Patient acuity based staffing

[HRSBSNRNC]

Good day all,

I am currently researching patient classification systems, or acuity systems. A recent employee survey on my unit identified a concern about workload distribution. While we have an acuity tool in place, I thought it might do some good to do some research to see what else may be out there.

I have been doing some research about nurse-patient ratios vs. patient-acuity based staffing.

If you are currently a practicing medical-surgical nurse and are using an acuity tool to determine workload distribution I would love to hear what you use.

I am trying to have my research gathered no later than June 30, 2011 and an acuity tool available to be tested by July 31, 2011.

Thanks,

Heather

[amarilla, RN]

While I don't have specific information to contribute, I just wanted to reply to say what a great project this is, and very much needed! I work on a very busy general surgical floor (trauma and med/onc overflow) and our staffing feels very haphazard. We each take 6 patients (or more) initially, and take turns with admissions; needless to say, this is woefully inadequate and unsafe when you wind up with 4/7 heavy or acutely needy post-ops with multiple issues. Kudos and I look forward to feedback from others!

[tokmom, BSN, RN]

I think some hospitals use a dartboard.

[Ellekat2]

I'm with Tokmom-except it's not even a dartboard. Our hospital re-evaluates staffing and "adjusts" it every four hours, sometimes less. So your patient load is constantly adjusted. This is very stressful for the nurses and I believe dangerous for the patients. If your dismissal doesn't leave "on-time" (an artificial time that they think is enough time for the patient to have left), staffing gets upset with the nurse and accuses them of trying to keep patients to avoid having a nurse moved, with the consequent change in the merry-go-round of patients. Evidently the fact the patient has to arrange for a ride home is of no importance. I have had both the staffing office person and our director sit and watch me work because they think I should have dismissed patients who are waiting for either a ride home or for a room to open on another floor. Evidently having two people sit and watch you work is considered efficient use of staff by the administration. And don't think you'll get time for a break or lunch!

[TriathlonRN]

My hospital uses RES-Q Acuity Tracking software that each nurse is responsible for entering for the next shift. Throughout the day the charge nurse keeps tracks of discharges, admissions, central lines, foleys, isolation, hemodialysis pts, etc when she is ready to make the next shift assignments. I just started on the unit and I'm a new RN but it seems to be working so far. Our ratio is 5/1.

[Ayvah, RN]

My floor implemented a staffing acuity form to be filled out each shift to determine ratios.... and quickly altered the form because the results showed we needed less than the current 1:6 staffing on days.

I can have a patient who on paper is much less acute than another, but turns out to take far more of my time due to family issues, educational issues, pain, dementia, etc.

Unfortunately, I don't see how an acuity forms tell the whole story.

While no system is the 100% answer, I think the best method is ratios (individual acuity should be capped based upon floor type) accompanied by a top notch charge nurse who knows the patients and can properly split up their acuity among the staff.