I recently volunteered at a showdown staff meeting [don't you love those?] to benchmark our staffing ratios and acuity tool with those use by other hospitals. We have recently experienced the loss of about 30% of our staff due to unexpected illness, opening a PICU, and just plain old job dissatisfaction. Our nurse/pt ratio has never been great, but now it's just unsafe. Our charge/resource nurse had 4 unstable vents, including an admission, in addition to having charge and transport duties. The rest of the staff is being hit with 2-3 vents + 1-2 feeders or intermediates, and maybe 1st or 2nd admit. Anyone who floats in to help can only take feeders/growers, which leaves us with 13 unstable vents to manage with 5 nurses on average. At this meeting, they told us they hired 5 people, who will be starting in a month or so, but our staff is currently in meltdown. I suggested that if we can't justify hiring more FTE's due to unpredictable census, why don't we change our outdated and ineffective pt acuity assessment tool to prove the need for hiring more FTE's/PRN's. We currently divide intensives by 2, [vents, dop/dobut] Intermediates by 3 [iv's vapotherm, etc] Continuing care by 4 [og/po feed/grow] and that gives us the # of rn's needed. however, a nurse won't get just 2 intensives. You may get 2 intensives and a intermediate.....#of meds, o2 instability, a's & B's are never considered.
Sorry for the long intro.........
Please tell me your unit size, teaching vs community, normal [real world] nurse/pt ratio, and what type of tool you use to determine a workable acuity level.
Our unit just went thru something similar Steve. We were all busting our butts. Then our hospital brought in NASH, who now dictates our staffing according to census...we have to fight tooth and nail to go above the number they deem fit. For instance, we have 38 patients, they say 16 nurses. All fine and dandy but I have 2 1:1's, 2 rooms isolated so that is 4 nurses tied up, and a board full over in L/D. Sucks. Basically, someone from finance sits, at home on the off shift, and watches the bed boards for the hospitals and if you don't input your staffing every 4 hours, you get a call. If they see you kept an extra person, you get a call within 10 minutes of inputting your data for an explaination. Too busy to put you numbers in, you get a call. It is like Big Brother watching!
Basically, the only 1:1's we have are cooling kids, super sick kids on NO, OSC, multiple vasopressors, operative kids until stable. Most of the time we have 3 kids in any combo of vents and feeders. But our charge nurse rarely, if ever has an assignment...we did get these NASH people to agree to that. Our unit is a level 3, 50 beds. We take transports, do some transports ourselves, teaching facility.
We have had to defer maternal transports before, but they understand, where are we going to put them? And we have deferred due to short staffing too...not ideal, but it has been done.
The acuity tool we use sucks too. It scores our stable vents the same as our feeders and does not take into account for those chronic kids that take up hours of your time. We are fighting this right now since it is being used to determine or FTEs.
Good luck with your unit...we are still fighting our battle
NicuGal, MSN, RN
2,743 Posts
Our unit just went thru something similar Steve. We were all busting our butts. Then our hospital brought in NASH, who now dictates our staffing according to census...we have to fight tooth and nail to go above the number they deem fit. For instance, we have 38 patients, they say 16 nurses. All fine and dandy but I have 2 1:1's, 2 rooms isolated so that is 4 nurses tied up, and a board full over in L/D. Sucks. Basically, someone from finance sits, at home on the off shift, and watches the bed boards for the hospitals and if you don't input your staffing every 4 hours, you get a call. If they see you kept an extra person, you get a call within 10 minutes of inputting your data for an explaination. Too busy to put you numbers in, you get a call. It is like Big Brother watching!
Basically, the only 1:1's we have are cooling kids, super sick kids on NO, OSC, multiple vasopressors, operative kids until stable. Most of the time we have 3 kids in any combo of vents and feeders. But our charge nurse rarely, if ever has an assignment...we did get these NASH people to agree to that. Our unit is a level 3, 50 beds. We take transports, do some transports ourselves, teaching facility.
We have had to defer maternal transports before, but they understand, where are we going to put them? And we have deferred due to short staffing too...not ideal, but it has been done.
The acuity tool we use sucks too. It scores our stable vents the same as our feeders and does not take into account for those chronic kids that take up hours of your time. We are fighting this right now since it is being used to determine or FTEs.
Good luck with your unit...we are still fighting our battle