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

[live4today]

I recently had a conversation at work with two other nurses about acuities. One nurse is VERY STRONGLY PASSIONATE about acuities and believes they DO work. The other nurse understood my viewpoint, but still feels the necessity of it.

I don't believe acuities work from what I've witnessed while working as a nurse since graduation sixteen years ago.

Any takes on acuities whether they work or not? And, why do they work if your answer is Yes, or why don't they work if your answer is no.

Thanks, and goodnight! Looking forward to reading your responses nurses.

[gwenith, BSN, RN]

I just hit another language difference - we call "acuities" patient/nurse dependency systems. So if you are looking for OS models google that title. Probably one of the most widely used systems is "Trendcare"

http://www.trendcare.com.au/products_1.html

Designed by a nurse as a masters project. She was a nurse manager for a regional hospital. It is simple. Allocates extra time for "confused" patients as well as counselling and education.

Is it the be all and end all of staffing? Heck no! Nothing will predict when the wheels fall off!

As with most of the posters here I agree that it works when it is staffed to the correct amount it is worse than useless if it is not used consistantly. One hospital I worked at would not staff to the level predicted and it became a measure of how short staffed you were. You would over hear nurses talking about being X no of hours "down" each shift.

I have also worked in hospitals that do not "believe" in acuities and ended up with the most uneven staffing I have ever encountered.

So acuities - yes/no? When used correctly - yes they are good and they are better than the alternative.

[pickledpepperRN]

The official term in California is Patient Classification System (PCS). Below is the new law just as regards the PCS. Underlined are new, double underlined are newest. It is a cut and paste from the web site:

http://www.dhs.ca.gov/lnc/default.htm

), Tthe hospital shall implement a patient classification system as defined in section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements. The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, licensed psychiatric technicians, who shall be assigned to direct patient care. Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care. The system developed by the hospital shall include, but not be limited to, the following elements:

(1) Individual patient care requirements.

(2)The patient care delivery system.

(3)Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population.

(b)© A written staffing plan shall be developed by the administrator of nursing service or a designee, based on patient care needs determined by the patient classification system. The staffing plan shall be developed and implemented for each patient care unit and shall specify patient care requirements and the staffing levels for registered nurses and other licensed and unlicensed personnel. In no case shall the staffing level for licensed nurses fall below the requirements of subsection (a). The plan shall include the following:

(1)Staffing requirements as determined by the patient classification system for each unit, documented on a day-to-day, shift-by-shift basis.

(2) The actual staff and staff mix provided, documented on a day-to-day, shift-by-shift basis.

(3) The variance between required and actual staffing patterns, documented on a day-to-day, shift-by-shift basis.

(4)(d) In addition to the documentation required in subsections ©(1) through (3) above, the hospital shall keep a record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments to individual patients by licensure category, documented on a day-to-day, shift-by-shift basis. The hospital shall retain:

(1) The staffing plan required in subsections ©(1) through (3) shall be retained for the time period between licensing surveys, which includes the Consolidated Accreditation and Licensing Survey process, and

(2) The record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments by licensure category for a minimum of one year.

©(d) (e) The reliability of the patient classification system for validating staffing requirements shall be reviewed at least annually by a committee appointed by the nursing administrator to determine whether or not the system accurately measures patient care needs.

(d)(e) (f) At least half of the members of the review committee shall be registered nurses who provide direct patient care.

(e)(f) (g) If the review reveals that adjustments are necessary in the patient classification system in order to assure accuracy in measuring patient care needs, such adjustments must be implemented within thirty (30) days of that determination.

(f)(g) (h) Hospitals shall develop and document a process by which all interested staff may provide input about the patient classification system, the system's required revisions, and the overall staffing plan.

(g)(h) (i) The administrator of nursing services shall not be designated to serve as a charge nurse or to have direct patient care responsibility, except as described in subsection (a) above.

(h)(i) (j) Registered nursing personnel shall:

(1)Assist the administrator of nursing service so that supervision of nursing care occurs on a 24-hour basis.

(2)Provide direct patient care.

(3)Provide clinical supervision and coordination of the care given by licensed vocational nurses and unlicensed nursing personnel.

(i)(j) (k) Each patient care unit shall have a registered nurse assigned, present and responsible for the patient care in the unit on each shift.

[live4today, RN]

Originally posted by barefootlady

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.

Now THIS is what I experience and believe about "Acuities"! I especially lived this drama the past two workdays when I had five patients......three were level "4" patients on the so called "classification system that is suppose to work", and one was a "3". The "REAL" acuities are happening on the units right under the noses of those preaching "Do your acuities" and NOT wanting to really see the joke of that statement to a nurse like me who seems to get dumped on royally with the worst patients on the unit every time I work! I can't tell you the number of ancillary and other departmental staff who frequent our unit who are always saying to me "Are you the only nurse working today? Boy you are always flying up and down these halls? I never see you sitting around like some of the others.".........AND SO FORTH!

WHERE'S MY HELP WHEN I NEED IT! I enter my acuities DAILY and I do NOT see the flesh to back up those little tiny digits I barely have time to stop and enter in the first place.......due to things like PATIENTS who are in need of their nurse and in need of her/him NOW!

Acuity Lovers who are always preaching "Do your acuities...have you done your acuities yet.....don't forget your acuities?????"..........YOUR SINGING TO THE CHOIR HERE!

[NICURN40]

Does anyone work in a hospital which uses Evalysis Acuity tool and

works in a level 3 NICU? Does it work for you when you have a 1:1 patient? How do you staff based on the "levels of patients"-

ex. how many level 1 patients would you have in an asignment?

How do you staff a Level 4 patient? Thanks