[BlearnRN]

On my floor (which is a small unit < 20 beds) it is mostly 8 hr nurses and we rotate charge nurse. We have to get in our needs for a nurse to the supplemental staffing office by 1:30 pm. During the day, the charge nurse tries to keep up with this or that pt coming or going and when. Sometimes, you will be told 3 or 4 people are leaving this shift but then maybe one or two will really go on your shift and maybe a few on the next shift. Then of course there will be a few surprise discharges pending by 2:45.- oh and also some of the so called real discharges are not being discharged after all - But by that time you have already assigned the next shift their patients and tried to split up the totals or the heavy patients and realized that the floor is overstaffed according to census. So all you can do is pass on to the new charge- maybe you should send the nurse back to supplemental staffing. But after all you have 5 heavy pt still on the floor, 1 is waiting for transport and the other is waiting for a clean bed on a different unit (and you are waiting for the call that the bed is clear and cleaned). Also, there is one pt getting ready to have a seizure and an underage pt whos mom had to take a break for a hour because the pt was being beligerant and it is two hours later, and a transfer coming in from a different floor that sundowns and doesn't remember that they cannot walk. I am new to this charge thing. I do ask for help. But, then I still get in trouble if I overstaff even if there is suppose to be staffing based on acuity.......but if I understaff and the floor gets slammed, then my collegues get mad...

[Advocate1]

How about both! On my floor (tele unit) we have a max of 5:1 with an acuity max of 12 (we- the nurses in coordination with the charge RN) made our own acuity rating system.

Its not perfect, and the acuity system, as hard as we tried not to make it subjective, still depends on the RN rating the pt. There were only a few days where some RNs had 6 pts. But overall I think its working.