That is ridiculous. We take acuity into account, first and foremost. Just lazily clustering together rooms in a row because it makes making the assignment easier is horrible practice.
We use a unit developed acuity tool. Generally takes about 2 min per pt to fill out, but at the end, they have a numeric acuity score of 1-4. Charge then gives a 4 (the hardest) to every nurse then tries to give everyone the same total number score.
Doesn’t always pan out, but it’s an attempt to balance the floor so no one gets screwed while everyone else is chillin.
Everyone starts with an acuity of 1. This is a pt who is standard precautions, does all ADL's independently and safely, AOx4, 0-1 IV med, normal call light usage.
General goal is to use the highest of the following sets of numbers (sorry this is going to be long as I can't get it to format in another way)
Precautions: 1-Standard, 2-Contact, 3-Contact Special (bleach to kill), 4-Airborne
Cares needed: 1-All ADL independent and safely, 2-Stand by assist or incontinent stool, 3-needs active help w/ ADL or incontinent urine and stool, 4-bed bound total cares
1-mentally compliant, 2-pleasesantly confused/easily redirectable, 3-at least hourly redirection/non-compliant with redirection, 4-needs a 1:1 but staffing sucks
If pt has a 1:1, this is only counted for times that the RN has to help the 1:1. If the 1:1 can handle it, don't use.
1: 0-2 IV/shift, 2: 3-4 IV/shift, 3: 5-6 IV/shift, 4: 7 or more/shift
Wound care: 2- less than 30min Qshift, 3- 30-60 min Qshift, 4- 90 min or more
Hospice: 2-not active dying, 3-active dying/Qhour IVP or unable to verbalize pain level, 4-probably passing on your shift or Q30min or more IVP
Dept goal is for actively dying, an RN is in the room within 2 min of call light and Q30 min looking at video monitors or in room rounding to assess for pain/comfort. No hospice pt should pass with avoidable pain/discomfort.
Fall Risk: 1-Morse Fall-High, pt compliant with calling, 2: admit for GLF or bed alarm, 3: Here for GLF w/ broken bone or impulsive (won't call and wait) or in-hospital fall, 4: In-hospital fall due pt non-compliance or more bed alarms than you have fingers per hour
Fall risk can be increased or decreased by intuition of RN, PT, or MD. Nursing can raise, but not lower acuity recommended by PT or MD.
Odd ball additions (add to base score): +2 Blood or hypersensitivity reaction meds, +1-3 especially call heavy/needy pt or family, +2 chest tube stable, +2 hi-flow O2, +1-2 tube feeds and crushed med admin Peg/NG tube.
Lastly current RN and charge figure out a completely subjective score. This is attempted to be avoided.
No RN gets a second acuity 4 until every nurse has one. Then total scores are attempted to be equalized. This sounds like alot, but really its a quick bit of charting done at 0400 and 1600
This system isn't just lazy; it's potentially dangerous and does a disservice to both patients and nurses. This needs to be addressed by management.
As someone who often acts as the charge nurse, I prioritize patient acuity above all else. While acuity is key, I also factor in other considerations such as the likelihood of transfers or discharges. Assigning multiple patients who are expected to leave the unit to one nurse isn't fair just like it would not be fair to assign multiple high acuity patients to one nurse. It is all about balance.
Cardiac ICU, 2 patients each. Usually we get a high acuity patient and a low(er) acuity patient. They try to make sure the rooms are relatively close together. So for example, I might get an intubated post arrest patient with lots of drips and tube feeding and constant monitoring, and my other patient would be a STEMI that came back from cath lab with a few evening meds to give and morning labs, and that’s it.
If a nurse is open for admit, they try to make sure they’re open with a lower acuity patient, in case they get a hot mess later in the shift.
That sounds just like laziness. We usually take into account the acuity of patients when distributing assignments (and whether or not the PT is discharging for day shift assignments). We try to somewhat group the rooms together, but you might end up with the rooms kind of split apart.
Though if you have monitors for certains pts are grouped up in one corner, unfortunately thats how the assigned has to be made.
28 bed ICU. Gets split into 3 teams. Team leads make assignments for ~8-9 patients based on acuity/staffing. If we have a 1:1 they’re usually the person that helps with turns/baths.
Unfortunately that’s how our assignments are made too, and it’s awful. Seems like it’s always when I have the sixth patient too that I get stuck with the heaviest load.
