assignment due to acuity with points??

SunnyAndrsn · Sep 13, 2009

When I was precepted before graduation, the unit I worked on was like this. Pts. were assigned a level of acuity, based on a number of factors including such things such as fall risk (do they require an alarm?), number of assist required for cares (set up, assist of one or two), and the level of care required. Is the pt on tele monitoring? What kind of medications do they require (Do these meds require additional monitoring, etc?) Observation pts? I think you get the idea.

The nurse that precepted me was charge, and spent quite a bit of time working on the assignment for the next shift. In addition, she had to take into account the skill level and experience of the nurses coming on, what the floor capacity was, and potential admits.

The cons that I saw were the amount of time it took for the charge nurse to work on the assignement and the fact that the oncoming nurses would get frustrated because of the assignments (That's not fair, she always gets an easier assignment...what, don't they think I can handle more...?) I saw this first hand as well.

The last shift I worked at the hospital, we had 8 pts between two nurses, I had five and the other nurse had three because they figured it would be easier for me to not have admits. She ended up with two admits.

Hi ,
A coworker and I are starting a project about assigning pat. due to acuity. We would like to use a point system for that and have some ideas.
We were wondering if there is anybody out there that works this way and would be willing to share the pro and con´s and explain how the assignment is done.
I thank you for any information that you are willing to share.
We work on a Med / Surg floor with 42 Pat.
We have 1 Unit Secretary
3-4 CNA
1 Charge that mostly takes no Pat
6 RN
1 ANM in the office
Christina

patwil73 · Sep 13, 2009

Hi ,
A coworker and I are starting a project about assigning pat. due to acuity. We would like to use a point system for that and have some ideas.
We were wondering if there is anybody out there that works this way and would be willing to share the pro and con´s and explain how the assignment is done.
I thank you for any information that you are willing to share.
We work on a Med / Surg floor with 42 Pat.
We have 1 Unit Secretary
3-4 CNA
1 Charge that mostly takes no Pat
6 RN
1 ANM in the office
Christina

My hospital originally used an acuity model called Quadromed to assign patient acuities. That created a number of staff to cover those patients - the higher the floor acuity the more staff you received.

The problem I noticed is that people rarely assigned by acuity - they just divied up the patients so everyone had roughly the same - 6 on days, 7 on eve, 8 on nights.

Since I was in charge of assigning admits to the floor I knew there would be a fight if I asked them to go beyond those numbers - even if the acuity model said they could.

Most staff did not know how to accurately assign acuity numbers - often times giving less points than they should.

The managers of each unit had an average acuity they were told to shoot for and if came back above that they had to try and lessen it to keep their budget in line - (note this didn't come about by changing the patients but simply by lowering their score).

Also the system was not good in capturing those patients that actually took up a lot of your time - walkie/talkies who needed everything 1 at a time can be a lot more busy than the isolation total care who you only need to see twice a shift.

The nurses often didn't like to walk far for their patients - so even when I assigned by acuity (a couple times I had to be the charge when we were short staffed) they asked for the assignment to be changed so they didn't have to walk so far - meaning skip 3 or so rooms to get to a patient.

Acuity based staffing can work - but you got to get the nurses to buy into it, and you have to train them well so they use it correctly. Without that you might as well staff by a matrix.

Hope this helps

Pat

dansamy · Sep 13, 2009

We're staffed by a matrix of "x patients = y nurses + z cnas". I hate it because when you do have higher acuity patients, then you feel short-staffed and over-worked because one patient is really sick, but you have 7 other patients you still have to take care of too.

paschick · Sep 13, 2009

The hospital that I worked at previously used a point system for acuity and used the scores to make assignments. The idea was that everyone would have an equal assignment. I thought it was a really good system and wish my current hospital used something similar. I would just make sure that the staff know how to accurately score patients.

ObamaRN08 · Sep 13, 2009

OMG... The nurses where I work are sooooo spoiled. our max Med/surg assignment is 4 pts to 1 RN PCU max is 3:1. Plus we have CNAs. So if my unit is full (14 PCU and 18 Medical beds) we get 11 RNs (if we are fully staffed) and 4 CNAs and we have an admissions and discharge nurse!. I am often charge nurse and have to work out assignments. My nurses will absolutely throw a fit if They have to walk to the other end of the hall. but then they throw a fit if their assignment is to heavy but is next to each other. There is absolutely no way to keep everyone happy when it comes to assignments. thankfully they only complain the first few minutes of the shift. I can't imagine tryng to keep track of 8 patients. It sounds dangerous to me.

LuvMyGamecocks · Sep 14, 2009

My facility uses the Synergy Model set forth by AACN. Assignments are made using this model.

Good luck!

http://www.aacn.org/WD/Certifications/Content/synmodel.pcms?pid=1&&menu=

locolorenzo22, BSN, RN · Sep 14, 2009

We use a model of 1-3 point system. Anyone with IVF, confused, altered mental status, total care would get three. Anyone who needed assistance with ambulating, with pain control, with tubes/lines at times(think IVPB or IVP meds here and there) got a 2. Everyone else got a 1.

But nobody is assigned by this system. We have 1 LPN on days, and everyone else is RNs, often LPN has more pts because she can't admit. Also, staffing is done by x patients = so many nurses/techs. So it really doesn't help, just try not to give too many "heavy patients" to one nurse.

just the way of world I think.

dansamy · Oct 10, 2009

I can't imagine tryng to keep track of 8 patients. It sounds dangerous to me.

Will you call my hospital's CNO? Some days are worse than others. One day I started with 7 patients, discharged 5 of them and admitted 6 more. By the end of the day I had been responsible for and charted on more than a dozen patients. Patients start running together by that point. And no CNAs, so it is all on the nurse.