If you’re a charge nurse, you know making patient assignments is stressful. Call bells light up the hallways like Christmas trees, family members ask for patient updates, and nursing staff make specific assignment requests. All you want to do is take care of patients, but you have to consider such questions as, “What about all the new admissions?” “Where will all these patients go?” “Who’s going to take care of them?”
Every day, charge nurses face the daunting task of balancing the unit’s budget with ensuring safe patient care. At the same time, they’re aware of the organizational push to increase staff and patient satisfaction. Balancing these sometimes competing needs can be difficult.
Most people agree that nurse staffing aims to match registered nurse (RN) expertise with patients’ needs. But staffing is fluid, which creates a challenge not just for nurses but also for patients. Consider the patient who has a different nurse every day, missing out on continuity of care.
A solid staffing plan with proper communication is the basic tool for success, for both individuals and the organization. The American Nurses Association (ANA) outlines principles for nurse staffing in the following areas:
- characteristics of patients and family members
- characteristics of RNs and other staff
- organizational and workplace culture
- practice environment
- staffing evaluation.
Think of these five principles as tools you can apply to your staffing decisions and, on a larger plane, help ensure the organization’s overall staffing plan is effective.
1 Assess characteristics of patients and families
Each unit has a unique set of patients and their families. While making assignments, first consider each patient’s clinical needs (such as acuity and functional ability) and family needs, such as education. Also consider patients’ room locations to avoid (if possible) having nurses walk from one end of the unit to another.
Try to give patients the best experience possible. Determine what matters most to them. Most important, view the patient and family members as individuals.
2 Assess staff skills
Once you’ve identified patient needs, consider characteristics of each nurse. Keep in mind that each nurse has a unique set of clinical skills, personality, and strengths and expresses these characteristics differently. Consider completed competencies, years of experience, culture, and emotional intelligence. Patricia Benner’s stages of clinical competence from novice to expert can help guide this assessment and should factor into your assignments. For example, if a nurse has been in clinical practice for only 2 years, she is unlikely to be an expert, so she shouldn’t be assigned the most complicated patient on the unit.
Also assess the skills, personality, and strengths of other staff, such as certified nursing assistants and licensed practical nurses. In this case, it’s especially important to be aware of each staff member’s scope of practice.
Managing the various characteristics of bedside nurses and other staff can be challenging. It’s a developed talent that doesn’t come easily to everyone. Also, you may need to overcome a perception of favoritism toward certain staff members. Remember—your decisions may not always be popular, but being an effective leader doesn’t always mean you’ll be liked by all.
3 Understand the culture
As a charge nurse, you’re a frontline leader—the first reflection of your organization—and you need to ensure you are meeting the organization’s goals and values. Each unit functions differently, but the charge nurse’s role is to make the unit run smoothly. Organizational success depends on charge nurses to execute this function well and help ensure staff are competent. A competent staff makes patient assignments easier.
Of course, your organization has a responsibility to support you in your efforts by providing such elements as orientation, ongoing education, and time to supervise other staff.
4 Consider the practice environment
Practice environment can be considered from an organizational and an individual perspective. For example, your organization should create an environment where nurses can practice autonomously; but as a charge nurse, you’re also responsible for creating a safe, positive work environment. One way to accomplish this is to build strong relationships, based on trust, with nurses and other staff through open communication. Sometimes you may need to explain constraints related to assignments; most staff members aren’t familiar with such terms as care hours, earned hours, or actual hours. If you don’t know these terms, work with your supervisor to learn more about them.
In addition, the care environment should remain calm even in the midst of chaos. As a charge nurse, you must lead the tone for the unit and establish the appropriate environment. Remain calm and coach others to do the same.
The bottom line: Staff should feel they’re working in a safe and fair environment. If they do, they’ll be more likely to embrace their assignments.
5 Evaluate staffing plans
As we all know, patient census fluctuates regularly on nursing units, and patient acuity can change quickly. Your staffing plan for the shift needs to remain flexible; you should reevaluate it on a regular basis. As needed, tap into experts, such as shift supervisors.
The ANA staffing principles focus on a more global level, but you can help there as well. Consider working with your supervisor to help evaluate overall staffing plans based on such factors as patient outcomes, use of supplemental staffing, and nurse and patient satisfaction. You might also want to start an RN-driven staffing committee, which allows bedside nurses to voice their opinion and have a say in nursing productivity.
Meeting the challenge
Making patient assignments can be challenging for the charge nurse. Using the tools described in this article can help you make optimal assignments to benefit both staff and patients.
The authors work in Delray Beach, Florida. Sarah Siebert is director of nursing at Pinecrest Rehabilitation. Jennifer Chiusano is chief nursing officer at Delray Medical Center.
American Nurses Association. Nurse Staffing. 2015. http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Nurse-Staffing
American Nurses Association. ANA’s Principles for Nurse Staffing. 2nd ed. ANA: Silver Spring, MD; 2012.
Marine K, Meehan P, Lyons AC, Curley MA. Inequity of patient assignments: fact or fiction. Crit Care Nurse. 2013;33(2):74-7.
Weston MJ, Brewer KC, Peterson CA. ANA principles: the framework for nurse staffing to positively impact outcomes. Nurs Econ. 2012;30(5):247-52.
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