimes if the census is low you may only get 3 pts and then you are expected to help out on the floor because you load is lighter. if you have more than one total on your load you just speak up and tell someone you need help. We don't employ CNAs and RPNs take just as many pts as RNs. My workplace is a culture of teamwork so it doesn't really matter if you assignment is unbalanced, nobody gets off sitting around while others try to catch up. Everyone leaves on time and everyone sgets breaks and lunch.

[ArwenEvenstar]

I no longer work in a hospital, but did for 14 years. Some of the units I worked did block scheduling (the rooms you had were all together, like you had rooms 1 - 5, and acuity was not taken into account), while other units divided up the patients based on acuity.

In THEORY, making assignments based on acuity would/should be a good thing!! However, my personal experience is that this never worked in practice. It seemed that the charge nurses (who would make the assignments) frequently did not have proper familiarity with the patients (for various reasons) or paid no attention to the room locations on the unit. And you could end up with really screwed up assignments.

Some examples: * The patients I got were spread out ALL OVER the unit. Meaning on a 30 bed, two hallway unit - I would have patients strung from one far end to the other far end of each hallway. And you'd spend huge amounts of time just walking from one patient to another. This was especially an issue if your two most time consuming patients were on the opposite ends of the unit! Ugh.

*Or the assignments, which were SUPPOSE to be based on acuity, simply were not. Like, one nurse would get 5 patients with early, first case surgeries! Duh. Weren't assignments based on acuity suppose to prevent this type of thing?

So, I found that block assignments ended up being better over all. I usually ended up with worse assignments on units that made assignments based on acuity. Go figure, because the opposite should be true!!!!!!! That's just my experience...

[Lifeofanurse]

I just viisted a step down unit.

There were 2 floor nurses divided between almost 50 patients.

these were more LTC type but all had something going on.

Four CNA's....2 of which were late. One over an hour and were nasty and grumpy all day.

One supervisiing nurse who was available if you needed them but was quite busy with paperwork, making appts and consults for pts.

For a new grad... that is too high of a ratio to be safe. and told them that maybe someone else could handle it but I know my limits and I can't go to work everyday wondering if I was offering safe care to my pts and worrying about hurting someone because I made a mistake...and with 24 pts... it was bound to happen. That doesn't make me a bad nurse it makes me a smart one. I know what I'm capable of and I do like to challenge myself but not at the expense of my patients or the quality of care I give.

[xtxrn, ASN, RN]

Depended on where I worked. Some places did (I LOVED getting the load of coma's and gomers)...got my work done, and no call lights (back in the days of REAL visiting hours ). When I worked where there weren't acuity considerations, I did them anyway. I was in charge, and didn't have patients, so would help out, as did the other nurses who had lighter loads.

I was lucky; the vast majority of people I worked with helped each other, and I rarely heard "not my patient" (which I would get really 'urinary outputted' over...if someone were sitting at the desk- don't care about breaks when all ' terminally hot place' is breaking loose....they had more to keep them busy the next shift we worked).