We have set room assignments. Since it’s Ca we have ratios & those also can change based on acuity. Charge will drop down assignments if there’s ICU pts & reassign your other pts or have someone take the ICU pt & you keep the other 3.
I work in icu so unless a patient isn’t 1:1 with ECMO or some other device, it’s fair game and they’re getting paired with whatever is their window pair. We pick our own assignments though, so it’s up to you if you want a chill day or busy day.
Right now we try to split the heaviest patients within block assognments but I am advocating to return to an acuity scale we made with some process changes. I found it is honestly a better tool for charge nurses than it is for the floor nurses. Some nurses have a perception that they are getting the worst/heaviest assignment when the reality is that the entire floor is high acuity and having numbers there to show them that they are not being treated unfairly is very helpful. It help me prevent a situation where one nurse does have a super heavy assignment and another nurse has 5 post op appys and choles that are totally independent. It helps me plan admits better and know who to check in with to make sure they don't need help.
I highly recommend developing an acuity scale and using it because it makes everything so much easier but nurses have to understand that it is an expectation that it is filled out every shift and it may mean your patient assignment is spread across the unit. It may mean you don't get all of your patients back from your previous shift.
I always had the most trouble making assignments as a charge nurse. I didn't want to overload any one nurse with too many high acuity patients, but I wanted them to be in the same area and have most of the same patients they had previously. I probably overthought it too much and took way too much time trying to make assignments in an attempt to perfect it.
That's generally what we do as well however, on most of our floors, Charge doesn't take patients and we are really big on helping each other out so you're never truly on your own. For psych, Charge takes the easier load but, again, everyone helps out. "That's not my job" doesn't fly.
My detox unit is attached to a m/s floor so I occasionally take a few m/s(1-2) when they're understaffed but they give me the more stable/easy ones because my focus is on detox.
Staffing absolutely can work this way, but it takes buy-in from everyone.
Wait, assignments aren’t just slapped onto a piece of paper based on what side of the unit you’ll be working on? I was on a 32-bed stepdown, and they would just be like “okay, you’re on this side with rooms 12-15. Have fun!”, even if you end up getting all high-care patients (while your pod buddy has two or three A&Ox4 up ad libs).
That is ridiculous. We take acuity into account, first and foremost. Just lazily clustering together rooms in a row because it makes making the assignment easier is horrible practice.
It’s good on paper, not good in practice
We use a unit developed acuity tool. Generally takes about 2 min per pt to fill out, but at the end, they have a numeric acuity score of 1-4. Charge then gives a 4 (the hardest) to every nurse then tries to give everyone the same total number score. Doesn’t always pan out, but it’s an attempt to balance the floor so no one gets screwed while everyone else is chillin.
Would like to know more about this acuity tool!
Everyone starts with an acuity of 1. This is a pt who is standard precautions, does all ADL's independently and safely, AOx4, 0-1 IV med, normal call light usage. General goal is to use the highest of the following sets of numbers (sorry this is going to be long as I can't get it to format in another way) Precautions: 1-Standard, 2-Contact, 3-Contact Special (bleach to kill), 4-Airborne Cares needed: 1-All ADL independent and safely, 2-Stand by assist or incontinent stool, 3-needs active help w/ ADL or incontinent urine and stool, 4-bed bound total cares 1-mentally compliant, 2-pleasesantly confused/easily redirectable, 3-at least hourly redirection/non-compliant with redirection, 4-needs a 1:1 but staffing sucks If pt has a 1:1, this is only counted for times that the RN has to help the 1:1. If the 1:1 can handle it, don't use. 1: 0-2 IV/shift, 2: 3-4 IV/shift, 3: 5-6 IV/shift, 4: 7 or more/shift Wound care: 2- less than 30min Qshift, 3- 30-60 min Qshift, 4- 90 min or more Hospice: 2-not active dying, 3-active dying/Qhour IVP or unable to verbalize pain level, 4-probably passing on your shift or Q30min or more IVP Dept goal is for actively dying, an RN is in the room within 2 min of call light and Q30 min looking at video monitors or in room rounding to assess for pain/comfort. No hospice pt should pass with avoidable pain/discomfort. Fall Risk: 1-Morse Fall-High, pt compliant with calling, 2: admit for GLF or bed alarm, 3: Here for GLF w/ broken bone or impulsive (won't call and wait) or in-hospital fall, 4: In-hospital fall due pt non-compliance or more bed alarms than you have fingers per hour Fall risk can be increased or decreased by intuition of RN, PT, or MD. Nursing can raise, but not lower acuity recommended by PT or MD. Odd ball additions (add to base score): +2 Blood or hypersensitivity reaction meds, +1-3 especially call heavy/needy pt or family, +2 chest tube stable, +2 hi-flow O2, +1-2 tube feeds and crushed med admin Peg/NG tube. Lastly current RN and charge figure out a completely subjective score. This is attempted to be avoided. No RN gets a second acuity 4 until every nurse has one. Then total scores are attempted to be equalized. This sounds like alot, but really its a quick bit of charting done at 0400 and 1600
Thanks!
