Who should make patient assignments??

[D.R.A.]

Ladies and Gentlemen,

I am curious who makes patient assignments on your units. Particularly, new pt assignments. Pts arriving to the floor after shift start. Is it your Director, your Charge Nurse, or you HUC/Unit secretary? Please include why or why not you think it is appropriate for that person to make patient assignments.

Also, do you believe that it would be appropriate/safe for a HUC/Unit secretary to make patient assignments? Why or why not?

I have included a poll.

Thanks in advance.

[applewhitern, BSN, RN]

Assignments should be based on acuity.

[D.R.A.]

Yes, I agree. Who should make them?

[Spika RN]

On my floor the charge nurse does, I think that is how it should be as a charge nurse my self I always get the input from the other nurses due to working night shift I have my own team so I don't always know what is going on with the other patients

[Dranger]

On my unit the charge nurse does but we can tell her if we don't want the same patient twice (if they are needy or time consuming) and things get adjusted. The HUC or secretary is not a clinician and shouldn't decide acuity.....so no way

[D.R.A.]

I completely agree. Let me add, how would you feel about the HUC making new pt assignments to nurses, including the charge, based on her assessment of how many pts each nurse should have, and that assessment being based solely on numbers and having nothing to do with acuity?

[SoldierNurse22, BSN, RN]

I completely agree. Let me add, how would you feel about the HUC making new pt assignments to nurses, including the charge, based on her assessment of how many pts each nurse should have, and that assessment being based solely on numbers and having nothing to do with acuity?

As the HUC is not a nurse, they do not have even the basic knowledge subset that is critical to making this assignment. It is absolutely inappropriate to have a secretary making acuity-based calls and assigning patients to professional nurses. I would not remain at a hospital that allowed a secretary to make these kinds of decisions, not because the secretary is lesser than the nurse, but because they have not been properly trained. They simply lack the assessment skills, critical thinking and knowledge to safely make this kind of decision.

Even a staff nurse, who is tending to his or her own assignment, does not have the full-picture view of the floor that the charge has. When I worked inpatient, I frequently disagreed with the decisions of the charge, but when I became a charge, I come to understand why you have to make the calls you do when you're in charge. As a staff nurse (when I wasn't working charge), I tried my best to support the decisions of the charge, because it's a tough spot to be in.

A supervisor or director is not working closely enough on the ward to make that kind of a decision.

As such, I'd say anyone making that decision aside from the charge is out of line and unqualified.

[D.R.A.]

I couldn't agree more. To expand a bit, as a charge, do you feel you can have adequate scope of the entire floor while caring for 6 pts of your own?

[Esme12, ASN, BSN, RN]

Technically by most nurse practice acts the nursing assignment of patients must be performed by a RN. While the charge nurse needs to have an assignment....especially these days.....administration is not seeing it that way. I am firmly in the camp the the charge nurse needs to have a lesser assignment.

[Spika RN]

I couldn't agree more. To expand a bit, as a charge, do you feel you can have adequate scope of the entire floor while caring for 6 pts of your own?

Oh defiantly not, my cna has the best knowledge of the floor, on how the patients are doing, that being said she has been a cna for 18 years so she K ow what is going on, I wish at time I could be out of staffing, got that the other night but was so bored, place very sparkly clean before morning

[D.R.A.]

I actually prefer working as an aide when I charge. May sound crazy, but it gives me the maximum patient interaction which is what I am after. I always feel like I am well informed when an aide calls in and I have to fill in.

[SoldierNurse22, BSN, RN]

I couldn't agree more. To expand a bit, as a charge, do you feel you can have adequate scope of the entire floor while caring for 6 pts of your own?

Absolutely not. If your'e drowning in your own assignment, you cannot and do not have time to pay adequate attention to the state of the floor and your fellow nurses.

To take off on Esme's post, charge nurse is more than just another duty that gets added to your task that day. It was frequently a full-time job on my floor between admissions/discharges, rounds and chemo. Only night charges were even allowed to take patients. Day charges were strictly prohibited from taking patients. Otherwise, patient care and the organization of the floor suffered.