charge nurse assignment sheet

Charge Nurse Report Sheet

Gather initial report from previous shift charge nurse, review all patients' data including medical status and care plan.

• 1 Patient 1
• 2 Patient 2
• 3 Patient 3
• 4 Patient 4
• 5 Patient 5

Identify high-risk patients requiring additional monitoring or intervention

Update patient progress notes, assess staffing resources for the current shift.

• 2 Short-staffed
• 3 Overstaffed
• 4 Uncertain

Determine patient assignments for nurses based on acuity and staff expertise

Coordinate patient transport for tests, surgeries or other procedures, communicate critical patient information to nurses and physicians, identify potential patient discharges and transfers, approval: patient care procedures.

• Update patient progress notes Will be submitted
• Determine patient assignments for nurses based on acuity and staff expertise Will be submitted
• Coordinate patient transport for tests, surgeries or other procedures Will be submitted
• Communicate critical patient information to nurses and physicians Will be submitted
• Identify potential patient discharges and transfers Will be submitted

Prioritize care activities based on patient needs and staff availability

• 1 Administer medications
• 2 Perform wound dressings
• 3 Monitor vital signs
• 4 Assist with mobility
• 5 Provide patient education

Monitor treatment plans and adjust as required

Identify any patients requiring specialist consultation, review lab test results and report significant changes to physicians, coordinate with other departments as necessary for patient care.

• 2 Radiology
• 3 Social Services
• 4 Nutrition
• 5 Physical Therapy

Approval: Treatment plan adjustments

• Monitor treatment plans and adjust as required Will be submitted
• Identify any patients requiring specialist consultation Will be submitted
• Review lab test results and report significant changes to physicians Will be submitted
• Coordinate with other departments as necessary for patient care Will be submitted

Update patient families about the patient condition and progress

Prepare the end of shift report for the next charge nurse, discuss concerns and suggestions for patient care with head nurse, take control of your workflows today., more templates like this.

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• South Dakota Nurse November 2018 issue is now available.

8 Steps for Making Effective Nurse-Patient Assignments

This article appears on page 14 of

South Dakota Nurse November 2018

Reprinted from American Nurse Today

Successful assignments require attention to the needs of both nurses and patients.

YOUR MANAGER wants you to learn how to make nurse­ patient assignments. What? Already? When did you be­came a senior nurse on your floor? But you’re up to the challenge and ready to learn the process.

Nurse-patient assignments help coordinate daily unit activities, matching nurses with patients to meet unit and patient needs for a specific length of time. If you are new to this challenge, try these eight tips as a guide for making nurse-patient assignments.

1. Find a mentor

Most nurses learn to make nurse-patient assignments from a colleague. Consider asking if you can observe your charge nurse make assignments. Ask questions to learn what factors are taken into consideration for each assignment. Nurses who make assignments are aware of their importance and are serious in their efforts to consider every piece of information when making them. By asking questions, you’ll better understand how priorities are set and the thought that’s given to each assignment. Making nurse-patient assignments is challenging, but with your mentor’s help, you’ll move from novice to competent in no time.

2. Gather your supplies (knowledge)

Before completing any nursing task, you need to gather your supplies. In this case, that means knowledge. You’ll need information about the unit, the nurses, and the patients. (See What you need to know.) Some of this information you already know, and some you’ll need to gather. But make sure you have everything you need before you begin making assignments. Missing and unknown information is dangerous and may jeopardize patient and staff safety. The unit and its environment will set the foundation for your assignments. The environment (unit physical layout, average patient length of stay [LOS]) defines your process and assignment configuration (nurse-to-patient ratios). You’re probably familiar with your unit’s layout and patient flow, but do you know the average LOS or nurse-to-patient ratios? Do you know what time of day most admissions and discharges occur or the timing of certain daily activities? And do other nursing duties need to be covered (rapid response, on call to another unit)? Review your unit’s policy and procedures manual for unit staffing and assignment guidelines. The American Nurses Association’s ANA ‘s Principles for Nurse Staffing 2nd edition also is an excellent resource.

Review the assignment sheet or whiteboard used on your unit. It has clues to the information you need. It provides the framework for the assignment-making process, including staff constraints, additional duties that must be covered, and patient factors most important on your unit. Use the electronic health record (EHR) to generate various useful pieces of patient information. You also can use the census sheet, patient acuity list, or other documents of nursing activity, such as a generic hospital patient summary or a unit-specific patient report that includes important patient factors.

Depending on your unit, the shift, and the patient population, you’ll need to consider different factors when making assignments. Ask yourself these ques­tions: What patient information is important for my unit? Does my unit generate a patient acuity or work­load factor? What are the time-consuming tasks on my unit (medications, dressing changes, psychosocial support, total care, isolation)? Which patients require higher surveillance or monitoring? Finally, always talk to the clinical nurses caring for the patients. Patient conditions change faster than they can be documented in the EHR, so rely on the clinical nurses to confirm each patient’s acuity and individual nurses’ workloads. Nurses want to be asked for input about their patients’ condition, and they’re your best resource.

Now ask yourself: How well do I know the other nurses on my unit? This knowledge is the last piece of information you need before you can make assignments. The names of the nurses assigned to the shift can be found on the unit schedule or a staffing list from a centralized staffing office. If you know the nurses and have worked with them, you’ll be able to determine who has the most and least experience, who’s been on the floor the longest, and who has specialty certifications. You’ll also want to keep in mind who the newest nurses are and who’s still on orientation.

3. Decide on the process

Now that you’ve gathered the information you need, you’re ready to develop your plan for assigning nurses. This step usually combines the unit layout with your patient flow. Nurses typically use one of three processes–area, direct, or group–to make assignments. (See Choose your process.)

4. Set priorities for the shift

The purpose of nurse-patient assignments is to provide the best and safest care to patients, but other goals will compete for consideration and priority. This is where making assignments gets difficult. You’ll need to consider continuity of care, new nurse orientation, patient requests and satisfaction, staff well-being, fairness, equal distribution of the workload, nurse development, and workload completion.

5. Make the assignments

Grab your writing instrument and pencil in that first nurse’s name. This first match should satisfy your highest priority. For example, if nurse and any other returning nurses are reassigned to the patients they had on their previous shift. If, however, you have a complex patient with a higher-than-average acuity, you just assigned your best nurse to this patient. After you’ve satisfied your highest priority, move to your next highest priority and match nurses with unassigned patients and areas.

Sounds easy, right? Frequently, though, you’ll be faced with competing priorities that aren’t easy to rate, and completing the assignments may take a few tries. You want to satisfy as many of your priorities as you can while also delivering safe, quality nursing care to patients. You’ll shuffle, move, and change assignments many times before you’re satisfied that you’ve maximized your priorities and the potential for positive outcomes. Congratulate yourself–the nurse-patient assignments are finally made.

6. Adjust the assignments

You just made the assignments, so why do you need to adjust them? The nurse-patient assignment list is a living, breathing document. It involves people who are constantly changing–their conditions improve and deteriorate, they’re admitted and discharged, and their nursing needs can change in an instant. The assignment process requires constant evaluation and reevaluation of information and priorities. And that’s why the assignments are usually written in pencil on paper or in marker on a dry-erase board. As the charge nurse, you must communicate with patients and staff throughout the shift and react to changing needs by updating assignments. Your goal is to ensure patients receive the best care possible; how that’s ac­complished can change from minute to minute.

7. Evaluate success

What’s the best way to eval­uate the success of your nurse-patient assignments? Think back to your priorities and goals. Did all the patients receive safe, quality care? Did you maintain continuity of care? Did the new nurse get the best orientation experience? Were the assignments fair? Measure success based on patient and nurse outcomes.

Check in with the nurses and patients to get their feedback. Ask how the assignment went. Did everyone get his or her work done? Were all the patients’ needs met? What could have been done better? Get specifics. Transparency is key here. Explain your rationale for each assignment (including your focus on patient safety) and keep in mind that you have more information than the nurses. You’re directing activity across the entire unit, so you see the big picture. Your colleagues will be much more understanding when you share your perspective. When you speak with patients, ask about their experiences and if all their needs were met.

