NURSING PATIENT CARE POLICY & PROCEDURE
November 24, 2017
Nursing Manual (Red)
Policy #: 14.39AP
Title: Assignment of Patient Care on
Inpatient Units (Adult & Pediatric)
To provide guidance in meeting the nursing care needs of each patient through
effective assignment and utilization of nursing staff on inpatient units.
The Care Team Leader (CTL), as the clinical and operational leader for the nursing
team, coordinates team activities and ensures patient assignments that appropriately
match caregiver skills and experience and patient and family needs, and provides the
necessary guidance and support to nursing team members.
A. The CTL is responsible for making patient care assignments for team members. In
the absence of the CTL, a Senior Team Member will assume responsibility for
making assignments. The Nurse Manager is available for consultation and support
as required in making patient care assignments. In the absence of the Nurse
Manager, the Nursing Coordinator is available to help resolve any potential
dispute or difficulty arising from patient assignments. Consider the following
when making assignments:
1. Assigned clinical responsibilities are based on the staff member's
educational preparation, applicable licensing laws and regulations, and an
assessment of current competence. Factors to consider include knowledge
and skills required to make appropriate decisions regarding nursing care,
the type of technology employed in providing care and continuity of care
2. Workload distribution takes into account patient needs, admissions,
transfers and pending discharges.
3. Assignments will be adjusted during the shift based on changing priorities
related to patient and/or unit needs.
4. The CTL's patient care assignment takes into account responsibilities for
coordinating work of the team and acting as a clinical resource to team
5. Primary Nurse.
B. The Primary Nursing care delivery system is used in assignment of team members
on inpatient units.
1. Every patient will be assigned a Primary Nurse.
2. Registered nurses (RNs) will be consistently assigned to their primary
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patients, with exceptions only as approved by unit council guidelines.
3. RNs are consistently assigned as team nurses when caring for another
nurse's primary patient, with exceptions only as approved by unit council
4. The total number of RNs caring for any single patient will be kept as small
5. Patient preference will be considered whenever possible within the context
of supporting Primary Nursing and an equitable distribution of primary
and team assignments among all staff.
6. Generally, the assignment as Primary Nurse extends for a patient's entire
stay on a particular unit. However, if a patient/family requests a different
Primary Nurse, this request (after follow-up by CTL/ Nurse Manager),
should usually be granted. There may be other rare occasions when it is
appropriate to change a Primary Nurse assignment, when in the judgment
of the CTL/Nurse Manager this is in the best interests of the
7. If a patient is re-admitted to the same unit, whenever possible they should
have the same Primary Nurse.
8. See UW Health Clinical Policy 6.1.11, Preventing Non-Therapeutic
Exposure to Hazardous Drugs, for guidance on the assignment of patients
to pregnant staff.
C. In patient care assignments where the RN has the assistance of Patient Care
Technician (PCT) or Nursing Assistant (NA) staff members, the RN assigns,
plans, supervises and evaluates patient care delegated to ancillary nursing
D. Consideration is given to assignments so that risk of transmitting infection
between patients is minimized.
E. If a staff member does not feel competent or comfortable with his/her patient care
assignment the following actions should be taken:
1. Discuss assignment with the CTL to negotiate appropriate changes and/or
to establish appropriate strategies to support or assist.
2. If the CTL and the team member are unable to reach consensus on a
patient care assignment, the Nurse Manager or the Nursing Coordinator in
his/her absence will establish an appropriate course of action. Actions may
include changing the patient care assignment and/or sending the individual
to another patient care area consistent with the individual's skills and
F. Notify the Nurse Manager of actions taken to ensure an evaluation and
development of plan to meet learning or competency development needs for the
A. Assignments are made by the CTL.
B. The CTL will make adjustments to patient assignments based on changing patient
condition and/or unit activity. RN staff will communicate with the CTL re: needs
for additional assistance in completing assignments.
C. The RN assigned to supervise a nurse resident, PCT or NA staff member
establishes a mechanism for routine verbal and written communications to assist
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them (Nurse Residents, Licensed Practical Nurses, Patient Care Technicians or
Nursing Assistants) to effectively complete their patient care assignments.
D. The CTL, in collaboration with the RN and other assistive staff, observes and
evaluates the effectiveness of assignments.
V. UW HEALTH CROSS REFERENCES
A. UW Health Clinical Policy 4.1.8, Standard Precautions and Isolation
B. UW Health Clinical Policy 6.1.11, Preventing Non-Therapeutic Exposure to
C. Nursing Administrative Policy 8.11, Student Clinical Practice of Nursing and
Advanced Practitioners at UW Health
D. UW Health Staffing Playbook for Nursing (on U Connect)
A. American Nurses Association Principles for Practice. ANA’s Principles for
Nursing Documentation. (2010) Washington, DC: American Nurses Publishing.
(Available on U-Connect at: Nursing/Leadership/Magnet Recognition
Program/Foundational Documents/Principles for Nursing Documentation
VII. REVIEWED BY
Director, Nursing Quality & Safety, November, 2017
Manager, Overnight Services at The American Center
Nursing Administrative Policy and Procedure Committee, November 2017
Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive