We used to staff by acuity. Our manager did a survey to get an approximation of nursing hours spent on each patient, then set up a system whereby we'd calculate acuity on a 1-5 scale (5 being a 1:1). Adding those numbers we'd then apply them to a staffing grid to determine the number of staff needed.
It failed for several reasons. One being some of the justifications for placing a patient in a higher acuity level were, to put it mildly, ridiculous. For example, they automatically were placed at level 3 if they had a central line. It didn't matter if the port was capped off and all they got was a daily flush--- it made them a '3'.
The criteria for acuity didn't factor in the enormous amount of time we spent with family and patients teaching, providing psychological support, discharge planning and follow up, etc. Being an oncology unit, that was a major flaw.
Another problem we had were charge nurses who would find a way to rank
everyone as a high level patient. Which defeated the purpose and in the end, was why the staffing went back to strictly numbers.
Rather than having these grids set in stone, be they based on acuity
or census, I think that charge nurses need to be trusted and given support by management to be able to decide what their needs are based upon acuity, census and strength and experience of their staff. Staffing is a fluid process; restricting it can be frustrating for all involved.
Perhaps guidelines that allow for a range of acceptable staffing ratios that your nurses can use to determine their needs. For example, if the patient census is 20, then they are allowed 4-6 nurses. If acuity is not that high, then they would staff with fewer nurses. Higher acuity, more nurses.
Just a thought
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