I need some advice on a problem that I have working with isolation patients.  It really isn't working with the iso's , it's a case of working the iso's and then working with the general patients. 

At the hospital that I am at, when they assign patients, they do not take into consideration the acuity of patients or their diagnosis.  For instance, you might have an MRSA (active) patient, then a patient that is undergoing chemo (you know what their white counts do), then a patient in DT's, an MI, COPD, and don't forget to throw in that fresh surgery patient.   I feel that we are putting patients in jeopardy by cross contamination.  I know that we wash our hands but you don't change your uniform every time you go in and out of a room.  Last night I had 2 MRSA's that had draining wounds and granted I wore my disposable gown and gloves but after leaving the room and washing (for the second time, once in the room as I was leaving and then when I got out on the floor), but then I had to go into a room where a patient's WBC's were practically nil.  What are my chances of spreading an infection to the next patient? 

The other problem that I have is that we do block assignments.  Another words if you have all the hard patients so be it.  Last night I had two MRSA's, one leukemia, two cellulitis pt's that have not been confirmed as MRSA (you want to take bets) a pt going through DT's and the simple COPDer that kept saying she was going to die in 45 minutes.  I opened charts at 4AM, gave pain meds every three hours to 4 pts, chart checked, called MD's, etc.  Of course during this time I also admitted one patient.  Now my problem is that one of the other nurses had a group that all the patients did was sleep and while 2 of us nurses worked our backsides off, she was on the computer. 

I guess my real questions is do all hospitals assign patients this way and if so how do you handle it.?  I have been a nurse for 30 years and I can work with the best of them and I realize that there are going to be bad days and nights, however, here it is like this all the time. Does anyone have any suggestions that I could take to the manager for possible changes or should I just suck it up and hope like heck that I don't cross contaminate and keep going with the flow.  Also our charge nurse takes patients so she has her own problems and we might have up to 54 patients on the floor. 

Any suggestions, criticisms or just support would be appreciated.

Thanks.

We also assign by room.On rare occasions if we have alot of  confused or out of control pt;s, we may try to break them up, but  it doesnt usually work that way .

Don't worry, I do stand up for myself. I have brought this more than once and was told that "this is just the way it's done".  Big help.  People don't like change and I understand that but if it is in the best interest of the patients and future patients then I think change should be implemented.

I have a situation simular to part of yours. One of the nurses yesterday said she was moving one patient in with one with MRSA in the wound. I inquired is that a smart thing to do with the MRSA in the room, there are other rooms this other patient could be moved to. Anyway, she exclaimed back to me..."I'm sick of you nurses that flip out about MRSA, it's not the big of a deal!!" She was not nice or professional at all, this was in the hall at a loud tone. I kept thinking all day yesterday, "are you kidding, what part did I not understand about MRSA?"

My husband had surgery in CA and I expressed my concern about MRSA to his nurse. She told me to quit worrying, everyone has MRSA and it's no big deal. This blow my mind. I wonder the about the patients that lost limbs, that are hospitalized for months to gain control of the infection think that it's no big deal. My husband was in a room with someone that had MRSA, scarey! My husband did have a different RN and CNA than hit rm mate, but still.