8. Keep practicing

Nurse-patient assignments never lose their complexity, but you’ll get better at recognizing potential pitfalls and maximizing patient and nurse outcomes. Keep practicing and remember that good assignments contribute to nurses’ overall job satisfaction.

What you need to know

Before you make decisions about nurse-patient assignments, you need as much information as possible about your unit, nurses, and patients.

Common patient decision factors Demographics •    Age •    Cultural background •    Gender •    Language

Acuity •    Chief complaint •    Code status •    Cognitive status •    Comorbidities •    Condition •    Diagnosis •    History •    Lab work •    Procedures •    Type of surgery •    Vital signs •    Weight

Workload •    Nursing interventions •    Admissions, discharges, transfers •    Blood products •    Chemotherapy •    Drains •    Dressing changes •    End-of-life care •    I.V. therapy •    Lines •    Medications •    Phototherapy •    Treatments •    Activities of daily living •    Bowel incontinence •    Feedings •    Total care

Safety measures •    Airway •    Contact precautions •    Dermatologic precautions •    Fall precautions •    Restraints •    Surveillance

Psychosocial support •    Emotional needs •    Familial support •    Intellectual needs

Care coordination •    Consultations •    Diagnostic tests •    Orders •    Physician visit

Common nurse decision factors Demographics •    Culture/race •    Gender •    Generation/age •    Personality

Preference •    Request to be assigned/not assigned to a patient

Competence •    Certification •    Education •    Efficiency •    Experience •    Knowledge/knowledge deficit •    Licensure •    Orienting •    Skills •    Speed •    Status (float, travel)

Choose your process

Your nurse-patient assignment process may be dictated by unit layout, patient census, or nurse-to-patient ratio. Most nurses use one of three assignment processes.

Area assignment This process involves assigning nurses and patients to areas. If you work in the emergency department (ED) or postanesthesia care unit (PACU), you likely make nurse-patient assignments this way. A nurse is assigned to an area, such as triage in the ED or Beds 1 and 2 in the PACU, and then patients are assigned to each area throughout the shift.

Direct assignment The second option is to assign each nurse directly to a patient. This process works best on units with a lower patient census and nurse-to-patient ratio. For example, on a higher-acuity unit, such as an intensive care unit, the nurse is matched with one or two patients, so a direct assignment is made.

Group assignment With the third option, you assign patients to groups and then assign the nurse to a group. Bigger units have higher censuses and nurse-to-patient ratios (1:5 or 1:6). They also can have unique physical features or layouts that direct how assign­ments are made. A unit might be separated by hallways, divided into pods, or just too large for one nurse to safely provide care to patients in rooms at opposite ends of the unit. So, grouping patients together based on unit geography and other acuity/workload factors may be the safest and most effective way to make assignments.

You also can combine processes. For example, in a labor and delivery unit, you can assign one nurse to the triage area (area process) while another nurse is as­signed to one or two specific patients (direct process). Unit characteristics direct your process for making assignments. Your process will remain the same unless your unit’s geography or patient characteristics (length of stay, nurse-patient ra­tio) change.

Stephanie B. Allen is an assistant professor at Pace University in Pleasantville, New York.

Selected references Allen SB. The nurse-patient assignment process: What clinical nurses and patients think. MEDSURG Nurs. 2018;27(2):77-82. Allen SB. The nurse-patient assignment: Purposes and decision factors. J Nurs Adm. 2015;45(12):628-35. Allen SB. Assignments matter: Results of a nurse-patient assignment survey. MEDSURG Nurs [in press]. American Nurses Association (ANA). ANA‘s Principles for Nurse Staffing. 2nd ed. Silver Spring, MD: ANA; 2012.

A practical guide to making patient assignments in acute care

Affiliation.

• 1 Definitive Observation Unit, Kaiser Permanente San Diego Medical Center, CA, USA. [email protected]
• PMID: 23232175
• DOI: 10.1097/NNA.0b013e3182785fff

Charge nurses have integral roles in healthcare organizations. Making patient assignments is an important charge nurse role that lacks theoretical support and practical guidelines. Based on a concept analysis of the charge nurse role, the author looks at a theory-gap analysis regarding how patient assignments are made and proposes a framework to guide the process of patient assignments.

