Published Nov 11, 2002
Does anyone know what kind of acuity tool is used at their hospital to determine the numbers of staff that should be on your floors????
Has anyone ever heard of something called the Navy Work Time acuity tool?? They use units called FTEs.
How often is the acuity tool used??? Every day??? Can you actually see the tool????
I've never heard of that specific tool, but FTE's (Full Time Equivalent) is used for staffing according to a census percentage and the actual patient contact time of nurses in a particular unit. It does not take into consideration acuity. The mathematical calculation to determine FTE's (staffing) is based on the facilities past history of the occupancy rate (ie. 90% of the beds were filled over x period of time) and standard number of hours per day per patient that nurses are in actual contact with patients (ex. 10 hrs/day/patient); I suppose this could be adjusted for acuity (I dont know). I'm not a staffing coordinator or a manager, so I don't know how often FTE's are calculated. To further complicate the process, the facility/manager has to consider the number of staff needed to cover sick days, vacation time, etc., so when core staff take time off for whatever reason, there are enough staff available to cover this time. At any rate, it's a mathematical calculation. I'm not sure where we fall short in using this system, as most know, staffing ratios can be horrid. Considering the complexity of all the factors to consider, my hat goes off to all those managers who strive for adequate staffing levels. It's a tough job.
LilgirlRN, ADN, RN
The one we have at work is called ANSOS, unfortunately I don't know what the letters stand for...sorry.
We use WMNS, Workload Management Nursing System or something like that
llg, PhD, RN
As others have posted "FTE" stands for "Full Time Equivalent," which is the most common unit of measurement for preparing a budget. It refers to one person working 40 hours per week. Someone who works 20 hours per week occupies a 0.5 FTE position in the budget, etc. Depending on the amount of vacation time, sick time, etc. calculated into the equations, it takes between 3.5 FTE's and 4.0 FTE's to have 1 nurses per shift around the clock all week.
The concept of acuity is used (and sometimes measured) to determine how many nurses you NEED per shift -- regardless of how many nurses you actually have available. Many different tools are available to measure acuity as it used to be a JACHO requirement that hospitals do so regularly and base their staffing on a system that took acuity into account. However, acuity is a VERY tricky concept to measure and to deal with because there are so many nuances involved. For example, some patients require a lot of time with their basic activities of daily living, but are actually very stable and much of that care could be provided by an LPN or aide. Other patients may be very unstable and require a lot of sophisticated nursing judgement, but might not be quite so time-consuming. Other patients require a lot of nursing attention because of their family's needs, or teaching needs, etc. while others have a lot of lab work and they are a "difficult stick." The acuity systems have big problems distiguishing between the different TYPES of acuity and therefore have declined somewhat in their popularity.
Another problem with the use of acuity systems on a daily basis is the time it takes for the staff to accurately calculate each patient's acuity each shift. Some systems add a tremendous burden to the workload.
Another problem is with insurance companies. Some started using acuity numbers to determine how much they would pay for that day in the hospitals. That increased the burden on the hospital (and the staff) to document and justify why the patient was classified as he/she was.
Also, computer companies saw an opportunity to make money developing and selling systems that combined acuity scoring with schedule making, payroll, etc. Once a hospital has invested lots of money on an expensive computer system, they are going to want to stick with it even if it is not perfect.
Currently, JCAHO does not require the use of an acuity scoring system as it once did ... though it does require some assessment of the patients' needs and a system for matching needs with staffing patterns. Nurse managers and scholars are still struggling with trying to develop a way to accurately measure patient needs so that those measurements can used to guide staffing decisions. But there is still a long way to go.
Final note, it's not just the acuity measuring tool that you use that counts .... it's how you use the system you have ... and what you do with the information it gives you.
llg -- who's been around the block with this stuff more than a few times.
We use WMNS also but if we ever had the staff this said we should have the world will end.We are usually working at half staff
I would like a copy of any tool (productivity/acuity) that anyone would be willing to share. I am especially interested in tools that have be successfully used in a Critical Access Hospital setting. (Our nurses cover med surg, ER, OB, OP infusion, etc.)
Any luck getting copies of acuity tools? I myself am looking for samples of acuity tools so I can do some tests on my unit to see what would be best for our medical surgical unit.
Any luck finding a scoring tool? I am looking for one as well. I found the WMSN and would like to compare it to others.
I am researching the pros and cons of integrating an acuity of care program in the med surg unit at my hospital. At first, i thought that it could only be a good move but after reading comments here i have realized that, like everything done in nursing, it comes at a price. It helps to have the input of those that have gone through it. I wrote down a BASIC list of pros and cons... Anyone care to add anything else?Pros: 1. Patient and family satisfaction could rise if a nurse has adequate time to take care of needs.2. Infection risk for very ill patients decreases.3. The focus turns more to the very ill patients that need more TLC. (Why else would ICU nurses take only 2 nurses?)4. It forces lazy patients to do more of their own cares thus making them move more on their own and improve faster. (I can see how this is a double edged sword but I read that studies have shown that lower patient ratios lead to higher infection rates and longer stays in the hospital - this is my flawed rationale)(p.s. I would love more pro ideas! You wouldn't believe it by looking at these lists but I'm generally for this) Cons:1. Staffing differences ( you may not have enough nurses to fill acuity needs).2. I'm not sure if they include needs that can be taken care of by CNAs or if they tend to overwhelm Or take advantage of CNAs too much. 3. Who assesses acuity and the time it takes to do so. 4. Consistency and accuracy.5. Do these systems account for needed nursing judgement and critical thinking?How do you measure if a nurse is using their time wisely?6. Insuranes pay systems 7. Cost of an acuity system (is this much needed? Couldn't it be as simple as filling out 1 sheet of paper per floor?)Also, I would love to see some of the tools that hospitals use and maybe try to improve them somehow so please send them my way! :DIf anyone has experienced some way of determining acuity that was actually helpful I would LOVE to know! Thanks! Ashley
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