Accuity Vs Staffing Needs: Are They Taking Us Seriously?

bellehill, RN · Mar 27, 2004

What acuity rating? It is up to the nurses to tell the charge nurse that their group is heavy and should be split up. Night shift is real good about doing it, day shift isn't. My floor doesn't staff by acuity, wish they would.

meownsmile, BSN, RN · Mar 27, 2004

i think we have 2 sets of standards. One we use, the template is filled out according to acuity and who is assigned that patient. The other they look at a sheet and staff strickly according to numbers. Depending on who is there (surveys etc) determines which they use to staff i think. Why bother even putting an acuity to a patient if they arent going to take that into consideration when staffing. So no acuity means nothing at my facility unless there is surveyors there.

akvarmit · Mar 27, 2004

Acuity? My hosp. says "we don't need no stinking acuity!"

It doesn't matter if we have vents, trachs, epidurals, q1hr vs on certain patients or q1 hr accu checks on DkA, or q2hr Perit. dialysis........the staff is the same. Including the usual call-off that you can depend on.

Some days I'm not even doing a good job at being a bad nurse :imbar

sharonbdanurse · Jun 1, 2004

Question: When your accuity ratings are reported to staffing at your facility, are they taking them seriously :) and staffing accordingly or are you feeling like they are just blowing them off?

Curious to see how others feel about this one.

I couldnt help but laugh--Acuity is an unknown word where I work. It doesnt matter what we have on the floor---the magic number is 13. With 13 we can have 2 Lpns and an Rn....Anything under 13, one of each. Doesnt matter if the patients are total care or are up and walking. The irritating thing is that the director always wants a list of how many are total care, acute care and so on.

SRbear · Jun 2, 2004

Question: When your accuity ratings are reported to staffing at your facility, are they taking them seriously :) and staffing accordingly or are you feeling like they are just blowing them off?

Curious to see how others feel about this one.

Years ago, the higher ups at my hospital decided to have an outside firm come in and assign acuity numbers for patients, based on the usual criteria..how many tubes, drains, how often vital signs, bedridden or up and walking, etc. I have no idea what outrageous amount of money that was spent. Any how, once the numbers were assigned, the higher ups saw that more nurses were needed. Well, the higher ups thanked the outside firm, paid them, sent them on their way, then changed all the assigned numbers so they would call for the same amount of nurses we were already using. We go strictly by those numbers. As a charge nurse, I try to even out the assignment as best I can. Too frequently we end up working with a nurse, patient care tech, or unit secretary short. We are always being told we have to score a '10' on patient satisfaction. If we were staffed to acuity, I think our patient satisfaction scores would be much higher.

**canoehead, BSN, RN** · Jun 2, 2004

As supervisor I find that I need to work the floor every once in a while or my perceived time-per-patient-need goes down. Also, I have some staff that complain when they have to take an admission, just on principal, and others that when they say they are overwhelmed I know they need help, like yesterday.

I gotta say, I can see that the managers that are getting cracked down on by the upper levels to cut costs seem to actually feel like they can crunch the staff more. I mean they honestly believe it's safe, but I can see that the pressure they are getting alters their perception of reality. The quickest cure is to have them work on the floor for a shift or two.:)

KaroSnowQueen, RN · Jun 2, 2004

Acuity??? The last time I heard that word was when I was in nursing school twenty years ago!!!! The hospital we did clinicals in was staffed according to acuity, presumably, the nurses there seemed to think it worked.

We get the same amount (or less!) staff no matter what we have. One day I will get six walky/talky pts and the next, like yesterday!!!! have five extremely needy patients (trach, ABT bladder irrigation, NGs, GTs, TPN, DM, you name it, they got it) and one that probably would be needier if she was awake. Supposed to get the ninety times more work done for the second team in the same amount of time as the first. AND get good pt satisfaction scores!!! I am SO SICK of pt satis. scores!!! Give us some staff and our scores will RISE??? Oh no they're cutting overtime now so they can look good on their fiscal year end reports. Don't get me started! :angryfire

Rapheal · Jun 2, 2004

Staffing by acuity is more expensive-so we don't do it. Most of our patients are sicker, older, with many needs such as feeding, suctioning, toileting, ect. Most hospitals look at the dollar figures. So acuity goes out the window.

katiep · Jun 2, 2004

Hi, just a bit curious to enquire how the 'acuity' of your particular areas is measured/assessed? Where I work in the UK, we use a 'GRASP' Score to determine the dependancy score for each patient. Each aspect of care that the patient is likely to receive within a 24 hour period is added up, to give an overal score for that day, e.g. headings include admission for each patient, activities of daily living, giving of medication and which route used, observations, educating patients, need for wound dressing etc, measurement of drains, catheters, you get the idea, I am pretty sure that nothing really comes of them though. The whole total for each patient is logged alongside the number of hours for each member of staff, for each shift.

How do other staff out there moniter their ratings please??

RN-PA, RN · Jun 2, 2004

Staffing by acuity is more expensive-so we don't do it. Most of our patients are sicker, older, with many needs such as feeding, suctioning, toileting, ect. Most hospitals look at the dollar figures. So acuity goes out the window.

Same here. We have no charge nurses and our patient assignment is generally given according to room numbers, unless there's a patient that an RN must take than an LPN can't be assigned (with PCA or continuous epidural, for example). I've been getting more high acuity patients recently-- chest tube, NG tube, multiple JP's, tube feedings-- all for one patient-- and even if it works out somehow that I only get 4 patients during my 8-hour shift (no admissions, transfers or post-ops in addition to my original assignment of 4), I can still end up staying overtime because of all the problems and documentation needed for one or two high acuity patients.

When my hospital was having financial problems last year, they were required to have consultants come in and look at staffing. We now have "Grids" that determine how many nurses a unit staffs. So med-surg can have 6-7 patients/RN or LPN, and our aides can have 12 (they frequently have more than that due to call-outs, high turnover rate, and increasing need for 1:1 for some patients.) It makes me wonder if the lower quality of care, decreased job satisfaction, and amount of overtime pay is worth their "Grids".

RN-PA, RN · Jun 2, 2004

Hmmm-- Interesting timing.... I just got off the phone with our unit manager to ask about staffing by acuity since, judging by the last 2 nights and new admissions, my assignment 3-11 today may include one patient with continuous epidural, one receiving 60 grams of IV gamma globulin beginning at 1800, and one with NGT, 3 JP's, TPN/Lipids, and PCA MSO4. I've been getting tired of seeing some co-workers with lesser acuity patients sitting around and leaving on time while I'm non-stop for 9 hours plus overtime. (Yes, I ask for and occassionally get help from them.) Well, it turns out that she and our unit director have been meeting and are finalizing a plan to make asignments more fair. I'll be EXTREMELY interested to see what they've got planned.