Staffing by acuity

catlady, BSN, RN · Jun 24, 2001

First of all, I don't understand how your nurse manager is coming up with her own acuity scale. There should be a consistent scale for all similar units, such as ICUs or medical floors, that comes from the hospital, unless you are a closed unit.

If I were designing an acuity scale that determined staffing, I would select a number of factors that actually affect the amount of hours each nurse needs to spend at the bedside. I would then give each factor a weighted value, because they're not all going to be equal. So you need to sit down and figure out just what it is you do all day. You might need different weighted values between shifts (baths might have a higher weight at night, vs. medications on days, for example). Then you decide what combined score will equal one RN and/or LPN, and set that as your standard. Divide the total score of all your patients by the standard, and you'll know how many nurses you need on a given shift. Again, you will probably need different standard scores for each shift.

And don't let them count CNAs or ward clerks or housekeepers in your staffing ratios (I've seen it done!).

psnurse · Jun 25, 2001

We use a computerized system called Pathways. We assign an acuity level 1 - 6, based on charge nurse judgement using pre-written criteria. Then we push a button and Voila! It tells us how many nursing people we need, including techs and sitters.

It all works pretty well, the thing about it is that they have now decided the charge nurses are padding the acuity. So they are breathing down our necks and asking for proof that the sick people are really sick.

OC_An Khe · Jun 25, 2001

That's the problem with acuity systems, if staff Rns fill them out the admin. feel the acuity is placed too high and when the admin. fills them out the staff feels that they are too low. The issue is trust, and a committment to staffing to the patient as opposed to the bottom line or we have x nursing staff avaiable so we

will make the system call for x.

kat9114 · Jul 23, 2007

Where can I find ICU, specifically CVICU type acuity based staffing models?

RainDreamer, BSN, RN · Jul 23, 2007

We have an acuity score sheet that was made up by a number of different people and it was tweaked until it worked for our unit.

During our shifts we add up the numbers and come up with an acuity score for our patients (we do this each on day and night shift). But a lot of times during report the charge nurse will ask us if the assignment is ok, if the baby should be 1:1 or what we feel would be a good assignment acuity wise.

We all work together though. The supervisors trust our judgement as far as what is too heavy of an assignment and they staff according to that.

MikeyJ, RN · Jul 23, 2007

My clinical nursing instructor was telling me about working as a staff nurse on a busy ICU floor many years ago. She said her hospital had just developed a new acuity system where the staff nurses would fill out the acuity paperwork a few hours before the end of their shift, so the floor manager could identify whether the next shift needed to float nurses to their units or float them elsewhere if they had low acuity. My instructor told us that her entire ICU department cohorted together to "up the acuity" for the next shift so they would float nurses to their department. Needless to say, the entire department was reprimanded and the acuity policy throughout the entire hospital changed to where a charge nurse had to do all of the acuity assignments.

EmmaG, RN · Jul 23, 2007

We staffed according to census, but the charge nurses were given some lee-way in staffing for acuity (i.e. if we had alot of chemos or acutely ill leukemics, etc.). It was always a sticking point with me; I felt we should have had the same staffing grid as PCU. But the administration lumped us in with med/surg. The supervisors disagreed with this as well, so they usually didn't give us grief when we "over-staffed".