• Continuity of Patient Care
• Nursing Staff, Hospital / organization & administration*
• Nursing, Supervisory
• Patient Safety
• Personnel Staffing and Scheduling*
• Planning Techniques*
• United States

What works: Equitable nurse-patient assignments using a workload tool

One unit’s experience developing and implementing a process change.

• Implementation of a workload tool can promote equitable workloads and improve perceived nurse satisfaction.
• Continuous collaboration within the multi-levels of leadership and bedside nurses is essential to improve compliance.
• Sufficient time is needed to allow the workload tool to be incorporated into standard practice.

Nurses on a 36-bed medical/surgical telemetry unit in a metropolitan hospital expressed frustration with their nursing workload. Many of them felt that the time needed to safely care for their patients wasn’t always considered when nurse-patient shift assignments were made. The nurses also voiced concerns about unfair assignments.

To address this problem, two bedside nurses (O’Connell and Nettleton), launched a project to understand the problem of unsafe and unfair patient assignments and the benefits of using a workload tool to equalize them. During our literature review, we discovered a simple one-page tool (Kidd and colleagues, 2014, myamericannurse.com/wp-content/uploads/2014/03/ant3-Workforce-Management-Acuity-304.pdf , see the second page of the article) that classifies nursing workload into a rating system that the charge nurse uses before change of shift to make assignments based on individual patient scores. Here is how we successfully adapted and implemented the tool to improve staff satisfaction.

Uncovering the evidence

Over the past 15 years, advances in technology and documentation have added to nursing responsibilities. Research shows that extensive workloads can cause nurses to feel a loss of control, overwhelmed, and stressed. Improved workload management may reduce stress and its negative impact on nurses, leading them to work with a higher level of integrity and loyalty to their organization.

Research indicates that using a workload tool can help promote equitable nurse-patient assignments, which may improve nurse job satisfaction. During our literature search, we discovered several studies found that nurses believed their assignments were more fair after implementing a workload tool. For example, a study by Firestone-Howard and colleagues suggests that nurse input on their assignments improved verbal communication and increased job satisfaction. When management engages nurses to participate in patient assignments, they feel their value is being acknowledged and that they’re part of a team, which can enhance unit camaraderie.

What we did

We introduced the 2014 paper acuity tool to the unit nurses, giving them ample time to review it. We then deployed an email survey via SurveyMonkey.com to evaluate nurses’ perceived workload distribution and job satisfaction. Included in the survey were open-ended questions asking about their current nursing assignments and suggestions for revising the sample tool to make it unit specific.

After reviewing the presurvey results, we revised the initial workload tool to meet the staff’s suggestions by deleting and adding tasks pertinent to the unit. After revisions were made, we led brief educational sessions on the unit at various times to accommodate all shifts. In these sessions, we taught nurses how to use the revised workload tool and used a case scenario to demonstrate its proper use. In our check-ins during the initial training, we found that bedside nurses were excited and willing to be actively involved in the entire change process, which at times led us to make additional unit-specific revisions to the tool.

Throughout the 12-week project, nursing staff shared suggestions for improving the tool and identified the need for an additional revision to it, including the addition of another level to the scoring system. At the end of the 12 weeks, we deployed another survey to re-evaluate nurses’ perceived workload distribution and job satisfaction.

Before implementing the workload tool, 28% of nurses felt their assignments were fair and equal compared to 57% postimplementation. The tool was being used nearly 52% of the time; when it was used, 70% of nurses felt that it helped equally distribute nurse-patient assignments. Postimplementation data analysis demonstrated a 34% increase in satisfaction with the distribution of patient workload in nurses’ daily assignments.

Initial successes and challenges

The high level of staff nurse and leader engagement in this project was remarkable, which suggests two things. First, the problem of unfair and unsafe patient assignments is a shared and prevalent problem. Bedside nurses who feel the stress of burdensome workloads were invested in trying to fix the problem. Second, management wanted to hear from them.

