Nursing by acuity seems a good idea , but who assesses the acuity of the patients , my experience is that although the bedside nurse inputs the scores , if the floor management , thinks they should be different , they change the scores and amazingly , always so that there is a lower number of bedside RN's .
Who sets the Acuity tool parameters ? , again on this if the acuity tool doesn't provide the staffing numbers management want to pay for ,the tool is changed . Again so that a lower number of RN's are needed .
Whether you use a acuity based system or a Staff Ratio law to set staffing levels , management will use it to manipulate staffing , to their benefit . If management feels in either system that the nuring budget is too high , they will cut nursing hours . If you do not have a staff ratio law they can and will cut both RN's and ancillary staff . If you have a ratio law they cannot reduce the RN hours to unsafe levels .
Although I would prefer that no staff was cut , I believe it is better for patients to be cared for by RN's , if I have to accept that a few more tasks are directed at me , it is part of the bargain , because on balance it is my experience I have more time to care for my patients , also my total workload is not as bad , as prior to ratios.