Hospital Acuities.........or NOT!!! - page 3
I recently had a conversation at work with two other nurses about acuities. One nurse is VERY STRONGLY PASSIONATE about acuities and believes they DO work. The other nurse understood my viewpoint,... Read More
Jul 7, '03we are required to enter into the computer our patient acuity's each 12 hr. shift.
I haven't done it in 6 months, I charge 3 of 7 days a week.... no one has asked.
think they amount for anything in my facility???
Jul 7, '03Originally posted by spacenurse
Most dishonest are hospitals that say they use acuity for staffing but don't. They have a matrix according to numbers and the charge nurse is to assign patients based on acuity.
How can that possibly work?
Staffing must be based on the needs of individual patients. Staffing must increase if one or more patients need more time. There should also be "wiggle room" for the times a medical crisis happens or there are many patients admitted.
What do they do when a nurse gets sick?
But then I've only been a nurse for 15 years, and never worked outside of California.
Just another $0.02 while I switch feet.
Jul 7, '03A shift supervisor told me she is evaluated on "budgetary alignment". Her superior patient advocacy and willingness to troubleshoot on behalf of quality care including assisting with a patient are "meets the standard."
Jul 7, '03It seems that acuities are all about meeting the standards outlined on paper regardless of what the actual patient situation calls for all because of "the budget, the budget, the budget". I've never been soooooooo sick and tired of hearing about "the budget"! :chuckle
Snooze time for me, so until tomorrow.......
Aug 1, '03Does anyone have a simple one page acuity sheet? I doubt it will
change our staffing but we only have a 4-5 page booklet for rating patients, which is not realistic. Any help would be great.
Aug 1, '03I think the problem is consistency, acuity staffing works if it is maintained but as we all know, oops we are short staffed again so out the window it goes. Any theory can work on paper but what management never understands is when families are calling every 2 minutes, call bells never stop, patient have the nerve to code at a change of shift, paper planning just doesn't work.
Aug 1, '03We are required to assign acuity every shift. It is a matter of punching in a number after we add all hospital defined descriptions to a patient. Does it work? No! No! No! We can give all of our patient a high acuity or give them all a low acuity, it only matters how many patient we have. Our staff is flexed down more than asked to flex up. The budget must be maintained. If you have 5 patients and they are all confused, combative, and disorientated, so what, just do the job. I am so sick of hearing,"do your acuity", it is just another piece of paper the hospital uses to justify poor staffing. I have tried to become a more positive nurse these last few weeks, but my attempt to change my attitude is fast becoming hard to maintain.
Aug 1, '03I have yet to see an acuity system that accurately reflects reality and is forward-looking. There is too much room for abuse and manipulation of the information on the nursing side and hospital side because the systems are too subjective or the data entered isn't verified.
I think there would be many benefits to a good, objective, forward looking system that reflected reality and is purely patient care needs driven. Of course these words come from me, one of those "evil, greedy, dishonest, administrator-types."
Nursing has really brought this on ourselves because we abused and manipulated the systems that were out there and as a result the system lost credibility and nursing took a hit as well. In my days as a nursing supervisor and nurse manager, we regularly manipulated the numbers to justify more staff. Administration caught on and pulled the system, we then went to a staffing matrix which is a one-size-fits-all and leaves no flexibility for staffing.
Aug 1, '03My opinion is pretty much in line with the majority of posts in this threads. Acuity systems are just that ... systems designed and used by people attempting to measure and document the nursing care needed and/or provided. Because they are human systems, they are only as "good" (ie. accurate, consistent, reflective of the the true needs, etc.) as the people who design and use them.
Aug 1, '03In my experience acuities are not particularly useful. If each unit has clear admitting and transfer/discharge criteria for their patients, then making uniform/fair asssignments should not be a problem.
That is not to say that the assignments will be manageable necessarily; that is a function of an appropriate/adequate number of care hours budgeted for each patient on any given unit.
So the problem is always two-fold: 1) Are the patients case managed properly and on a timely basis so that they are at the appropriate unit/level of care? (Doing so should leave you with relatively homogeneous patient populations in terms of care hours required) and 2) Are adequate hours provided to meet the needs for a typical patient for a given unit?
Management must do both for adequate care delivery; regretfully they often do neither.
Aug 1, '03I just hit another language difference - we call "acuities" patient/nurse dependency systems. So if you are looking for OS models google that title. Probably one of the most widely used systems is "Trendcare"
Designed by a nurse as a masters project. She was a nurse manager for a regional hospital. It is simple. Allocates extra time for "confused" patients as well as counselling and education.
