Acuity Based Staffing Tool in Mother/Baby?

[FemmeRN]

Hi all,

I've been reading about tools that are used to measure pt acuity and determine staffing needs on med/surg units, and I'm curious if anyone has seen or used a tool like this to staff a mother/baby unit?

I realize there isn't the variablity or high degree (hopefully!!) of acuity on a postpartum floor that there is on med/surg or ICU. Nonetheless, taking care of a pt on her second day after a lady partsl delivery w/ no complications, and taking care of a c/s post-op who's receiving blood and antibiotics, and has an exclusively breastfeeding baby under bili lights are clearly different!

Our charge nurses do their best to have us all "share the wealth", and we basically just rotate through the nurses for any admissions during the day. They'll write "mag" and "abx" and "new" on the assignment sheets to kind of show which nurses already have more acute patients, as well. But, as far as the staffing matrix goes, it's just X number of patients equals Y number of nurses. And with the economy the way it is, we're now required to have more patients per nurse. Some days, it's not that bad, and we could probably get away with a nurse or two fewer, if we had to. But other days it's an absolute nightmare. I just wonder if anyone has a good way that they deal with this. Also, where do those staffing matrix numbers come from anyhow? Who makes them up? Is it based purely on budget, or is it based on some sort of actual nursing guideline? We're at about 1:5 couplets, so I know ours can't be based on AWHONN.

Sorry if this all sounds naive. I'm in my first year of nursing, and I think I'm still adjusting to the difference between the 'real world' and what they told us it was going to be like in school!!

[BookwormRN]

Hi FemmeRN,

Yes, our hospital uses an acuity based staffing tool for Mother/Baby.

I've included a link to the MESH website---this tool is used in our ED/Med/Surg/ICU/OB

Hope it's helpful-sounds like you and your co-workers have your hands full!

http://www.uwhealth.org/aboutuwhealth/managementandeducationservicesforhealthcaremesh/12761

[MomBabyUnitRN]

Our staffing is based off AWHONN and their standards.

It's usually 1:3 couplets with the most 1:4. This usually happens if most moms are on auto pilot. Moms who are still getting magnesium sulfate or fresh c-sections are a different story. The mg++ patient is usually 1:1 and fresh c-sections are usually 1:2 unless they're 12 hours post op.

I hope that made sense.

[cherokeesummer]

I wish so much that we had staffing based on acuity but we don't and it stinks! As charge nurses we try to distribute the wealth like you mentioned above, if we know someone is on mag or abx or blood or whatever but it doesn't allow us to have more staff. We are alloted staff strictly based on census. Regardless of acuity. This often leads to the more helpful charge nurses taking assignments as well to spread it out more.

We usually start out with 1:5, one nurse to 5 couplets.

[cherokeesummer]

Our staffing is based off AWHONN and their standards.

It's usually 1:3 couplets with the most 1:4. This usually happens if most moms are on auto pilot. Moms who are still getting magnesium sulfate or fresh c-sections are a different story. The mg++ patient is usually 1:1 and fresh c-sections are usually 1:2 unless they're 12 hours post op.

I hope that made sense.

I want to come work where you are! :):) I don't know if it is our region or what but it doesn't matter if we have a fresh section, we still have the same number of couplets. Most days we start with 4 or 5 couplets and then we have admissions and discharges. I wish I knew if it was better somewhere in our region but I really don't think it is.

Hubby man and I need to consider moving! :):) I do love my job though, just very tiring!

[herring_RN, ASN, BSN]

The second post has the standards:

https://allnurses.com/ob-gyn-nursing/pt-nurse-staffing-190438.html

[babyktchr, BSN, RN]

Wow, I am surprised at the 1:5 ratios going on out there. AWHONN guidelines suggest 1:3-4 couplets. Does anyone staff based on acuity anymore? Seems like a blast from the past.

[chris724]

We are about to merge and start doing couplet care. We still have LPN's in our mix and I was wondering what their responsibilities are. Our unit committee has decided that an RN should have 4 couplets max(trying to keep with guidelines), but I know there will be days when it may be 5. A team of RN/LPN would take 6 and the LPN would have assigned couplets too.

With the economy as it is, we are being told to do more with what we have. Really stretching us even further.

[zoo*moon, BSN, RN]

wow, i am surprised at the 1:5 ratios going on out there. awhonn guidelines suggest 1:3-4 couplets. does anyone staff based on acuity anymore? seems like a blast from the past.

i just got off orientation and am overwhelmed with 4 couplets. and i have worked on a med/surg telemetry floor with 8 to 10 patients. when i voiced my frustration, i was told up to 5 couplets was standard so in other words, it could be worse. pts/beds are assigned by the previous shift and i don't think they all look at the acuity of the patients to balance the load.

i also want to know about nursery staffing-- ours until recently had just one nurse for 1 to 20-some babies. now they have decided to put a tech in there to help if census is high, decision up to the shift charge. for an almost 30 bed unit, i don't understand how one nurse with the possibility of twenty some babies is safe. if there is only one tech on for the shift then the nurse will be in the nursery alone. and yes there are many parents who take their baby to the nursery for the night. (apparently they want sleep.)

[babyktchr, BSN, RN]

AWHONN states 1-10 for well newborns.

[cherokeesummer]

We are about to merge and start doing couplet care. We still have LPN's in our mix and I was wondering what their responsibilities are. Our unit committee has decided that an RN should have 4 couplets max(trying to keep with guidelines), but I know there will be days when it may be 5. A team of RN/LPN would take 6 and the LPN would have assigned couplets too.

With the economy as it is, we are being told to do more with what we have. Really stretching us even further.

Our LPN's and RN's do the same tasks and have the same assignment load with the exception that LPN's cannot have a Mag patient.

[OBRN1994]

i just got off orientation and am overwhelmed with 4 couplets. and i have worked on a med/surg telemetry floor with 8 to 10 patients. when i voiced my frustration, i was told up to 5 couplets was standard so in other words, it could be worse. pts/beds are assigned by the previous shift and i don't think they all look at the acuity of the patients to balance the load.

i also want to know about nursery staffing-- ours until recently had just one nurse for 1 to 20-some babies. now they have decided to put a tech in there to help if census is high, decision up to the shift charge. for an almost 30 bed unit, i don't understand how one nurse with the possibility of twenty some babies is safe. if there is only one tech on for the shift then the nurse will be in the nursery alone. and yes there are many parents who take their baby to the nursery for the night. (apparently they want sleep.)

at my regular facility (i am currently on a travel assignment, but will be returning in april), we charge nurses come to the unit 15 mins prior to the rest of the staff and get report from the night shift/day shift charge. the charge nurse that will be working that shift makes the assignment for her nurses. we have a mix of l&d, antpartum, mother/baby & nursery. we also have an 8 bed mother/baby unit that is separate from our unit and run by a different charge nurse and we've got a 10 bed nicu that is run by another charge nurse. i can't imagine having another shift make assignments for my shift. i know the "comfort" level of my staff and who can "handle" better each different assignment. there is no safe way for one nurse, even with a tech to take care of 20 babies!