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

VickyRN, MSN, DNP, RN · Jul 7, 2003

Have a peaceful and blessed shift tomorrow, Renee!

pickledpepperRN · Jul 7, 2003

Most dishonest are hospitals that say they use acuity for staffing but don't. They have a matrix according to numbers and the charge nurse is to assign patients based on acuity.

How can that possibly work?

Staffing must be based on the needs of individual patients. Staffing must increase if one or more patients need more time. There should also be "wiggle room" for the times a medical crisis happens or there are many patients admitted.

What do they do when a nurse gets sick?

nimbex, RN · Jul 7, 2003

we are required to enter into the computer our patient acuity's each 12 hr. shift.

I haven't done it in 6 months, I charge 3 of 7 days a week.... no one has asked.

think they amount for anything in my facility???

4XNURSE · Jul 7, 2003

Originally posted by spacenurse
Most dishonest are hospitals that say they use acuity for staffing but don't. They have a matrix according to numbers and the charge nurse is to assign patients based on acuity.
How can that possibly work?
Staffing must be based on the needs of individual patients. Staffing must increase if one or more patients need more time. There should also be "wiggle room" for the times a medical crisis happens or there are many patients admitted.
What do they do when a nurse gets sick?

I've seen acuities used to send nurses home, but I have yet to see a house supervisor who will bring in extra staff either before or during a shift, because of high acuities.

But then I've only been a nurse for 15 years, and never worked outside of California.

Just another $0.02 while I switch feet.

ken :devil:

pickledpepperRN · Jul 7, 2003

A shift supervisor told me she is evaluated on "budgetary alignment". Her superior patient advocacy and willingness to troubleshoot on behalf of quality care including assisting with a patient are "meets the standard."

live4today, RN · Jul 8, 2003

It seems that acuities are all about meeting the standards outlined on paper regardless of what the actual patient situation calls for all because of "the budget, the budget, the budget". :rolleyes: I've never been soooooooo sick and tired of hearing about "the budget"! :chuckle

Snooze time for me, so until tomorrow.......

jilpil3 · Aug 1, 2003

Does anyone have a simple one page acuity sheet? I doubt it will

change our staffing but we only have a 4-5 page booklet for rating patients, which is not realistic. Any help would be great.

jilpil3

BadBird, BSN, RN · Aug 1, 2003

I think the problem is consistency, acuity staffing works if it is maintained but as we all know, oops we are short staffed again so out the window it goes. Any theory can work on paper but what management never understands is when families are calling every 2 minutes, call bells never stop, patient have the nerve to code at a change of shift, paper planning just doesn't work.

barefootlady, ADN, RN · Aug 1, 2003

We are required to assign acuity every shift. It is a matter of punching in a number after we add all hospital defined descriptions to a patient. Does it work? No! No! No! We can give all of our patient a high acuity or give them all a low acuity, it only matters how many patient we have. Our staff is flexed down more than asked to flex up. The budget must be maintained. If you have 5 patients and they are all confused, combative, and disorientated, so what, just do the job. I am so sick of hearing,"do your acuity", it is just another piece of paper the hospital uses to justify poor staffing. I have tried to become a more positive nurse these last few weeks, but my attempt to change my attitude is fast becoming hard to maintain.

ainz · Aug 1, 2003

I have yet to see an acuity system that accurately reflects reality and is forward-looking. There is too much room for abuse and manipulation of the information on the nursing side and hospital side because the systems are too subjective or the data entered isn't verified.

I think there would be many benefits to a good, objective, forward looking system that reflected reality and is purely patient care needs driven. Of course these words come from me, one of those "evil, greedy, dishonest, administrator-types."

Nursing has really brought this on ourselves because we abused and manipulated the systems that were out there and as a result the system lost credibility and nursing took a hit as well. In my days as a nursing supervisor and nurse manager, we regularly manipulated the numbers to justify more staff. Administration caught on and pulled the system, we then went to a staffing matrix which is a one-size-fits-all and leaves no flexibility for staffing.

llg, PhD, RN · Aug 1, 2003

My opinion is pretty much in line with the majority of posts in this threads. Acuity systems are just that ... systems designed and used by people attempting to measure and document the nursing care needed and/or provided. Because they are human systems, they are only as "good" (ie. accurate, consistent, reflective of the the true needs, etc.) as the people who design and use them.

llg

rstewart · Aug 1, 2003

In my experience acuities are not particularly useful. If each unit has clear admitting and transfer/discharge criteria for their patients, then making uniform/fair asssignments should not be a problem.

That is not to say that the assignments will be manageable necessarily; that is a function of an appropriate/adequate number of care hours budgeted for each patient on any given unit.

So the problem is always two-fold: 1) Are the patients case managed properly and on a timely basis so that they are at the appropriate unit/level of care? (Doing so should leave you with relatively homogeneous patient populations in terms of care hours required) and 2) Are adequate hours provided to meet the needs for a typical patient for a given unit?

Management must do both for adequate care delivery; regretfully they often do neither.