Acuity tool?

[elRae]

I'm wondering about acuity tools? Does anybody actually use them? I've only worked in one hospital and most of my clinical were here too, so I don't know much else. We are always very busy and fill beds almost as soon as patients are discharged. Due to the physical layout of my unit, teams are assigned based on proximity, not acuity. This could mean one nurse has six walker-talker's, while another has six complete care. Just wondering how other places assign their patient loads, hoping to bring some ideas to my manager and initiate some changes. Thanks!

[Dragonfly.RN]

My previous place of employment was similar; you could have 6 independent self cares while someone else has 5 completes and is drowning. Thankfully my particular unit was very team oriented and we helped each other out. Every night was pretty much a dumpster fire though. 

My current place uses the acuity, and while they try to keep you in the same "mod" (hallway), you might end up split but you're at least not going to be running from one end of the unit. If you do happen to have a patient down an opposite hall, that is typically an independent patient. Honestly it's a good system. It takes into account whether the patient is on certain drips, if they are confused, if they are incontinent, and various other aspects of the patient and patient care; pretty much everything, and of course you can use your judgement too if you feel they don't really fall in the parameters or guidelines for a certain score. You're still gonna end up with some chaotic nights, but it's nothing near as bad as my previous hospital. 

[OUxPhys, BSN, RN]

It helps to serve as a guideline. Unfortunately too many take it literally, thus making it harder for the charge nurse to make an assignment. The best thing to do is make the assignment as fair as possible. Some charge nurses make the assignment by assigning rooms based on location and I hate that. The one thing to remember is there will always be someone who isn't happy. Always. 

[Been there,done that, ASN, RN]

My unit used a one through five acuity scoring. The off going nurse would gauge the acuity near the end of the shift, to assist the oncoming charge nurse in making out the new assignment. It was clear which patients were complete care. As charge, I did my best to balance the acuity numbers while trying to keep the assignment as close as possible.

Basing assignments on proximity does not promote safe patient care.

Good luck with your project. But management should have already done that work. I wonder how they are going to receive your suggestions.

[Nurse Beth, MSN]

I think a hybrid of proximity and acuity works best, as Been there, done that and OUxPhys said.

What's most important is to match the competency of the nurse with the needs of the patient.

[Sour Lemon]

They are one of many considerations at my hospital. The "big" thing, is giving each returning nurse the patients they had the night before. Beyond that, location, acuity, and friendship matter.

I think our charge nurses are generally fair, but also human. And like someone above me stated, there will always be someone who is unhappy. I have respectfully complained a few times over the years, but only in extreme cases.

[CalicoKitty, BSN, MSN, RN]

Always need to keep in mind someone will always have the easiest load, and someone will always have the hardest.

Matching the sickest patients with the most qualified nurse is a good way to alienate people by punishing competence.

Typically, in med-surg, our "acuity" generally revolves around toileting (self, standby, moderate, total). But we add in things like drips, feeding tubes and trachs to try to keep it balanced.

These days, though, I'm finding the patients in their 50s with 90000 allergies to be the roughest.. Usually pain management and an emotional drain....

[amoLucia]

1 hour ago, CalicoKitty said:

Matching the sickest patients with the most qualified nurse is a good way to alienate people by punishing competence.

SUPER TRUE to the max!!