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.

[loriangel14, RN]

Where I work the Charge Nurse from the current shift makes up the assignment for the oncoming shift. Usually they try to keep us with the same number of patients and have our rooms grouped together. If we get an admit the person with the least patients usually gets the admit unless they already have a heavy load.If you have had to deal with a needy patient or the family from hell for more than a couple of days you can ask for a different assignment.Sometimes if the CN is busy someone else (even the PNs) will do the assignment.

[D.R.A.]

Thank you so much for your response! The situation is very similar where I am. We don't use the room number system exactly. Pts are divided evenly right now, but the old way of number system still lingers when it comes to assigning new admits. It's a full out riot right now.:***:

[RNKPCE]

The off going charge nurse makes assignments for the oncoming shift. She tries to give people back the patients they had the previous day. Our unit is geographically quite large. We tried to keep patient's assignments close together as much as possible. However we have to spread out the isolation patients and the confused or more acute patients. We all pretty much say we'd rather have to walk a little farther than have too heavy an assignment. We also try to spread out the discharges so one nurse doesn't lose all her patients and have to take too many admits. Our charge rarely has patients, in California we have to maintain ratios at all times, so our charge along with a relief nurse cover us during our breaks. We kind of know if you have a discharge be ready to take a patient unless you have an unusually heavy assignment, a critical event, or just got an admit.

[D.R.A.]

I like to spread out discharges as well. However, on my unit, where the secretary has been accustomed to assigning patients, and patients have been divided according to sections, regardless of acuity or pt load, new pts are assigned in order of who gets first second and third admit regardless of current pt load. They have literally tried to assign a 7th pt to someone when another nurse has 3 pts. Naturally, I would never allow that, but they try it almost every day! Its absurdity. I have not been well received, but these people act like morons.

There is no coverage for breaks. All the aides break together, and nursing staff was accustomed to do the same....until I came along. I'm really astounded on a daily basis. Very unprofessional.

And geographically I like to group pts together, but at the end of the day the assignments need to be based on acuity. And we only have 21 beds divided in two halls. So its not like they have to walk that far.

[loriangel14, RN]

No coverage for breaks? That's nuts. We split into to 2 breaks.Half the floor goes to first and half to second.

[D.R.A.]

Nope. NO coverage. Staff have no leadership. They do as they please, and since most of them clearly have no integrity,

Its like Lord of the Flies up in there! Never-Never Land!

[wheeliesurfer]

Basically what batmik said! Off going CN makes patient assignment, CN doesn't carry a load except a small load on night shift if we are down a nurse. CN covers for other nurses during breaks and answers call lights. Ends up helping with PRN pain meds, bringing blankets, helping walk patients to the bathroom or clean up soiled chux, etc. The CN really gets the "lay of the land" on how the floor is running at any given time. He/She does try to keep the room assignments close so no one nurse is walking crazy amounts on our large floors!

[utadahikaru]

Everywhere I've worked, pt assignments are usually handed out by the fattest, laziest, grouchiest nurse on the unit.

[LibraSunCNM, BSN, MSN, CNM]

My first job as a nurse on a med/surg unit, the assignment was made by the offgoing charge RN, went by room number, but equally divided so that each nurse had about the same amount of patients. Acuity was not a factor, so some nights were heavier than others. Teamwork was very strong on that unit so we made it work. My next job I moved to the mother/baby unit, and the offgoing charge RN made the assignment and based it on acuity, which was much better. But on both units there was always a charge nurse who had no assignment, just handled patient flow, helped cover breaks, and generally oversaw the shift.

After Hurricane Sandy we were displaced to another hospital to care for our displaced postpartum patients, and the assignment was made by the unit clerk. I'd never experienced that before and felt like the only sane person in an insane asylum!!! It was so awful. No charge nurse, and this random stranger who isn't a nurse and has no concept of patient acuity is telling me I need to take an admission. In the nursery, the clerk didn't even make the assignment. A new baby needing to be admitted would be brought in, and then it was "Who's taking this baby?" Of course no one ever volunteered! It would take 15 minutes of argument to assign the admission.

A charge nurse dedicated to assigning patients and overseeing the flow of the unit is so vital!

[lub dub]

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?

Is this really happening on your floor? If so, where is the nurse manager???

[D.R.A.]

Yes, it really has happened. The nurse manager is Laissez-Faire....and busy playing Candy Crush. People constantly complain, and nothing ever really gets done. Its every man for himself out on the unit. Survival of the fittest. Apparently, the other CN let this go on...then I showed up, and I was astounded. I've been employed for about 1.5 years. Initially, I didn't charge that much, now I charge quite a lot. I don't tolerate this, but it still happens. Its like pulling teeth to get these fools to understand that its unacceptable. The secratary has been employed by the facility for 16 years. Apparently, that makes her a nurse in her eyes. Absurd!

[DoeRN]

Assignments are by room order. Simple and stupid. Getting somebody to change a time honored tradition is impossible. Anybody can divide the unit up into 34,5 sections. Usually it's whoever shows up first.[/quote'] Where I first worked as a nurse the assignment was done by acuity. Where I work now the assignment is done by room number. It's so silly and crazy and I have never been so burned out. I would rather walk down the hall and around the corner and have a fair assignment then have 6 totals and the nurse next to me have 6 walkie talkies.

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