Re: staffing...please explain

  1. I am not really interested in nurse-to-patient ratios right now. I can read many threads regarding this.

    My question is, do any hospitals staff according to acuities anymore?

    Case in point: I have worked two shifts now 7P-7A where the acuities of patients (not that this hospital cares about how much care the patient needs) exceeds the number of staff working. I am especially worried because we work 12-hour shifts now and anything can happen! On paper, 2 nurses for 10 patients sounds easy. (No CNA by the way or secretary). The nurses station is left unmanned. Call lights go unanswered. Phone calls go unanswered. 6 admissions between 3 p.m. to 6 p.m. Visitors all over the place. Toilet leaking in one bathroom. Pt transferred to another room. Heavy vaginal bleeding with one pt. New admission right at change of shift. (Requires hourly checks x 4). Patients in pain...need to assess and medicate.

    I was expected to call people at home who were off to come in! Who has time for that. Supervisor would not make calls.

    This is probably typical for most of you. Why do we put up with this?!

    Just once, I would like to have an administrator for a patient and have them "wait" for someone to help them.

    How do I get the hospital to rethink acuities? This worked great in the 80's. Each shift was responsible for the next shift's staffing.

    We have an extensive float pool. Why aren't they utilized?

    Oh...I was told by my manager that we staff according to ACOG standards. What?!
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  3. by   Ortho_RN
    Debbie.. Our hospital has just recently gone back to staffing by acuities.. I'm assuming that is what it is called.. They rank each patient as a Low, Medium or High.. Then the computer tells you what staff you SHOULD have...

    Not sure how it is working, I am a PCA so there have been instances when most were lows and mediums and they left one PCA for 30pts on a Orthopedic unit.. Whatever..

    But our hospital is in so much financial trouble right now, I am not sure anything will help.. It has been rumored that Baptist is buying our hospital... Is that a good thing??
  4. by   teeituptom
    Cant trust those Baptists, first thing you know they will try to Dunk ya
  5. by   MandyInMS
    We have a form that is filled out each shift that is based on acuity of is SUPPOSED to be used to calculate shaff needed for the next shift...what a crock...we are staffed according to the number of pts NOT the acuity...they just don't seem to "get it" could have 6-7 pts one time without difficulty...another time 2-3 could wipe you out...somehow this doesn't seem to sink in :/
  6. by   Joycean
    We have worked hard to get to where we are. Our staffing is done by ratio. (4 : 1). The assignment is done by the Resource Nurse (charge nurse by assignment) for the oncoming shift. This is where acuity comes into play. We also look at teaming up new grads with experienced nurses and assigning RN's with the lighter load, if possible, to cover any LPN's on the shift. The facility uses a shared governance when making decisions, so we have input in how things work. As far as staffing needs, we have a Staffing Dept that takes care of most of the calling needs. When things get tight, the Assistant Director jumps in to adjust staffing discrepencies.
  7. by   Tweety
    We don't staff by acuity but by numbers. X number of patients gets you X number of staff. Sometimes we can go over budget if we can honestly say our acuity warrants it, and we aren't requesting extra staff all of the time.

    As a charge nurse I need to be aware of what's going on the floor and make assignement appropriately. When a nurse is in a high acuity assignement, I help her/him, I don't give him/her admissions, etc. Sometimes I have to tell the ER and the supervisor, we are done for the night, I'm sorry but acuity is just too bad right now and "my" nurses can't take any more. Usually that is enough because I have a reputation of being upfront and honest. When I say we are in the weeds, they believe me. But on the other hand when things are slow we admit it and take admissions.

    Sometimes we don't know an assignment is high acuity until it's too late to change, but we will make things easier for the next shift and make appropriate assignments.
  8. by   Cheyenne RN,BSHS
    I started out on the medical floor in 1985 before I transferred to ICU nursing. After years of doing critical care and working part time in home care, I wanted a break. I took a few years and worked LTC and then tried my hand at adolescent care in correctional facilities.

    I recently started to work on the med/surg floor again where our ratio goal is 1:6. (please note the word goal here) We work 12 hour shifts and use computerized charting. There is one PCA/NA and she is divided between two hallways so she may have up to 12-16 patients.

    The severity and acuity of the patients can range from "true ICU material but no beds are available" to patients who are waiting for long term care beds.

    Either way each one is total care and any patient that can feed themselves or even use a call light is considered a plus.

    I now have patients on the floor that would have only been in ICU back when I started nursing 18 years ago. Acuity is not considered at our facility, only number of patients and warm bodies with a license.

    I can tell you acuity has definitely changed from when I started and so has the number of staff to care for them. It seems that administration is trying to care for sicker patients with fewer staff than ever.

    It is scary to say the least.
  9. by   rdhdnrs
    Your staffing standards are not meeting ACOG guidelines. You need to show your manager the standards. And no, this kind of unsafe staffing is not the norm. Your supervisor is REQUIRED to get help for you when a shift is like this. There are some major issues on your unit, and I think you and your coworkers need to go up the chain and try to address them.
  10. by   webbiedebbie
    Thanks, rdhdnrs....I sent you a pm.

    I work a Postpartum unit...granted, there are many times we are not busy. But when we are, that is when we are short-staffed.

    I am a professional and I feel I know an unsafe situation when I see one. (So far, I have worked 2 of these nights in this hospital).

    Our system currently only allows for 3 nurses total for 11 patients and higher (up to 23 beds). That may be fine in some instances, but the majority of the times, we only have 2 nurses and may or may not have a CNA (and they only work up to 11 p.m.).

    How do I get the hospital to start staffing by acuities??????
  11. by   Sophronia
    What are acog guidelines? I havent heard of that.
  12. by   nell
    Funny, (well not really...) we assign an acuity number to all of our patiets for the upcomming shift - this number is used for billing purposes - we are staffed according to "the grid": warm bodies to patients. We must justify when a patient needs to be 1:1 or 1:2. Thank goodness for ratios, or it could be much worse. (this is in NICU).
  13. by   susanmary
    Last edit by susanmary on Jan 14, '05
  14. by   Jenny P
    ACOG= ? American College of Gynecology?

    If so, no, your hospital is NOT following their guidelines (try checking their website and see if they can tell you their guidelines).