First let me start by saying I absolutely love having unit secretaries. Our unit secretaries have many responsibilities such as ordering supplies, keeping up with inventory, answering and diverting calls, placing consults to physicians. Our days are so much more stressful when we do not have a unit secretary.
My only issue I have with my current unit is that the secretaries are allowed to assign patients to nurses. When I work as relief charge I always make the assignments because I want to make sure acuity of patients are divided or a nurse doesn't get stuck with multiple blood transfusion, heparin gtts, or multiple admissions. However, I notice that the unit manager is perfectly OK with unit secretaries assigning nurses to patients.
I just think that nurses should be the one to make the assignments due to the above reasons. The few places I have worked as a nurse, the nurses were responsible for assigning patients to oncoming shift. Am I being too harsh? or unrealistic? Is this the norm on your unit?
I think this is inappropriate, for my own reasons (which have to do with the dynamics that seem to frequently be involved or become enabled by situations like this).
Your real problem is with management. Why are they allowing the assistants.. to run the show?
I think that is exactly what JKL was alluding to. It gives too much social clout to a Unit Secretary who is then prone to get too big for her britches, leading to her making the work lives of her unfavorites miserable.
The closest I've ever done to this was when the charge was on dinner and we got paged for an admission. And even then I grabbed a nurse and said "So-and-so has 3 patients and everyone else has 4, do you think they can take this admission?" Just because somebody has to take report
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
THIS HAS NOTHING TO DO WITH SOCIAL CLOUT, TRADITION, OR FAVORITISM. (Sorry to shout). The allocation of NURSING resources, I.e., staffing a patient care area with licensed and UAP for the purposes of delivering nursing care, is the explicit responsibility of the registered nurse in every nurse practice act I have ever read. ONLY a registered nurse is licensed to assess patient acuity and evaluate nursing practice (of the staff there is to work with). Your administration is cruisin' for a bruisin' if they don't realize this and change the policy (or write one if they don't have one). If this doesn't change immediately, the implications for liability are big (and they'd better hope and pray nothing comes up from past cases, come to that). Your risk management officer can help them see the light; so could a little call from the Board of Registration in Nursing and/or the state DPH that accredits hospitals after they get an, ahem, anonymous phone call to report it.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
Sorry to shout, I'll try to edit it, but this was really an unsafe and actually illegal practice and could have very serious implications, as well as a BON not looking kindly on it. Social dynamics don't determine nursing judgment in terms of the Scope and Standards of Nursing Practice and the Nurse Practice Act.
THIS HAS NOTHING TO DO WITH SOCIAL CLOUT, TRADITION, OR FAVORITISM. (Sorry to shout). The allocation of NURSING resources, I.e., staffing a patient care area with licensed and UAP for the purposes of delivering nursing care, is the explicit responsibility of the registered nurse in every nurse practice act I have ever read. ONLY a registered nurse is licensed to assess patient acuity and evaluate nursing practice (of the staff there is to work with). Your administration is cruisin' for a bruisin' if they don't realize this and change the policy (or write one if they don't have one). If this doesn't change immediately, the implications for liability are big (and they'd better hope and pray nothing comes up from past cases, come to that). Your risk management officer can help them see the light; so could a little call from the Board of Registration in Nursing and/or the state DPH that accredits hospitals after they get an, ahem, anonymous phone call to report it.
As far as I know, no such BON or accreditation requirement exists. Both would evaluate hospitals on whether nurses are practicing outside of their scope, but the mechanism they expect to see to avoid that is that action is taken when a nurse receives report and notifies the NTL or other appropriate staff that a patient requires nursing care that is outside of their scope.
And actually the most effective methods for making patient assignments that I've come across don't involve an RN at all when making the assignments; systems that track the amount of time different staff members spend in a room, which then produces time requirements by role for each patient, don't require an RN to make the assignments.
It is possible for assignments to be made using decision making that is specific to RNs, various ways of matching patient learning styles to the different teaching styles of different nurses, etc, although that isn't a BON or accreditation requirement.
This has been a pet peeve of mine at my facility. We have unit receptionists who have been making assignments for a while. I don't think it's safe or legal, since only RNs can delegate to RNs, but I'm fighting a long tradition of letting unlicensed personnel make the assignment. When I'm charge, I make the assignments, but my assignment is made by a night shift unit receptionist. We are staffed primarily with travel RNs, and they just come to work and go home, so it's just me making any waves about it. The result has been some pretty crazy assignments like those others have mentioned.
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JKL33
7,031 Posts
I think this is inappropriate, for my own reasons (which have to do with the dynamics that seem to frequently be involved or become enabled by situations like this).