patient re-assignment question

[NurseCallus]

I am a mid shifter in a busy ED. I work 3p-3a most of the time. More often than not, when I come to work I have to take a busy patient assignment from another nurse so that that nurse can then go float, or take a less busy assignment. I feel this is unsafe for the patients, and unfair to me. There is no continuity in care when this happens. Last night I took over for a patient, whom I was then rushing to surgery 30 minutes after I took report so that that nurse could sit in triage. Last week I took over for a poor man whose oxygen saturation was in the 70s and we were about to intubate...Why? So that nurse could go sit in our fast track area. There are many examples of times like this.

Anyway, is this a normal practice? Am I wrong if I refuse the assignment? Help me out nurse friends.

[wyosamRN]

While not always possible, we try to avoid this, especially on sicker patients, patients transferring/being admitted/go to the OR. If it is going to happen reasonably soon, it make more sense for the nurse who knows the pt to continue with them, and give report to the next level of care. Temporary room swaps, and just a little teamwork go a long ways.

[psu_213, BSN, RN]

At 11 am we get more staff. At that point, one nurse usually serves as a float--to settle medics, do discharges, help with critical patients, etc., etc. Some RNs make better floats than others--there are some floats I, when I am in charge, never have to direct--they just know what to do and where help is needed, the they get it done. There are others that I feel like I am baby sitting. They sit there, wait for direction and won't do anything unless directed, even if it is very apparent where help is needed. The point to all this? If there is no RN that comes in at 11 am who makes a good float, and there is a good float who came in at 7 am; I will have one of the 11 am RNs take that 7 am RN's patients and have the 7 am RN float.

Now if the 7 am RN has a patient of the verge of being intubated, he/she is in the middle of an arrest, he/she is infusing tPA, etc., then I will generally not have that RN give up his/her patient(s), because (a) there will be better continuity of care if the first RN keeps the patient, and (b) it is unfair to the RN just coming in. Then again, at a more traditional shift change time--say 7 pm--those types of patients are handed off all the time.

In summary, I think you are being treated unfairly; however, you cannot just refuse the assignment based on that. If you have a good relationship with your NM, an open discussion is in order.

[Lev, MSN, RN, NP]

Hmmm, I wonder if this is more common on 3p-3a, which is the shift I just got hired on...

[caliotter3]

I once took a mid shift position. I was to be responsible only for a med pass. Lo and behold, when the other nurses informed me I was supposed to also be doing weekly summaries, etc., etc. but get done in only the time frame that I was being paid for. That job did not last long.

[NickiLaughs, ADN, BSN, RN]

I've been mid shift, and I noticed a couple things.

Your coworkers on previous shifts can make a difference on how much you float. Word gets around to management. If you are a good float, you frequently float. Sometimes I asked if I could take over an assignment because my previous 4 shifts I just had it handed to me the entire time. I was averaging 12 miles a shift with all the patients that I would take up to the floor, etc.

If the nurse has a sick patient and I'm taking over, they should either be going home or going on lunch. Continuity of care in the ill is always a priority when possible. If I have a sick patient, I usually try to keep them also.

[psu_213, BSN, RN]

This goes for triage too. Generally, our busiest times are late afternoon into the evening. I want someone fast out there in triage, and, let's face it, some are much faster than others in triage. Aside from that, some just do a better job out there. Maybe that is not what is happening in the OP's ED, but it is definitely a consideration.

[Loo17]

I asked this question and was given an explanation that made sense. When you have shifts that start at 7, 11, & 3 around the clock you need to look at the big picture/staffing matrix. Not every nurse works in trauma or triage for example. The 7a-7p nurse might get bumped from her assignment in triage at 3pm because there isn't a triage trained nurse that comes in at 7pm but there are several that come in at 3pm that day. Or maybe there are triage trained nurses coming in at 7p but they are also trauma trained and need coverage there. Sometimes it is easier to bump a nurse to triage for the last 4 hours of the shift because after they report off their patients they can just walk over and start working (no report really needed and no overtime for the nurse going home).

With the varying shifts and staffing needs for different times of the day I think that usually when a nurse is bumped from their assignment and put in triage its for a good reason and not just to take advantage of one nurse or help out another.