Pt assignment in the ED

[JmanRN80]

So I have worked in 2 EDs so far and at both places we have give the RN's a set of 4 preassigned rooms and place pts in the rooms as the pt come into the ED trying to do rotation whenever possible. However, at my current FT ED we are stepping away from this assignment and will assign pts to nurses based on acuity of the pt. This process was termed the "free for all". The logic explained to us was that this would allow us to develop our newer nurses by managing the acuity of pts they get assgined. As they progress they can take a ESI 1 or 2 pt without the worry of their other pt load or being assigned new pts as the remaining nurses would take on the lower acuity. On the flip side I see this as a way for the more seasoned nurses to get either overwhelmed with the higher acuity pts or be being slammed with lower acuity pts and causing a skew in the pt/nurse ratio.

Has anyone out there worked in a assignment setting like this before? What were the struggles or Pros/cons of this system? Is it still being used or was it scrapped from the table eventually?

I would love to hear any feedback.

[amzyRN]

In my ED we use the 4 room assignment system for most of the ED except for the resus/trauma rooms. Those are the only rooms that require some experience to get to rotate through, usually the length of time of the unit combined with ED experience. Most of the time we try to put higher acuity patients closer to the trauma rooms just in case they need to switch. They usually start new ED nurses or nurses who are unfamiliar with the unit in the back of our ED where the less sick patients tend to be placed. There is a faster turnover there because the patient is not sick enough to admit. They can learn skills and quicken the pace. Then as nurses develop their skill and familiarity with the unit are put in higher acuity pods. Both EDs I've worked at did this.

I think new nurses should be able to handle an esi2 right off the bat. I mean esi 2s like ACS, possible CVA, new onset rapid afib, sepsis. Those are pretty straightforward.

It would suck to get all high acuity esi 2 for a whole shift and it would probably be boring for the nurse getting the lower acuity patients all day. I think it's good to try to not overwork people or potentially cause some staff to feel unchallenged.

[JKL33]

What is the size and department lay-out of this place? That will have some bearing on the success of this, I think.