Staffing tool

[sphinx, BSN, RN]

hi, i did a search about acuity based staffing tools but didn't find exactly what i was looking for. i work at a nursing home with around 700 beds. most are general ltc, a few "locked" units for severe dementia, a comfort care unit, and my unit which is rehab.

our facility does not currently use any type of staffing tool. typically they go by census alone. compared to when i started a few years ago, staffing has really deteriorated. if our census is low, they float one of us to another floor. now sometimes that is appropriate, but others it is terribly unsafe. for example if we get a few new admits, some hoyer/readistand or 2 assist patients - that isn't taken into account. also we occasionally get some patients with dementia who never really progress in rehab but are kept on the unit far too long. that's a bad mix with rehab folks, and we are not very well equipped for dementia patients, not like on other floors at least. also, on dementia floors they may have wanderers but who are safe to stand and ambulate. if they are on our unit they may or may not be cleared to be up yet (too weak, partial or non-weight bearing, etc). we have constant call lights, which is not always seen on other floors. because our floor is the smallest unit, going by census is often leaving us in a hard position. we have increased number of falls when not properly staffed, and patient satisfaction is in the toilet. i feel powerless when we don't have enough staff and call lights are not answered in a timely manner, or if someone is in pain and we aren't able to address it right away. i do evenings and the house supervisor is stretched thin when there are fires to be put out all over, and speaking to angry patients/family isn't high priority.

i am not a supervisor, manager or admin. i'm just a floor nurse struggling to care for my patients in a safe and caring manner. most nights i am too busy to chart (other then the med book) until i sign off, and i usually get out at least an hour late, up to 3 1/2 hours late. i have no decision as to whether or not to implement a staffing tool, but think that instead of simply moaning about it, perhaps i can offer up a suggestion.

so i am wondering if anybody has a tool they could share? i'm looking for practical advice, not a "reality check" sort of response or group commiseration. (i get enough of that with my coworkers, haha). any tool that uses more than just census would be helpful!

[Nascar nurse, ASN, RN]

"but think that instead of simply moaning about it, perhaps i can offer up a suggestion". i'd give you a hundred kudos for just this one sentence! i think you could teach my staff a thing or two.

now unfortunately, here is the reality check you didn't want - i really do apologize but just trying to enlighten you. is your facility part of a chain? if not, you may actually be able to suggest an acuity based staffing tool. if you work for a chain of ltc companies your opinion (even if you are 100% on track) will probably never be considered. as a don, i completely agree with you that staffing should always be based on acuity of the residents but those suits in some far off corporate land that haven't worked the floor in a hundred years (if ever) only see a census based staffing ratio.

[luv_o_so_much]

Maybe post what state you are in also. I do not know about skilled nursing facilities, but hospitals have a minimum ratio designated by the state. I did staffing for many years (obtained the nurses not the acuities).

Hope you get the info you are looking for!

[sphinx, BSN, RN]

I am in New York state :)

[sphinx, BSN, RN]

now unfortunately, here is the reality check you didn't want - i really do apologize but just trying to enlighten you. is your facility part of a chain? if not, you may actually be able to suggest an acuity based staffing tool. if you work for a chain of ltc companies your opinion (even if you are 100% on track) will probably never be considered.

it is not part of a chain :)