Hospital Acuities.........or NOT!!!

Tweety, BSN, RN · Jul 4, 2003

Originally posted by cheerfuldoer
Sooooooo.......you believe in acuities when they work, and not when they don't.......is that what you're saying??? :)

In that case, I believe they would serve a useful purpose IF ONLY they jived with the reality of our staffing.

Thanks for your response, 3rdShiftGuy! :)

Cheerful, basically how we do it is that if we have a highly acute patient that can not fit into our normal staffing pattern, we identify that patient and make assignments appropriately. For instance if we have a noncritical patient on the floor that needs a labetelol drip and frequent bp checks, she won't be transfered to the unit, but would be part of a 4:1 or 3:1 assignment, but moved to the intermediate unit.

What I also said is that is sometimes sabatoged by our own staff, the one with the less acute patients and the higher number of patients sometimes resents the staffing pattern.

We don't on a routine daily basis fill out acuity sheets and turn them in.

Every now on then for surveying and budgeting purposes we will do an acuity sheet.

Am I making any sense?

live4today, RN · Jul 5, 2003

Wow! Thanks nurses for all the wonderful input here! Thumbs up to you all for telling it like I also see it where I work. :rolleyes:

If those darn acuities only represented the truth of what the reality of the unit quo is perhaps they'd be worth the time it takes to enter them into the system. One can only wish for a miracle, eh?

3rdShiftGuy.....you make a lot of sense! Kudos! :)

Now, what should hardworking floor nurses do to get the hospital and admin to realize acuities are not effective the way they may be meant to be? :nurse:

pickledpepperRN · Jul 5, 2003

The best way is to have the nurses on your unit in agreement.

Documentation is the first step.

I think an incident report should be filled out along with the ADO. . Check with your state nurses association for their advice too.

Whay some nurses near me did. You can click the second from bottom link to see what the looked like a couple years ago.

Improved Telemetry

Staffing

The CNA Professional Practice

Committee at St. Vincent, LA:

"Our telemetry unit assignments

were too heavy to allow safe

delivery of patient care. After

meetings with nursing administration

proved unproductive, the telemetry

nurses and the PPC initiated an

intensive two-week ADO campaign

on all shifts in the unit to document

the unsafe assignments that

resulted in a private meeting with

JCAHO and the State Department

of Health Services (DHS).

Violations of Title 22 were reported

and the facility was cited for

staffing deficiencies. When

administration still did not comply,

the nurses held a candlelight vigil at

the hospital about the staffing

deficiencies at which copies of the

DHS report were distributed to the

media, physicians, and other staff.

A few days later, the staffing ratios

recommended earlier by the PPC

were implemented. The staffing

matrix now includes 2 acuity levels

at 1:3 and 1:5."

http://www.florenceproject.org/

http://www.florenceproject.org/adodisclaim.shtml

http://cna.igc.org/cna101/nursingpractice.htm

http://www.florenceproject.org/ado.shtml

ASSIGNMENT DESPITE OBJECTION

________________________, a registered nurse employed at ________________________Hospital on _______(shift),

_______(unit), hereby object to the assignment as:

___charge nurse ___primary nurse ___team leader ___team member/patient care assignment made to me by

__________________(supervisor) at _______(time) on ________(date) despite my objections on the grounds that I was:

(check appropriate description)

a)___not oriented to the unit

b)___not trained or experienced in area assigned

c)___given an assignment which posed a serious threat to my health or safety

d)___given an assignment outside my current job description

e)___case load assignment is excessive and interferes with delivery of adequate patient care

f)___not given adequate staff for acuity (check appropriate description)

___staffed with excessive registry personnel

___staffed with unqualified registry personnel

____staffed with excessive number of unlicensed personnel

___short staffed

___not provided with unit clerk

g)___transferred or admitted new patient(s) to unit without adequate staff

e)___other: (please specify)________________________________________

_____________________________________________________________

This assignment is accepted because I have been instructed to do so, despite my objections.

STAFFING COUNT on date of objection:

regular float/casual registry/agency staff currently employed on unit

RN____________________________________________________

LPN___________________________________________________

AIDE__________________________________________________

Unit Clerk yes__ no__

CENSUS (on date of objection): ACUITY: high average low (circle one)

Number of patients on unit___ Unit capacity___

Brief statement of the problem:_______________________________________________

______________________________________________________

ACTIONS TAKEN BY NURSE:

Notified Head Nurse:___________________time_______date___________

Notified Nursing Supervisor:______________time_______date___________

Notified Doctor________________________time_______date___________

K O'Malley · Jul 5, 2003

When I worked in MICU we did acuities. What a joke! If we wanted to classify a patient as a 1:1 we had to get permission from the supervisor. And the acuities nener made a difference in how much staff they alloted. The supervisor would mostly use them to see how many nurses she could pull from us. If we were really short it was tough luck. The answer was always "I have no-one to send you."

nowplayingEDRN · Jul 5, 2003

The DoD/Army has an Acuity System in their hospitals called the Workload Management System or WMNS for short. It is a 2 sided form with a variety of items on it from Activities to dsg changes to use of IV infusion pumps to patient teaching, family support and obtaining labs and EKGs. The hard copy ties in with a computer system of which the values are entered into. Each task/item has a numeric value assigned to it and based on the total of points at the end, and to what catagory the patient falls into 1 thru what ever (lets say 5 for an example for the sake of arguement) Those numbers get spit out every 24 hours and they based staffing on those numbers. It is a pain in the butt and 1 more piece of paper to fill out but it seems to work for them and our staffing is quite fair and safe. Once I get my printer/scanner back on line, if anyone is interested, I'll bring a form home and scan it into my puter and email it to anyone interested in seeing it. I do have to admit, this is the only time I have seen an acuity system in place so I really can not compare it to another facility. So I guess for now you could say my opinion is biased.

