The Patient Perspective: Nursing Assignments – On Caring and Grief
Empower yourself to be the best healthcare advocate possible.
Sign-up to receive logistical advice on how to navigate the world of healthcare and grief.

The Patient Perspective: Nursing Assignments

  posted on:  November 9, 2016

With the exception of Pawn Stars, Flipping Out, and Wahlburgers, I’m not a fan of reality TV. Okay, so maybe that’s a bit of a lie. I do like a little reality TV, just not the obnoxious shows. You know the ones I’m talking about…

Anyway, my all time favorite reality show is NY Med. NY Med is a documentary-like series following ER nurses and doctors at hospitals in NYC and NJ. Unfortunately, NY Med is no longer on, but when it was, I watched it religiously, mostly because of one of the show’s featured nurses, Katie Duke. I loved Katie’s energy, specifically her motto, “deal with it.” That motto stuck with me in the early days of K’s cancer diagnosis. It still does, to be honest, which is why I continue to follow Katie on social media, including her YouTube show on the Scrubs Beat channel.

What does any of this have to do with Nursing Assignments?

I recently watched an old episode (#58) of The Katie Duke Show. In this episode, Katie and her guest, Kati Kleber, author of the blog Nurse Eye Roll, talked about patient assignments. Specifically, they debated if assignments should be made based on the number of patients needing nursing care or by acuity. Thankfully, they both agreed that the patient-nurse ratio should be based on acuity. I say thankfully because, I mean, why would it be any other way?

Think about it. Why should a patient who does not need a lot of care, but obviously needs some care  be forced to…take a backseat because his or her nurse has another patient who really requires 1:1 care?  And vice versa?

Why am I so interested in this?

Obviously because of K’s experience. But also because of the numerous hospitalizations I’ve experienced with other close family members. Between the two, I’ve seen a lot. A lot that has convinced me that making nursing assignments based on acuity is the only way to make assignments, and will always be my expectation as a healthcare consumer, whether as a caretaker or a patient.

Here’s a scenario that describes why I’m for assignments based on patient acuity.

During his stay, K had a major open wound that…well, had a lot of output (we’ll keep it at that) and required a lot of nursing care to keep it and the skin around the wound clean. When the dressing  leaked (and believe me when I tell you it leaked a lot), he would be laying in liquid that was really bad for his skin. Laying in it too long could have caused his skin to break down, which could have led to an infection, and on and on and on.

In the SICU, where K was for the first 4 months of his hospitalization, he obviously had 1:1 care. During that time, we never thought much about what life would be like on the floor where nurses have two to three (I believe) patients at a time, give or take.

Unfortunately, K’s original move to the floor did not go well. The dressing would not hold and his nurse, who I will call “Charlie,” was in his room for what felt like at least 8 of his 12 hour shift (again, give or take) trying to keep K and his skin dry. K just wasn’t ready for the floor from a wound perspective, yet there he was.

We were fortunate that Charlie was able to spend that much time in K’s room. It made for a very long day for Charlie (who was still on the floor charting three hours after his shift ended) and the other nurses who had to cover for Charlie’s other patient(s), though.

And while Charlie worked hard to keep K healthy that day, I can’t help but wonder, what if? What if we had that one nurse (and really, there was only ever one nurse who, well, had a bad attitude) who wasn’t going to go above and beyond for a patient that did not belong on the floor?

Why is this even an issue?

The main reason why nursing assignments are not always made based on acuity seems pretty obvious— it’s all about reducing overhead costs. Even when institutions claim to be invested in the “patient experience,” staffing always seems to be done on the lower end of projections. But if the patient experience is really important to an institution, then nursing assignments should always be made based on acuity. It’s the ethical way to care for the patients who are dependent on others to get them well.

What can you do if you find yourself in a situation where you’re not getting the care you need?

Everyone’s situation is different, so please be sure to do what is best for you or your loved one. Based on our experience, I know that nurses work hard to provide the appropriate care to all of her/his patients. But if you feel that you or your loved one’s nurse is overloaded and that your care is being impacted, try mentioning your concern to the nurse in charge. Keep in mind, though, that the nurse in charge is usually not responsible for providing the exact number of nurses to the unit, but I’m sure she/he will do whatever they can to make you or your loved one feel safe.


I am not a healthcare professional. I am not a doctor. I am not a nurse. I am not a social worker. I am simply sharing the information learned from my own experience. Your experience is going to be different. 

By reading, and if you chose, utilizing any information, tips, etc. found on On Caring and Grief you are doing so at your own risk.

Opinions expressed here on On Caring and Grief are mine and mine alone.