Stressed about staffing grid!

[AKRNOCN]

Hi all just got back from a meeting where we wer informed we will be implementing a new staffing grid. I am looking for information on other Oncology units! Our unit is a inpatient unit with 17 beds. We take In patient hospice patients, medical/surgical oncology patients, and "overflow med surg patients". We also have outpatients that come in for everything - blood, remicade, IVIG, IVF, Neulasta shots, Port flushes, etc. We are all RNs, Techs, and Student nurses. No LPNS or aids.

I would like to here from other oncology nurses what type of unit you have and your staffing grid and also your staff. We are trying to get our status to show more of an PCU/step down unit because of the acuity of our patients. They are counting RNs and techs the same so we rarely get to even have a tech help us.

Please let me know if you have any questions! Thanks for the help!!!

[jo272wv]

I work at a hospital that uses the grid and it is not a cure all. Under 11 pts will call for 2 Rns only not matter how bad the pts are. When you get that 12th pt, good luck getting another nurse to come in, especially if it is 1am and even if they are on call. Nurse managers have the power to change the grid at will and do so to come under budget which a lot of the times leaves nurses taking care of 7 and 8 pts at a time. I go in and either work my butt off or have 5 pts that sleep all night. To bad the grid on my floor can not have an acuity built in to assure pt safety. Dont get me wrong, I love working at my hospital and all the floors do not have nurse managers that tighten the grids as does mine. I just feel that acuity should be considered for safety sake.

[AfloydRN, BSN, RN]

And they wonder why there's a nursing shortage! Not safe for you or your patients. Noone can watch that many patients safely.

[meownsmile, BSN, RN]

I agree with jo,, those grids are absolutely horrible. They look good on paper and technically may work sometimes, but without acuity factored in somehow it can leave people completely overwhelmed with no avenue for getting assistance if needed. It has and does make for a very dangerous situation sometimes. If whoever is doing your staffing shift to shift will actually LISTEN to those working the unit it might help. But in my experience they dont and wont.

[mbryan]

Due to budget cuts, we have to implement staffing grids for our Med/Surg unit. We are a 32 bed unit. Staffing consultants have been to our facility and are recommending some drastic changes and I am uncomfortable with their Nurse:Patient ratio. Does anyone have any grids or info to share? In Georgia, there is no guidelines from the state as to what is recommended.

[cisco]

on our 34 bed oncology, med/surg floor we did two things that seemed to help. First each nurse would rate their individual pts 1-5 according to the acuity, it was based on the number of meds, treatments, walks, noncompliant, pre-ops, post ops, discharges etc. They would pass this on to the charge nurse prior to the end of the shift. The charge nurse then would put the acuity number next to each patient on the patient staffing sheet for the charge nurse on the next shift. Then the new charge would try to balance the assignment so that each nurse got close to the same total number with their assignment...sometimes this meant that the nurse may not get the exact same assignment as the night before...but each nurse had the option to change patients as long as the charge for informed.

The second thing that we exercised was filling out the "Exception to Assignment" form whenever we felt the assignment was unsafe/unfair etc. These were turned into the nursing supervisor for that shift therefore bypassing the nursemanager so she couldn't just ignore the situation if this form was turned into her.

Lastly, we finally went Union....much better negotiating power now.

Hope that helps some.

[R. Edgar L.P.N.]

Who do current staffing grids benefit, Patients, or Management? In Hospice care, where the Patients are in their last weeks, days, and sometimes moments of life, don't they deserve better care than one might find in a long term care facility or assisted living facility? The standard staffing grid, if there is a standard, for other health care facilities should not be applied to Hospice care. Hospice care is different, very, very different. Trying to care for six or more often seven terminally ill patients, their families, and also trying to satisfy the needs of Physicians, is not effective care. The maximum patient assignment in an inpatient Hospice facility should be no more than four, maximum five patients per nurse.

Unfortunately, here, in Colorado, Hospice Management is stubbornly steadfast in their insistence on reliance upon the clearly dysfunctional "grid".