Acuity-Based Staffing Model

llg, PhD, RN · Oct 13, 2015

I have never seen a system that counted non-RN roles as less than 1 person. Most systems are based on a matrix that establishes the number of people you need in each role to make things work. What we are talking about is termed "staffing mix" as opposed to the "staffing levels." I suggest you start looking for literature on how to determine the right staffing mix for your unit as opposed to trying to consider the raw number of people only.

A full time LPN is a full person, not a fraction of an RN. If you could reduce it to a single number, you would be able to say that a given number of LPN's + CNA's would equal an RN -- but you could never say that because the scope of practice needed for certain responsibilities is that of RN, and could never be filled with any amount of LPN's and CNA's.

So ... educate yourself about "staffing mix" and "staffing matrix" systems.

Good luck!

turnforthenurse, MSN, NP · Oct 13, 2015

At my previous job (charge nurse - ER) we had a census-based staffing model so that we could maintain productivity. Everybody, regardless of position, counted as "1." Some staff were completely necessary, such as the charge nurse and triage nurse. I actually still have that staffing grid...here's some examples (Nurse = RN or LVN)

ED census: 0-4 patients

Clerk: 1

Triage tech: 1

ED tech: 0

Nurse: 2

Charge nurse: 1

Triage RN: 1

CT/EMS RN: 0

Flow RN: 0

So basically 4 nurses, 1 triage tech and 1 clerk.

ED census: 5-8 patients

Clerk: 1

Triage tech: 1

ED tech: 0

Nurse: 3

Charge: 1

Triage RN: 1

CT/EMS RN: 1 (this was basically the charge RN)

Flow RN: 0

ED census: 9-12 patients

Clerk: 1

Triage tech: 1

ED tech: 1

Nurse: 4

Charge: 1

Triage RN: 1

CT/EMS RN: 1

Flow RN: 0

ED census: 13-16 patients

Clerk: 1

ED tech: 1

Nurse: 5

Charge: 1

Triage RN: 1

CT/EMS RN: 1

Flow RN: 0 (Flow RN didn't come in until census was at least 17-20)

Etc.

We also had a staffing grid for fast track....1 tech and 1 RN for up to 5 patients, and once the census was 6+, we could have 1 tech, 1 RN and 1 LVN.

I realize the ER is different but hopefully that will give you an idea.

llg, PhD, RN · Oct 13, 2015

The previous poster gives an example of a type of matrix. It's not just the number of bodies, it's the roles they have. However, not that the example is not based on acuity. It is based only on the number of patients. In reality, 10 really critical patients may need more resources than 14 really stable ones. If you are going to base your system on acuity, you need to incorporate the level of care needed by each patient (usually done by giving each patient an acuity score and summing those scores to yield the expected workload).

jrt4 · Oct 19, 2015

The previous poster gives an example of a type of matrix. It's not just the number of bodies, it's the roles they have. However, not that the example is not based on acuity. It is based only on the number of patients. In reality, 10 really critical patients may need more resources than 14 really stable ones. If you are going to base your system on acuity, you need to incorporate the level of care needed by each patient (usually done by giving each patient an acuity score and summing those scores to yield the expected workload).

I agree.

I have never seen a PCT counted as half a person. We practice a mixed model system currently. Our grid allows for so many Hours Per Patient Day. We have allotted so many nurses and PCTs per shift based on the amount of patients we have...this in itself is not acuity based. However, we also look at the patients acuity and staff around that so we may have 10 patients and 4 RNs. Some days 1 RN may have 4 and the other 6 are split between the other 3 RNs or any other combination. Unfortunately we do not currently have an objective system that measures acuity for pediatrics but the organization is looking at one. Most days this works...some days it does not.