Christie

Tephra · Jul 5, 2003

We have an acuity system in place. It's mostly a *retrospective* classification, used annually to justify staffing. Although it generates numbers that are used to determine "load" in M/S, i.e., "Susan's patient crew is a total of 58 points, while Jenny's group is a 67 -- Susan gets first admit" -- it didn't seem to make a difference in staffing. The grid that we followed recommended staffing levels per total acuity but staffing still depended on number of warm bodies available.

However -- acuity was used against us in ICU -- we didn't fill in the numbers high enough one year and we lost one FTE the next year, based on that.

I'm no fan of acuities. If you hold to guidelines based on them, they *might* work. But how many times have y'all been told, "Just try to 'get by' 'make do' 'get through the shift' with what you've got, and dang the acuities?

live4today, RN · Jul 5, 2003

Spacenurse........thank you ever so much for taking time to post that form and sites to visit. I'm making a copy of it to see how it will go over at work. I'll let you know! :nurse:

pickledpepperRN · Jul 5, 2003

I don't know of any administrators who like such forms. It is VERY important that mose if not ALL the nurses on the unit sign the form for the unsafe shift they work. Sadly advocating for patients can get a nurse labeled as a troublemaker. Nurse managers have varying reactions to such forms.

Remind your risk manager that to ignore such notice places the facility at risk for losing a law suit if there is a sentinel event.

The best way is to ask all who agree to sign the form. Make a copy or use carbon if the hospital won't let you make copies. Give everyone who signed a copy. If there is a med error or incomplete charting when the number and acuity of the patients was too much for the staff provided proof that management was notified can save a nurse from discipline.

If there is a law suit a nurse can be removed as a defendant, becoming only a witness. (Read that in a journal).

In the event that the nurse is reported to the licensing board it can save a license.

BUT it gets you labeled a troublemaker. Without the support of your co workers you may be deemed insubordinant and disciplined.

live4today, RN · Jul 5, 2003

Spacenurse.......I've walked that path more than once in my sixteen years as a nurse. I don't mind being "labeled" anything others may want to pin on me because one thing I know for certain and that is WHO I am and WHAT I am capable of in every aspect of my life.

I am a very strong patient advocate for which hospitals and admin really don't like. They just like saying they are patient advocates on paper, but when it comes to putting the money on the table, they bow out of their positional stance in a hurry. :rolleyes:

My belief is you must stand for something or fall for anything. Which one we choose to adhere to will say a lot about our character as a human being. :nurse:

Thanks for the information. It will be used very wisely and professionally!

pickledpepperRN · Jul 6, 2003

Cheerfuldoer:

I hope my loved ones (including myself) are fortunate enough to have a nurse like you when hospitalized.

Hospitals seem not to understand that the only reason to be admitted to a hospital is for nursing care.

Thank you.

flashpoint · Jul 6, 2003

One of my biggest complaints is that acuities rarely consider how much work the patient actually is. A lot of patients who are AAOx3, ambulatory, and self sufficient are more work and take more nursing time than a patient with two IVs, a PEG, and a foley, but the patient with the two IVs gets more points. It also seems a little unfair when there is no attempt to balance a patient load. We get tons on whining when we have a nurse with four high acuity patients and another nurse with eight low acuity patients.

live4today, RN · Jul 7, 2003

Originally posted by spacenurse
Cheerfuldoer:
I hope my loved ones (including myself) are fortunate enough to have a nurse like you when hospitalized.
Hospitals seem not to understand that the only reason to be admitted to a hospital is for nursing care.

Thank you.

Oh so sweet of you to say that spacenurse! :kiss

I do fight for my patients rights. I am very proactive in getting them up and running to their fullest potential as quickly as they are able. I love on them, I pray for all my patients before, during, and after work. I give them diversional activities when I can. I make suggestions to them when they seem to run out of ideas of their own on how to get through their hospitalization. I don't shy away from sharing with my patients my own numerous hospitalizations because I've been in that bed stripped of my independence and dignity more times than I can count and completely relate to them in that respect. I know what it is like to be in pain, and can't get that pain med fast enough.

My frustration with acuities is they do NOT take into account the amount of time it takes a nurse to soothe a patient who is frightened, to pass meds to a patient who has difficulty swallowing, to go in a patient's room to do one thing, and end up having to do numerous things to make the patient comfortable, painfree, and satisfied so they can rest and get better....the list is endless.

I started my shift the other morning with one patient, and it was an hour later before I got to my other four patients. Why an hour later? She was confused, combative, and needed calming and reoriented and made to feel secure in her environment before I could leave her room. She was quite elderly, no family present, and in a room all by herself far away from the nurses station.

Had I left that patient to see my other patients "on time", we would have had a serious fall occur with the confused patient. I prevented that fall, secured the patient, made her feel somewhat safe, and reoriented her to her environment as much as her condition would allow. Did this get counted in the acuities? NO!

This is why I protest so much about the acuity system currently in place where I work.

Nursing is my calling. I don't doubt that for one minute. The frustrations I have towards admin for "acting blind" to the reality of what nurses really contend with gets my dander up everytime.

I'd love to keep sharing, but must get to bed since I have to get up at five thirty in the morning for a twelve and a half plus shift tomorrow. :eek: Sooooooo....until tomorrow..... :nurse: