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 Nursing Standards > You Asked Us 

 Last modified May 18, 2004  

Nurse-Client Assignment

Q

As an RPN, I was always assigned four clients in a ward room and another one or two clients in a semi-private room. Recently, the nurse who makes the assignments isn't doing it based on room numbers and I now have clients in different rooms. Why would she change the way client assignment is done?

A

Nurse-client assignments are based on client complexity, environmental supports and the availability of consultation between nurses. Assignments based on bed or room number clearly are not setting the client's needs or complexity as the priority and are, therefore, not client-focused. Some clients on a particular unit or even within one room may have more complex nursing needs than their room mates.

CNO's document Utilization of RNs and RPNs practice guideline states that RNs can autonomously meet nursing needs of a range of clients, including complex clients. RPNs autonomously meet the needs of less complex clients. When an RPN cares for more complex clients, it's done in consultation with RNs and/or other health professionals. The availability of consultative resources can vary from shift to shift or from weekday to weekend. This changes how assignments are made. For example, an RPN may be assigned a moderately complex client on Friday when an RN resource is available. When the RPN returns to work on Saturday, and no RN resource person is available, she/he is assigned to a less complex client who she/he is able to care for autonomously.

The last factor to consider is the availability of environmental supports. Are there clear policies that guide nursing practice? Are there care pathways and medical directives that help nurses with decision-making? Are there clear and easy-to-use assessment tools? Also, is there support in the form of time and expertise for consultation as required for all nurses? Answering these questions will help determine the stability of the environment.

 

Reference

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