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Charge nurse getting a 4 patient assignment
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<Luca>
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Was speaking with a nurse the other day from one of the bigger companies. She told me she is being told it is now standard to have a 4 pt assignment and also be in charge. I think the clinic is around a 16 station clinic, so that would be 2 nurses and 2 techs for 16 patients. Assesing, doing meds, dealing with problems. rounding with/calling doctors, and having to deal with a 4 and 4 assignment seems to be a little extreme. I know about bundling and everything, but that just doesnt sound safe to me. Is this now standard practice? .... just seemed kind of scary to me...
 
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It sounds like you're not getting the whole story. It's not only not standard practice but, it's against regulations. Per CMS guidelines, if there are 9 or more patients, there must be a dedicated "charge" nurse. If there are less than 9 patients, the "charge" nurse can have a patient assignment.

Chuck


DISCLAIMER : My opinions and views are mine and may not be the same as my employer.
 
Posts: 1787 | Location: Baltimore, MD USA | Registered: 24 October 2001Report This Post
<guest rn>
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Chuck,
Where can one find these regulations?
 
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<old school>
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Rare to see an RN take 4 patients.Refer to your state regulations for this one.CMS V757 requires an adequate number of qualified personnel be present when patients are being dialyzed.Usually clinics will use an Lpn or Dialysis tech to take the other patients.Most clinics do not require the CHARGE NURSE to monitor patients,those who do get burned out and leave..
 
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<Luca>
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Chuck,

I'm sure there are times when she only has to take care of 2 or 3 patients, but she has had 4 and 4 assignments in the past. I was always under the impression that the charge nurse shouldn't have any patients, especially if there are over 10 patients in the facility, but I'm not seeing anything that says it is illegal to do so. If you have any info like that. I would love to see it. I looked up CMS V757, and it doesnt say anything about it being against regulations.
 
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I can't find it in the CfC either, it may be a state specific thing though I can't find it on the MD Commission on Kidney Disease site either. I do know that we had been cited for it in the past so, I will try to find it next week when I'm back in the office.

Chuck


DISCLAIMER : My opinions and views are mine and may not be the same as my employer.
 
Posts: 1787 | Location: Baltimore, MD USA | Registered: 24 October 2001Report This Post
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My apologies, it is a Maryland specific regulation. COMAR 10.05.04.06 section C which reads.....

Dialysis Monitoring.

(1) Staffing Ratio.

(a) The monitoring individual-to-patient ratio at each center shall be a minimum of one staff member to three participants and staffing shall be sufficient to meet the needs of patients.

(b) The center shall establish provisions for back-up staff coverage during unexpected illnesses, vacations, and holidays.

(c) The charge nurse may not be included in the staffing ratio except:

(i) When there are nine or fewer patients; or

(ii) In the event of an emergency.

Chuck


DISCLAIMER : My opinions and views are mine and may not be the same as my employer.
 
Posts: 1787 | Location: Baltimore, MD USA | Registered: 24 October 2001Report This Post
<guest rn>
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Well hooray for Maryland. To bad the other states don't get onboard. I know in my area I hear of not only the charge RN having patient assignments but also the Nurse Manager works the floor frequently as well. As stated above, this leads to burn-out and loss of good nurses. I am afraid as financial pressures continue to rise, this will only get worse.
 
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