staffing model/grid

[Colts1RN]

Hi I am looking for anyone and everyone who can help me with their input on a staffing model/ or grid for a surgical floor. I currently work on the busiest floor in our hospital...it is a 47 bed unit and we are the only floor in the hospital that houses all the surgeries excluding women's surgery. We also are the pediatric floor too. Now the problem is the staffing. On a typical weekday we may discharge 15 or more people and we may get 15 or more back in the same shift (7a-7p). We have anywhere from 6-7 patients at any one time and that may not sound bad but these could be split up on anywhere from 2-4 different long hallways making it CRAZY!!!! Our techs are supposedly responsible for keeping up with I/O's, post-op vital signs, ambulation, and any other needs. They cannot perform accuchecks, or empty any drains or tubes. Half of the time we are doing their work and our current staffing model is not working. We usually have about 6 nurses on day shift and 2-3 techs. Several of us are meeting to discuss what we could do different to prevent the nurse turnover on our floor and increase patient satisfaction. (LOT OF OUR NURSES HAVE LEFT BECAUSE THEY JUST CANNOT HANDLE THE STRESS AND CRAZINESS!!) I am thinking about suggesting team nursing, but need some input. I have worked alot of places and this has got to be the busiest, most stressful place I have ever worked. Some of the suggestions i have mentioned the Director of Acute Care said that we could probably not do because of budget, however I believe patient safety and satisfaction is more important and we are losing nurses left and right. I need input from people who work on a VERY BUSY SURGICAL unit, keep in mind we also have the sick little babies and kids but they only make up a small portion...90% surgical 10% pediatrics. by the way we do not use an acuity tool (which actually would be very useful). Also our charge nurse (not unit manager) on days does not USUALLY take pts, but helps the secretary put in orders and gets charts ready for the new surgeries coming to the unit, so basically she is of no help to us on the floor. On busy surgery days she informs of post op pts coming back by calling us down in our pt rooms and says "you have a surgery pt coming to rm 441 and they are on their way right now from PACU". So no matter what you are doing you pretty much have to stop and go receive the pt via bedside from the PACU nurse immediately.

Any and all input is vital and would be appreciated ASAP!!! Thanks!

[Christie RN2006]

Try to group nurses rooms together as much as possible instead of splitting them up between hallways. Also try grouping patients by acuity level... as in try not to assign all total cares to one nurse,etc. Try to split the load evenly.

I work in a surgical unit which has both an ICU and a step-down unit. Our step down is 15 beds and we will only assign 3 patients per nurse and on a rare occasion 4. We do team nursing also. A team is usually assigned 6 patients. Normally we only have one PCA (tech) on the floor and they are in charge of vitals, blood sugars, emptying foleys and jps, helping with meals, ambulating, etc. Of course, the nurse has to oversee the PCA and make sure they are doing what needs done. Some of our PCAs do a great job and make our lives so much easier, but we also have a few that make things worse.

[plumrn, BSN, RN]

To begin with, your pt load is too high. Surgeries with peds mixed in is too high acuity, especially combined with such a high turnover of pts. Your staff turnover will never get better with all that going on. It sounds like a disaster waiting to happen.

The hospital could decrease the turnover of nurses-saving them money- if they would lower the nurse to pt ratio to 5, increasing the pt and the nurses satisfaction level. Even at 5, on a busy surgery floor, that may be pushing it.

Good luck. Let us know if you find something that helps with that incredibly hard load.

[Katie-in-charge51, BSN, RN]

In my humble opinion, having peds pts with adults is itself a problem, unless there is an actual peds nurse caring for all the peds pts. We also have a staffing grid at my large hospital, and I hate it. It does not take into account the accuity at all! This is a huge error as we all know. I have not heard if any other hospitals staff by accuity anymore. As charge nurse, I only use the grid as a guideline, and try to staff by accuity as well. If I get called on the carpet for it, I am prepared to go down fighting for my patients. As long as I am charge, we will take care of patients first, not the budget. They can remove me anytime they please............. Katie