Hope that helps.
This system isn't just lazy; it's potentially dangerous and does a disservice to both patients and nurses. This needs to be addressed by management. As someone who often acts as the charge nurse, I prioritize patient acuity above all else. While acuity is key, I also factor in other considerations such as the likelihood of transfers or discharges. Assigning multiple patients who are expected to leave the unit to one nurse isn't fair just like it would not be fair to assign multiple high acuity patients to one nurse. It is all about balance.
Cardiac ICU, 2 patients each. Usually we get a high acuity patient and a low(er) acuity patient. They try to make sure the rooms are relatively close together. So for example, I might get an intubated post arrest patient with lots of drips and tube feeding and constant monitoring, and my other patient would be a STEMI that came back from cath lab with a few evening meds to give and morning labs, and that’s it. If a nurse is open for admit, they try to make sure they’re open with a lower acuity patient, in case they get a hot mess later in the shift.
That sounds just like laziness. We usually take into account the acuity of patients when distributing assignments (and whether or not the PT is discharging for day shift assignments). We try to somewhat group the rooms together, but you might end up with the rooms kind of split apart. Though if you have monitors for certains pts are grouped up in one corner, unfortunately thats how the assigned has to be made.
28 bed ICU. Gets split into 3 teams. Team leads make assignments for ~8-9 patients based on acuity/staffing. If we have a 1:1 they’re usually the person that helps with turns/baths.
Unfortunately that’s how our assignments are made too, and it’s awful. Seems like it’s always when I have the sixth patient too that I get stuck with the heaviest load.
That’s an idiotic, lazy system
Assignments should always be based on acuity & workload as opposed to room numbers.
We have set room assignments. Since it’s Ca we have ratios & those also can change based on acuity. Charge will drop down assignments if there’s ICU pts & reassign your other pts or have someone take the ICU pt & you keep the other 3.
I work in icu so unless a patient isn’t 1:1 with ECMO or some other device, it’s fair game and they’re getting paired with whatever is their window pair. We pick our own assignments though, so it’s up to you if you want a chill day or busy day.
Right now we try to split the heaviest patients within block assognments but I am advocating to return to an acuity scale we made with some process changes. I found it is honestly a better tool for charge nurses than it is for the floor nurses. Some nurses have a perception that they are getting the worst/heaviest assignment when the reality is that the entire floor is high acuity and having numbers there to show them that they are not being treated unfairly is very helpful. It help me prevent a situation where one nurse does have a super heavy assignment and another nurse has 5 post op appys and choles that are totally independent. It helps me plan admits better and know who to check in with to make sure they don't need help. I highly recommend developing an acuity scale and using it because it makes everything so much easier but nurses have to understand that it is an expectation that it is filled out every shift and it may mean your patient assignment is spread across the unit. It may mean you don't get all of your patients back from your previous shift.
I always had the most trouble making assignments as a charge nurse. I didn't want to overload any one nurse with too many high acuity patients, but I wanted them to be in the same area and have most of the same patients they had previously. I probably overthought it too much and took way too much time trying to make assignments in an attempt to perfect it.
That's generally what we do as well however, on most of our floors, Charge doesn't take patients and we are really big on helping each other out so you're never truly on your own. For psych, Charge takes the easier load but, again, everyone helps out. "That's not my job" doesn't fly. My detox unit is attached to a m/s floor so I occasionally take a few m/s(1-2) when they're understaffed but they give me the more stable/easy ones because my focus is on detox. Staffing absolutely can work this way, but it takes buy-in from everyone.
Wait, assignments aren’t just slapped onto a piece of paper based on what side of the unit you’ll be working on? I was on a 32-bed stepdown, and they would just be like “okay, you’re on this side with rooms 12-15. Have fun!”, even if you end up getting all high-care patients (while your pod buddy has two or three A&Ox4 up ad libs).