Is it the be all and end all of staffing? Heck no! Nothing will predict when the wheels fall off!
As with most of the posters here I agree that it works when it is staffed to the correct amount it is worse than useless if it is not used consistantly. One hospital I worked at would not staff to the level predicted and it became a measure of how short staffed you were. You would over hear nurses talking about being X no of hours "down" each shift.
I have also worked in hospitals that do not "believe" in acuities and ended up with the most uneven staffing I have ever encountered.
So acuities - yes/no? When used correctly - yes they are good and they are better than the alternative.
Aug 1, '03The official term in California is Patient Classification System (PCS). Below is the new law just as regards the PCS. Underlined are new, double underlined are newest. It is a cut and paste from the web site:
), Tthe hospital shall implement a patient classification system as defined in section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements. The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, licensed psychiatric technicians, who shall be assigned to direct patient care. Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care. The system developed by the hospital shall include, but not be limited to, the following elements:
(1) Individual patient care requirements.
(2) The patient care delivery system.
(3) Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population.
(b)(c) A written staffing plan shall be developed by the administrator of nursing service or a designee, based on patient care needs determined by the patient classification system. The staffing plan shall be developed and implemented for each patient care unit and shall specify patient care requirements and the staffing levels for registered nurses and other licensed and unlicensed personnel. In no case shall the staffing level for licensed nurses fall below the requirements of subsection (a). The plan shall include the following:
(1) Staffing requirements as determined by the patient classification system for each unit, documented on a day-to-day, shift-by-shift basis.
(2) The actual staff and staff mix provided, documented on a day-to-day, shift-by-shift basis.
(3) The variance between required and actual staffing patterns, documented on a day-to-day, shift-by-shift basis.
(4)(d) In addition to the documentation required in subsections (c)(1) through (3) above, the hospital shall keep a record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments to individual patients by licensure category, documented on a day-to-day, shift-by-shift basis. The hospital shall retain:
(1) The staffing plan required in subsections (c)(1) through (3) shall be retained for the time period between licensing surveys, which includes the Consolidated Accreditation and Licensing Survey process, and
(2) The record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments by licensure category for a minimum of one year.
(c)(d) (e) The reliability of the patient classification system for validating staffing requirements shall be reviewed at least annually by a committee appointed by the nursing administrator to determine whether or not the system accurately measures patient care needs.
(d)(e) (f) At least half of the members of the review committee shall be registered nurses who provide direct patient care.
(e)(f) (g) If the review reveals that adjustments are necessary in the patient classification system in order to assure accuracy in measuring patient care needs, such adjustments must be implemented within thirty (30) days of that determination.
(f)(g) (h) Hospitals shall develop and document a process by which all interested staff may provide input about the patient classification system, the system's required revisions, and the overall staffing plan.
(g)(h) (i) The administrator of nursing services shall not be designated to serve as a charge nurse or to have direct patient care responsibility, except as described in subsection (a) above.
(h)(i) (j) Registered nursing personnel shall:
(1) Assist the administrator of nursing service so that supervision of nursing care occurs on a 24-hour basis.
(2) Provide direct patient care.
(3) Provide clinical supervision and coordination of the care given by licensed vocational nurses and unlicensed nursing personnel.
(i)(j) (k) Each patient care unit shall have a registered nurse assigned, present and responsible for the patient care in the unit on each shift.
Aug 2, '03Originally posted by barefootlady
We are required to assign acuity every shift. It is a matter of punching in a number after we add all hospital defined descriptions to a patient. Does it work? No! No! No! We can give all of our patient a high acuity or give them all a low acuity, it only matters how many patient we have. Our staff is flexed down more than asked to flex up. The budget must be maintained. If you have 5 patients and they are all confused, combative, and disorientated, so what, just do the job. I am so sick of hearing,"do your acuity", it is just another piece of paper the hospital uses to justify poor staffing. I have tried to become a more positive nurse these last few weeks, but my attempt to change my attitude is fast becoming hard to maintain.
WHERE'S MY HELP WHEN I NEED IT! I enter my acuities DAILY and I do NOT see the flesh to back up those little tiny digits I barely have time to stop and enter in the first place.......due to things like PATIENTS who are in need of their nurse and in need of her/him NOW!
Acuity Lovers who are always preaching "Do your acuities...have you done your acuities yet.....don't forget your acuities?????"..........YOUR SINGING TO THE CHOIR HERE!