Hospital Acuities.........or NOT!!!

  1. 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, but still feels the necessity of it.

    I don't believe acuities work from what I've witnessed while working as a nurse since graduation sixteen years ago.

    Any takes on acuities whether they work or not? And, why do they work if your answer is Yes, or why don't they work if your answer is no.

    Thanks, and goodnight! Looking forward to reading your responses nurses.
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  2. 39 Comments

  3. by   Tweety
    I worked on a floor that had acuities. Say we had a trach that needed q1h suctioning for heavy secretions. We would make him a "4 to 1". But we're our own worst enemy, because someone would inevitably complain "why do I have 7 patients and she only has four, that's not fair."

    I transferred away from that floor. Now it's simply numbers and not acuity. If we have high acuity we can advocate for extra staff and we can usually get it, if we don't abuse the priviledge.
  4. by   live4today
    Sooooooo.......you believe in acuities when they work, and not when they don't.......is that what you're saying???

    In that case, I believe they would serve a useful purpose IF ONLY they jived with the reality of our staffing.

    Thanks for your response, 3rdShiftGuy!
  5. by   VickyRN
    At the teaching hospital in which I worked, there was an acuity system. It was very confusing as we had to "classify" our patients everyday and the guidelines were confusing. The guidelines also discriminated against our cardiac floor--somehow, a patient with a trach had higher acuity than the pt with v-tach. Anyway, don't have much confidence in this system. It was just another little hassle, filling it out on all of our patients, and too many subjectivities to really be of much practical use on the floor.
  6. by   live4today
    Amen to that, Vicky!
  7. by   pickledpepperRN
    Staffing to the needs of the patients is necessary. Seems like 3rd shift guy works at a decent place.
    When a non ICU supervisor wants to change the acuity in order to give us an admission that is not OK.
    Say I have a patient with vasoactive drips titrated to hemodynamics, ABGs, and vital signs. A ventilatoe and IABP too. How can a supervisor who doesn't know a PCWP from an SVRI tell me I must take another patient?
    She can't and we know it. We fill out an incident report and assignment despite objection form making the hospital responsible for any harm to a patient due to unsafe staffing.

    No acuity system is perfect so the RN in consultation with the charge nurse should be able to over ride the numbers to get a sitter, LVN, or another RN as needed.

    Are you able to tell the licensure, competence, and number of staff needed in your acuity system?
    Or is it an inflexible computer program?
    Gives hours per patient day (HPPD) with no guidance as to license, training, or experience?
    Do they count management nurses who don't have a patient assignment?
    Then it is a budgeting tool not really an acuity system. Key words to define budget driven are "productive HPPD"

    Best I ever saw was where the DON would come to each unit and ask, "How many nurses will you need for the next shift?"
    They got what they asked for and did not exaggerate. Trust and respect brought quality care to patients!
  8. by   featherzRN
    Where I was (I work in a clinic now, so this doesn't apply to me anymore :>), the management would insist on acuities every shift but hardly anyone would do them. The staffing was NEVER (not even once) changed or increased based on acuity and even if you could point out you had some really heavy patients that was just too bad. I once did an acuity that said I needed 3 licensed people and two aides and we had the same two people we always had (one of each).

    Needless to say compliance was really poor.

    One hospital I worked at the acuities were done by the supervisor walking to each floor and asking 'how many IV's and how many heplocks?' - that was the acuity. /sigh.

    H.
    Last edit by featherzRN on Jul 4, '03
  9. by   pickledpepperRN
    Once a med-surg unit at my hospital sent the nursing office all '4's (highest acuity) for a week. The next week all '2's. They got the same 6 patients per RN with an aide or LVN for every 10. Not really bad for average acuity, but reallu unsafe for the times there are a LOT of very sich patients.
    I'm going surfing for the new standards for patient classification in California.
  10. by   Mimi2RN
    We have a computer related system called Evalysis. Does anyone else use this? It doesn't make any difference whatsoever to our staffing, but the paperwork is part of the patients hard chart.

    The nurse doing staffing confirms the number of patients, and tells us how many nurses the next shift will get. I don't know if it works in the rest of the house, either..........
  11. by   pickledpepperRN
    Evalysis has made the Catalyst company million$.
    That was money meant to be spent for patient care.
    I bet the bedside nurses could create a simple acuity system that worked better.

    They talk the talk but don't walk the walk! Too willing to 'taylor the system to the individual hospital'. Read that, "Bring the staffing into alignment with the budget."
  12. by   plumrn
    Acuities are good in theory, but I don't believe they are used consistently or correctly. They look good on paper, but if there are only 3 bodies available, thats all you get-no matter what.
  13. by   Genista
    Here's why I "forget" to fill out acuities...
    It doesn't matter if I have extremely high acuity patients or low acuity...the staffing matrix never changes. And when I forget to fill out acuities, somehow, we still are staffed (oh the miracle/however do they figure it out).

    The reason I don't often fill them out is that they are only for show where I work. We NEVER get extra staff for high acuities.NEVER. And when there is an empty bed, it barely has time to grow cold before another body is in it, regardless if we are all missing breaks & overtime,etc.We do work short alot. So, I find I don't have the time for that sort of busywork.
  14. by   Tweety
    Originally posted by cheerfuldoer
    Sooooooo.......you believe in acuities when they work, and not when they don't.......is that what you're saying???

    In that case, I believe they would serve a useful purpose IF ONLY they jived with the reality of our staffing.

    Thanks for your response, 3rdShiftGuy!

    Cheerful, basically how we do it is that if we have a highly acute patient that can not fit into our normal staffing pattern, we identify that patient and make assignments appropriately. For instance if we have a noncritical patient on the floor that needs a labetelol drip and frequent bp checks, she won't be transfered to the unit, but would be part of a 4:1 or 3:1 assignment, but moved to the intermediate unit.

    What I also said is that is sometimes sabatoged by our own staff, the one with the less acute patients and the higher number of patients sometimes resents the staffing pattern.

    We don't on a routine daily basis fill out acuity sheets and turn them in.

    Every now on then for surveying and budgeting purposes we will do an acuity sheet.

    Am I making any sense?

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