Who does the patient assignments on your unit?

[SkateBetty]

The unit secretary does ours, which doesn't make sense to me. Unless the secretary is sitting in report how would she/he know the clinical condition of the patients as well as the skills and time needed to perform care if the patients? For example, it would make sense to assign the same nurse to two MRSA patients in the same room, rather than split the assignment so the nurses are going back and forth into non-MRSA rooms. Sometimes nurses are overburdened with a line up of patients requiring trach care, dressing changes, and other treatments, while other nurses have low-maintenance patients. As long as I'm going there I might as well add the secretaries on our unit practically run the place, ordering nurses around and holding a certain degree of power over the nursing staff. Is this typical? When I was a secretary, before graduating, my responsibilities were limited to secretarial duties, and I had no power whatsoever, except as was related to being a unit secretary.

[Tweety, BSN, RN]

The charge nurse from the shift prior makes the assignment for us.

I agree with you, the secretary should not be delegating assignments to nurses. The patients should be matched to the nurses skill level, their condition, etc. etc. etc.

If you want to get technical, making an assignment is "delegation" and "delegation" to RNs, LPNs, CNAs, cannot be done by anyone but an RN.

[Gompers, BSN, RN]

EEEEK! That is a strange situation. A unit secretary has no business delegating patient assignments. I'd have a talk with your nurse manager, or even leave her a typed anonymous letter. This is NOT typical. In most places, the charge nurse makes patient assignments. And that is who SHOULD make them - the charge nurse is IN CHARGE! He or she is supposed to know what's going on with every patient on the floor or unit so who better to make assignments?

I work in a huge unit with over 4 dozen patients and usually about 20 nurses per shift. Our charge nurse doesn't take an assignment of her own, but it's still quite a job to do assignments! The hardest is on night shift, making the assignments for days when everybody is changing shift at 7am - whereas later in the day you have people coming and going at 3pm, 7pm, 11pm, etc. so there is less decision-making there. So what we do is on night shift, each section of the unit has a "leader" who not only gets updates from all the nurses on her section, she also passes on those updates to the charge nurse and then helps make assignments for her area. Since she's been working there all night, she knows what babies are more time-consuming and which can be paired or tripled with each other. It works out great and we almost always have pretty fair assignemnts.

[snowfreeze, BSN, RN]

The charge nurse from the prior shift makes assignments but the oncomming charge nurse gets there a bit earlier than the rest of us and sometimes makes some changes. If a lighter assignment is made the charge nurse makes sure that nurse does assist the heavier loads as needed. The unit I work on right now does have a really wonderful team working group so a bad assignment isn't really all that bad as someone is always willing to help out.

[mtngrl, ASN, RN]

Where I previously worked the charge nurse made assignments, of course. If I were you I would speak to someone about that. It doesn't make any sense. So what does your charge nurse do???

[TXNurseBSN]

I see a scary trend happening in health care. UAP are becoming more in control, while RN's are getting less. Now, I do not consider myself above UAP's, we are all integral parts of a team. However, only R.N.'s have the education and training to delegate and form a pt plan of care!

[nurse_clown]

[color=dimgray]on my unit at the hospital, the unit secretary makes the assignments. but it's pretty simple. the rooms are split up and each full timer gets assigned to a unit for four weeks. then it switches. the part timers get divided up and there are two rotations. i never really questioned that. at our hospital, we don't get much of a choice. patients are assigned to whatever bed is available and insurance coverage (even though we have ohip). one unit may have eight very dependant patients who are violent, incontinent and confused and of course "full codes" just transferred from icu because the "higher ups" need to get them transferred to make room for patients who are waiting for icu beds in er cardiac trauma and two of them code at the same time. believe me! it's happened. and the other unit will have mostly independants but with different issues like pain control, tpn, chest tubes and chemo/radiation side effects. patient assignments can be complicated. but we just stick to the assignment when it comes to documentation. other than that, it's working together to get the job done. if one unit is heavy, the other unit usually comes over to help and vice versa. one morning i had to draw blood from 13 picc lines and the other unit only had one. she handed me her task of drawing blood but also did my final round. i thought that was a deal! i think i've rambled enough

[babiesX2]

You need to speak to your unit director about this problem. Only RN's can delegate to RN's, LPN's, and CNA's. I don't know what state you are in. I would research it on your state board of nursing website and print out the necessary information to take with you when speaking to your unit director about this problem. The RN's on your unit are putting their licenses in jeopardy by allowing this to continue.

http://www.lsbn.state.la.us Click on the delegation tree link. Your state most likely has delegation criteria clearly outlined on the website.

[ern91]

A secretary delegating an assignment to a nurse is a lawsuit waitng to happen. I'm sure your state board of nursing would have something to say about that. Speak to your director as soon as you can . It would help your case if you have a copy of your nurse practice act in hand to show her/him the rule that applies. If nothing is done to change this, get another job pronto!

[Altra, BSN, RN]

Agree w/the above posters - this is inappropriate from a clinical/patient care standpoint, and also a risk management nightmare waiting to happen.

If this has been the practice on your unit for a long time, there may well be considerable resistance to change but it will only happen (over time) if someone speaks up.

[BittyBabyGrower, MSN, RN]

I agree with everyone else...this is trouble waiting to happen. The secretary is NOT a medical/nursing person and it is obvious that she isn't by saying she is giving MRSA and non-MRSA's together. What does the charge nurse do? And what is stopping anyone of you from CHANGING that assignment if it isn't acceptable. You are totally responisible for ANY assignment you accept and if she is making unacceptable ones, then the nurses are the ones that are going to be up the proverbial creek if something happens. Where is the unit manager in all this?

[SkateBetty]

Where I previously worked the charge nurse made assignments, of course. If I were you I would speak to someone about that. It doesn't make any sense. So what does your charge nurse do???

Our charge nurses stay pretty busy with assisting the staff nurses, taking calls from the supervisor for new admissions, arranging transfers off the unit, grabbing things from central supply for us, etc. The few times I've questioned the unit secretaries making out the assignments I've gotten replies like "don't understimate them, they know more than you think", and so on, to which I've replied "Yes, I was a secretary during nursing school, and I knew a lot too".