Bedside nurses are crucial to patient safety, so they must be included in any change process. Their input and engagement can make all the difference in the success of a project. Involving them helps improve nurse satisfaction, communication, and collaboration, all of which has an impact on patient safety.

Although the workload tool improved nurse satisfaction, some nurses felt that because it was on paper it added to their already busy schedules. We know this can lead to nonadherence, so the next step will be to see if the tool can be incorporated into the electronic health record.

We also may have initially underestimated the fear that change can produce. Implementing any new project can make staff feel uneasy. Anticipating this uneasiness, we used engagement strategies—such as acknowledging the staff’s involvement in the change process, remaining transparent throughout, and providing support when needed—to get ready for the change ahead, but we realize that more effort in this area would have been helpful.

What we learned

Collaboration between bedside nurses and all levels of leadership was essential to successfully implement the workload tool. We don’t know yet whether it will be fully adopted on our unit, but we gained some unexpected knowledge about change and its effects on staff.

We were reminded to be patient and understanding. Sufficient time is key for change to be incorporated into standard practice. When relationships are built based on trust and respect, participants will reciprocate with honest feedback. Including bedside nurses in decisions about future change will promote an eagerness to participate in creating a stronger community on the unit.

Nurses’ time is valuable, so education and training should accommodate their schedules. Using email, SurveyMonkey, and the TigerText app made communication easy and allowed us to reach nurses who couldn’t attend trainings or check-ins on their off days.

With collaboration, patience, trust, respect, and open communication, the change process can result in improved care quality and nurse work satisfaction.

Amanda L. O’Connell is a float pool nurse at Trinity Health Of New England Saint Francis Hospital and Medical Center in Hartford, Connecticut. Rita M. Nettleton is a medical/surgical staff nurse at Charlotte Hungerford Hospital in Torrington, Connecticut. Dawn R. Bunting is an adjunct professor at the University of Hartford in West Hartford, Connecticut, and nursing division director at Capital Community College in Hartford, Connecticut. Susan Eichar is an associate professor at the University of Hartford in West Hartford,  Connecticut.

Chiulli KA, Thompson J, Reguin-Hartman KL. Development and implementation of a patient acuity tool for a medical-surgical unit. MedSurg Matters . 2014;23(2):1,9-12. amsn.org/sites/default/files/private/medsurg-matters-newsletter-archives/marapr14.pdf

Ericksen K. Nursing burnout: Why it happens and how to avoid it. Rasmussen College. February 27, 2018. rasmussen.edu/degrees/nursing/blog/nursing-burnout-why-it-happens-and-what-to-do-about-it

Firestone-Howard B, Zedreck Gonzales JF, Dudjak LA, Ren D, Rader S. The effects of implementing a patient acuity tool on nurse satisfaction in a pulmonary medicine unit. Nurs Adm Q. 2017;41(4):E5-14.

Hairr DC, Salisbury H, Johannsson M, Redfern-Vance N. Nurse staffing and the relationship to job satisfaction and retention. Nurs Econ . 2014 ; 32(3):142-7.

Harper K, McCully C. Acuity systems dialogue and patient classification system essentials. Nurs Adm Q . 2007;31(4):284-99.

Kidd M, Grove K, Kaiser M, Swoboda B, Taylor A. A new patient-acuity tool promotes equitable nurse-patient assignments. Am Nurse Today . 2014;9(3):1-4.

Lowe M, Santamaria N, Tacey M, Rowe L. Nursing absenteeism following the introduction of the Northwick Park Dependency Scale Hospital version (NPDS-H) in the rehabilitation setting. Australas Rehabn Nurses Assoc J . 2015;18(1):11-7.

MacPhee M, Dahinten VS, Havaei F. The impact of heavy perceived nurse workloads on patient and nurse outcomes. Adm Sci . 2017;7(1):7.

Thomasos E, Brathwaite EE, Cohn T, Nerey J, Lindgren CL, Williams S. Clinical partners’ perceptions of patient assignments according to acuity. MedSurg Nurs . 2015;24(1):39-45.

Vortherms J, Spoden B, Wilcken J. From evidence to practice: Developing an outpatient acuity-based staffing model. Clin J Oncol Nurs. 2015;19(3):332-7.

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