Does anyone else feel the acuity of the patient is changing?

[RN4evr]

I have been a nurse for 25 years and feel the acuity of the patients is getting higher and higher. I currently work as a staff nurse and the assistant manager of a 22 bed medsurg unit in rural Wyoming. Our nurse to patient ratio can be anywhere from 4:1 to 7:1 depending on our census. Which in it's self is like a yoyo. Of course with the revolving door. We have a high ADT most of the time. We have even had the same nurse, admit and discharge the same patient, in the same shift. This is very labor intensive. In addition to all this the patient acuity seems to continue to go up. We staff by a matrix that is based only on numbers and not on acuity. The manager and myself try to look at the acuity of the patients but we are also held to a budgeted MH/stat by upper management. We are working on an acuity tool at the present time but it has not been approved or implemented yet. We can have a 50% admit and discharge turnover in 24hrs. Is anyone else out there seeing these types of trends? Does anybody else have a similar problem? And if so how are you dealing with it? Any input would be greatly appreciated.

[SuesquatchRN, BSN, RN]

No question. Part of it is because people are discharged toosoon and sent off shen still sick. They also get to you sicker.

[diane227, LPN, RN]

Of course they are sicker. Patients I have on the floor now used to be in the ICU in the old days. Everything now is done as an outpatient. Patients don't stay in the hospital very long. We discharge people every day to nursing homes that I think I too sick to go but Medicare won't pay for another day in the hospital. It would scare me to death to work in long term care.