Productivity

scb7620 · Nov 21, 2012

We use a staffing "grid" that determines how many nurses we can use based on census- then from there our charge nurses have to decide whether or not a particular patient's acuity will require them to "tighten up" an assignment- for example instead of giving 2 nurses 2 babies each, if one is really sick that baby may become a 1:1 assignment and the other nurse will take 3 babies instead. It can end up being pretty awful if one of those 3 kids ends up getting sick, but sometimes that's just how it happens.

prmenrs, RN · Nov 21, 2012

We used to have "acuity tools"--sometimes they were good, sometimes not. As usual, we often had to adapt an adult tool to babies. It seems like a good tool for NICU should be available by now. I searched google, found this article:

https://engineering.purdue.edu/BME/Research/Personal/Lawley/Publications/pdfs/pdfs/2002_Assigning_Patients_to_Nurses_in_Neonatal_Intensive_Care_JORS.pdf

catlover314 · Nov 25, 2012

Agree that a realistic staffing grid is vital. When the mgr and director set up the guidelines, the average mix of patients has to be taken into account, not just average daily census. We sat down and 'ballparked' our average of 1:1 patients (our self designed acuity tool is based on standards that come via the state perinatal organization), 1:2 and 1:3 pts and then figured all that into the guideline. There are times when the patient acuity doesn't match the plan, but in general it comes close, and reflects the care actually needed at the bedside. But the numbers will differ according to each particular unit's patient population. One size will not fit all!

prmenrs, RN · Nov 26, 2012

A good staffing tool enables you to justify "over" staffing--"Well, nursing office bimbo, we have 3 p-ops, one going for heart surgery, one on ECMO, and L&D's full of preterms, so, yes, we're kinda overstaffed." High maintanence parents can count higher, so can babies w/drawing.

We were handed a staffing tool from the PTB, totally adult. We figured out [eventually] how to fit our "square" babies into their "round" categories. It wasn't pretty, but.... we did it.

Of course, sometimes, you finally get the tool to work, and they change it. :mad:

Be careful you don't have nurses over valuing the babies. You need to be able to justify how you get the numbers!!

labordude, BSN, RN · Nov 28, 2012

Nursing side - The problem with linking productivity with staffing ratios is that there is often an inverse relationship (i.e., the more patients, the less productive a nurse actually is). Part of the issue is the way that productivity is being defined, which often differs from hospital to hospital and is usually done by someone who doesn't know a blood pressure cuff from a scalpel. In the land of NICU, most nurses I know would be inclined to define productivity based on the depth of quality care they can provide for their patients, something that suffers tremendously when we are forced/pushed into assignments that have us running around like blue chickens with our heads cut off.

Business side - The staffing ratios are designed to be a guide only, they can (and should be modified) as the patient care warrants, but as prmenrs said correctly, you have to be able to back it up. AWHONN has recommended guidelines for staffing and so does NANN, but they differ in that NANN doesn't generally allow 4 babies to 1 nurse as it only really considers Level III NICU and not Level II special patients. If the unit outcomes are good and the patients are receiving care at an appropriate level as defined by unit standards, why would you need more nurses? Are the tasks that you need assistance with something that an assistant could do for a third of the cost? Productivity is likely based on hours per patient day which IMHO...sucks and is relatively useless in actually determining how much time is spent with a patient. Since we are paid based on case-mix indices, in order to provide that 1:1 care for a sick infant, other people might have to be 1:3 or 1:4 as their acuity doesn't justify an extra staff member at this time.

A major, major issue is that often both sides don't have a clue what the other is doing/dealing with. I can't stress enough that more education in nursing programs needs to be on the financial aspect of healthcare and that orientation to administrative and financial positions in hospitals should include time spent on a nursing unit with the staff. You can say that "they don't get it" because they don't and chances are neither do you (I'm not referencing any poster, just ranting in general). If we really want to provide the best care for our patients in the most efficient, economical way, we have to understand the totality of hospital operations, not just our own specialty whether it be NICU or grilling the worse Grade-E hamburgers a hospital cafeteria can purchase.

TL;DR: Nurses, if you need better staffing, document why. Managers - We only have so much money to go around and what we are getting paid for this acuity doesn't cover more nurses. All of us, let's work together to fix this junk.

alleppey · Jun 25, 2020

I am wondering if anyone can share their staffing grid for NICU level 2 and level 3. We are trying to make some changes.