Patient Assignments

[CareQueen, BSN, RN]

Does anyone else work on a unit where they get to choose assignments? I do and I absolutely hate this method. I'm a new grad who has been on my unit now for 6 months. Once I was off orientation, I was supposed to be pre-assigned...to the "easier" patients (I work in a cardiac ICU though, so interpret that how you will).

However, this winds up not always happening and it sucks. Orientees and preceptors always get to choose first. If there are 3 or more of them on one shift, your assigments can be eaten up quickly. Also, ppl who were there the day before get to choose after that. THEN, the new grads are supposed to be preassigned, but usually have to choose. You can see how that can often leave us with more intensive assignments. I do NOT mind working while at work, but if it's one thing I can't stand, it is when the more senior nurses take the easier assignments. Yes, I understand that they have paid their dues, but it's crazy to leave the new grads with intensive, busy and higher acuity patients, who often tank, when we have barely gotten down our time management skills. I've not had to take any patients where I feel completely unsafe, but sometimes it pisses me off that the charge nurses don't look out for us in a better fashion. I really wish that charge simply assigned patients and let that be that. At least it would seem fair.

Does anyone else work on a unit where they do this??

[seasidesoul]

So everyone is free to choose regardless of acuity? Or is acuity factored in somehow? If it isn't, that's absolutely terrifying. Even though I'm not always thrilled with my assignments, I'm grateful that they're pre-assigned and based on how heavy each patient is. I'd be interested to hear how common your unit's method of assigning patients is.

[CareQueen, BSN, RN]

So everyone is free to choose regardless of acuity? Or is acuity factored in somehow? If it isn't, that's absolutely terrifying. Even though I'm not always thrilled with my assignments, I'm grateful that they're pre-assigned and based on how heavy each patient is. I'd be interested to hear how common your unit's method of assigning patients is.

Basically, yes. The orientees/preceptors can take whatever they want if they feel like it is something they haven't experienced..even if it is an "easier" patient load. The sickest patients (i.e fresh post-ops or ones who have just coded, are usually given to the other charge nurse on staff(b/c there have to be two per shift), but it's an ICU, so everyone is sick! I just think that sometimes it can be unfair and possibly unsafe. I have seen some of my fellow new grads get stuck with complex post-ops and marginal patients that I don't think they would be equipped to handle. I just wish they would abandon this whole process and assign based of experience level, and a review of previous patient acuity alone.

[HouTx, BSN, MSN, EdD]

Wow - I've never heard of this before. I certainly understand why Preceptors with Orientees would get first choice for obvious reasons. But the rest of it just sounds like management has abandoned the staff. The most basic & essential management responsibilities are to ensure patient safety & staff equity. I don't see how this is being addressed if the newbies have 'stretch' assignments & the most expert staff are coasting with easier patients. ... it blows equity right out of the water.

If this is the established process, it would be very difficult to change, especially in an environment where it sounds like the inmates are running the asylum. Maybe the only alternative is to seek a job in a better environment.

[CareQueen, BSN, RN]

Wow - I've never heard of this before. I certainly understand why Preceptors with Orientees would get first choice for obvious reasons. But the rest of it just sounds like management has abandoned the staff. The most basic & essential management responsibilities are to ensure patient safety & staff equity. I don't see how this is being addressed if the newbies have 'stretch' assignments & the most expert staff are coasting with easier patients. ... it blows equity right out of the water.

If this is the established process, it would be very difficult to change, especially in an environment where it sounds like the inmates are running the asylum. Maybe the only alternative is to seek a job in a better environment.

Just the other day, I had to pick LAST..and I was lucky that the other nurse just ahead of me chose to keep the more intensive assignment, who would up tanking that day too. It just shouldn't happen. I like my team here and they are mostly helpful and knowledgeable, but if a process is meant to give orientees experiences while also giving new grads patient assignments that are safe, that should be the way it plays out. This whole "take who you had the day before or otherwise whoever you want" keeps that from being the truth consistently and it bothers me...because I know for sure if I am stuck with an assigment that I don't feel comfortable with, I will say so and that may not bode well with the team.

You are right in saying that it probably won't be changed. When I asked why they do their assignments that way, they said that that's how they have always done it.😕

[kiszi, RN]

"That's how they've always done it" is about the most worthless excuse ever. Not even factoring in acuity, when there is THAT patient on the floor for an "extended stay" (you know, the one with the hostile family or that threatens to call administration every day), the person to pick last will always get that patient? There is no way I could work like that. Doesn't that cause unnecessary delays at the beginning of the shift as well? I can just picture everyone waiting around for all the preceptors and such to show up and pick. Much better to come in and be able to get your assignment and take report right away.

[NewGradRN114]

I work on a postop med/surg unit and this is also how we get our assignments. I'm also a new grad and I'm often stuck getting whatever patients are left over. It makes sense for people to want to have the same patient assignment every day but at the same time I feel like I sometimes get stuck with the more difficult patients. I have worked shifts where the charge nurse has two patients who are stable and who have been in the hospital a long time while I get four patients, some who have come from ICU or are more complicated and I feel like I can't keep up. This past week I have worked every other day, so whenever I go into work I always have a different patient assignment.

[NotReady4PrimeTime, RN]

I work on a postop med/surg unit... I have worked shifts where the charge nurse has two patients who are stable and who have been in the hospital a long time...

It might surprise you to know that the charge nurse had a much more difficult assignment than you did. It might also surprise you to know that on many units the charge nurse is not responsible for a patient assignment... because they're responsible for ALL the patients. And the staff. Being in charge is a thankless assignment with little to no real authority, just responsibility. Having to take on a patient assignment in addition to charge duties is a sign of short-staffing.