Acuity in patient assignments

[n1jmfn]

I've been a nurse for over year working nights, and for the last year I always wonder what the day shift charge RN with no patients does. When I come in for patient assignments, it honestly looks like half the time they just throw the numbers up there in dividing patients without putting any thought into it. At the start of a shift, a nurse shouldn't have the least # of patients with a new admit that hasn't gotten there yet leaving them open for the one of the next admissions, which happens a lot. A nurse starting the shift, shouldn't have 5 patients with the new admit who hasn't gotten there while others have 4 patients and no new admit. Those are 2 issues on my floor, which are obvious that should be easily fixed. The bigger issue I notice is that people either wind up with a cake group full of walkie-talkies or a heavy group full of crazy ETOH patients, just plain crazy/needy patients, or patients that are actually really sick and require extra care. I've spoken with some of the night charges and nurses who have been there for a while and have heard that it's impossible to sometimes get the full picture of the pt load with 30 pts. I say that's fair enough, and I also say there can be some basic acuity rating you ask the nurses to give you to divide the patients up evenly. I've seen the acuity rating discussions on here, but most of them are in regards to getting more staff. We use a matrix and the matrix seems to be just fine when we have patients divided fairly. My question is: Does anyone utilize some sort of unit based acuity rating strictly to divide up patient's fairly? Some nights are beyond frustrating when I'm running my butt off and not wanting to beg for help while I see others sitting around.

[Anna Flaxis, BSN, RN]

How does your charge nurse respond when you tell them that you are swamped and need help?

[n1jmfn]

All the staff for the most part is pretty good at offering assistance. Charge on nights has a full patient load, but most will still offer help. Charge on days has none. My question was does anyone utilize some sort of simple acuity rating to give an equal load of bad patients to all nurses that way no one is overly swamped. I know there is no perfect formula and you can't predict how bad some patients will be, but one person getting all confused patients and someone getting all walkie-talkies should never happen. It seems to happen a lot on my floor, not just for me. It's almost like a game of who's night is going to suck? So back to my original question. Does anyone utilize some sort of acuity rating inn diving patients? How do you rate the patients? and Does it actually work? Thanks in advance for any responses

[MunoRN, RN]

There are a variety of acuity score systems out there, most are proprietary (you have to pay to use them), but for the most part, no matter how in depth the acuity scoring system is, they usually just assign a score of 1, 2, or 3, which isn't really that complicated. Obviously the easiest patients will be a 1, the hardest will be a 3, and then you just need to define what a 2 is. Give each patient a score of 1, 2, or 3, add up the total acuity of the floor, divide that by the number of nurses and you have what each nurses acuity score total should be. This may need to be weighted if aids aren't evenly distributed, but really it shouldn't be that hard to get a general idea of how to evenly divide assignments.

[n1jmfn]

Do you work at a hospital that does it and does it work well? I brought up the idea to our nurse manager of pretty much this concept and she didn't completely brush it off, but she definitely didn't embrace the idea either.

[Anna Flaxis, BSN, RN]

We used an acuity rating system based upon how much nursing time each patient required (based on how many treatments/meds the patient had, how sick they were, etc.) but it really wasn't very useful in dividing up patient assignments due to the high volume, fast turnover nature of our department plus the physical layout. It was impossible to plan ahead enough to evenly distribute the heavier patients physically, as the moment a bed opened up, it was filled immediately. The physical layout of the floor made it so that if you tried to break up patient assignments by acuity, you'd have assignments too spread out. The charge nurses basically made assignments based on consecutive room numbers, but if you had a particularly heavy patient, you might have one less, like 4 instead of 5. None of our charge nurses took patient assignments, but they stayed very busy.

The unspoken rule was that if you had down time, you found someone to help. Nobody sat around doing nothing if there was anyone running like crazy.

[xoemmylouox, ASN, RN]

Teamwork makes it easier. Everyone knows who can be trusted and relied on. If you're sinking ask for help. Assigning based on acuity has never been done in any place I have worked.

[Do-over, ASN, RN]

We do, but it is ICU and so much easier to do than on the bigger tele or med-surg units.

[kcochrane]

When I became the charge nurse on nights on my old floor, they already were assigning rooms by block assignment with no regard for acuity or empty beds. Night charge nurse did the assignment for days and vice versa. Both of us attempted to start assigning by acuity and the uproar was so bad we stopped. I was able to at least assign the empty beds fairly, but that was about it. Even one room change was met with resistance with some people looking like they were going to have a heart attack from the change. But of course they would be the ones whining when their load was too heavy. It really should be the charge nurse on the prior shift assigning by acuity since they know how the patients are. It also has to be supported by both the charge nurses and the nurse manager in order for it to be enforced. At nights it is easier to help each other out when one assignment is heavier than another. On days it is almost impossible. It is the best and right way to do it IMHO.

[n1jmfn]

Thanks everyone for the replies. Glad to see I'm not the only one who has at least tried to get some kind of acuity thing going. Also glad to see I'm not the only one who was obviously met with resistance from the manager and others when trying to get it implemented. I know there is no perfect way to do things, but it never hurts to try new things when the old system obviously has flaws.

[smartin13]

we do our assignment by acuity. Our scale is 1-4. 1 being independent walkie talkie and a 4 being a total care, tube feeds, turns, incontinent etc. We try to make our acuities as equal as possible. Sometimes that gets messed up when a nurse is back over several days because they want their patients back (usually this means they have a higher acuity). We also take into account discharges and open beds. The previous shifts charge nurse makes the next shifts assignment. On nights our charge takes a full patient load so she/he may call and ask the other nurses what their acuity and discharges are if they haven't had time to check it out themselves. we don't really pay attention to physical location of the patients however we also do not have a super long hallway either.

[delilas]

I think we work on the same floor