‘Toxic Nursing’: Dealing with unfair patient assignments


Patient load checklist

iStockphoto | ThinkStock + Scrubs

In the Spring 2014 issue of Scrubs (get your copy here!), we gave you an in-depth look at incivility in the hospital with “Toxic Nursing.”

Now we’re sharing more on this subject with in-depth look at coping with unfair patient assignments.

Linda’s first job out of nursing school is at a private, for-profit hospital in Southern California. She likes her job, but after a while, she starts to notice that her patient load is harder than most.

Linda talks with Jane, another new-grad nurse, and says, “I would come in a few minutes before my shift began and discover that my patient load was way, way harder than that of my colleagues.” Jane and Linda eventually realize that the experienced nurses are coming in for the shift early and switching around the patient load, intentionally giving the nurses who came in later the harder patients.

Jane is trying to give her colleagues the benefit of the doubt and tells Linda that she doesn’t think the senior nurses are intentionally trying to be cruel. Linda’s perspective is less rosy. She replies, “Maybe not, but they totally know they’re screwing someone over, making their day way harder.” Linda goes on to say, “It’s especially inconsiderate because I’m a new graduate, and they should have been helping me, not taking advantage of my ignorance and naiveté! I think what really upsets me is that they don’t feel any allegiance to the team at all. They are just looking out for themselves.”

Expert Commentary

Linda and Jane need to jointly bring their concerns to their manager. The manager can do some investigation to see if Linda and Jane’s perceptions are accurate. If the manager determines that Linda and Jane are indeed getting all the hard patients, he or she should take action.

Another thing the manager can do is provide a unit-wide mandatory in-service on mentoring and supporting new employees. New nurses could be assigned a designated mentor and champion who could help them with issues like the ones that Linda and Jane are facing. It might be necessary to draw up formal expectations regarding assignments for new nurses (for example, no more than one patient who is high acuity for the first 3 months). If the problem continues, a neutral party, such as a charge nurse on the previous shift, could be appointed to make the assignments, which are not subject to change by the nurses on the oncoming shift.
–Susan Johnson

After Jane and Linda share their concerns with the nurse manager, who can then monitor how work is being distributed. If their beliefs are legitimate, the manager needs to address the issue directly with those nurses who are taking advantage of Jane and Linda. It doesn’t matter if you’re new or experienced; what they’re doing is taking advantage of their coworkers.

The thing that concerns me is that whoever made the assignments originally had a rationale for the way he or she did it; when other nurses change it, that’s disrespectful to the scheduler. If the nurse manager made the assignments and assumed they were implemented as he or she created them, it will be a shock to discover they were altered.

If this practice continues, and the nurse manager is never made aware of what’s going on, nothing will change. How the nurses approach him or her is critical, however. Maybe Jane and Linda could say, “I’m not sure if you’re aware that after the assignments are made, they’ve been adjusted. If you’re OK with this practice, that’s fine, but we weren’t sure if you knew this was happening.”

The nurses who are making the changes need to be aware that if you’re treating someone else unfairly, eventually the same thing will come back to you. It all goes back to what is fair.
–Kathy Curci


How are patients assigned in your unit? Do unit politics make their way into the patient assignment? If so, what can you do to try to avoid this?

Do the nurses on your unit feel like patients are assigned in a fair way? Have you ever asked them? Do they have any ideas about how to make sure assignments are equitable?

Adapted with permission from Toxic Nursing by Cheryl Dellasega, PhD, RN, CRNP, and Rebecca L. Volpe, PhD. Published 2013 by The Honor Society of Nursing: Sigma Theta Tau International.

This is part seven of nine; don’t miss parts one, two, three, four, fivesix, eight and nine!

Scrubs Contributor
We welcome your ideas and submissions to Scrubs Magazine! Here's how to submit your own story or story idea to our editors.

    Scrubs Caption Contest! – April 21, 2014

    Previous article

    5 best apps for a healthy mind

    Next article

    You may also like

    More in Scrubs