tracking pt acuity

live4today, RN · Dec 16, 2003

As a RN.......acuities have never proven to work anywhere I've ever worked. They are a waste of time, and too many trees are being unnecessarily killed for the paper that is required for that task.

What really works is an up close and personal eyeball view of the reality of the nurse/patient ratio. And, nooooooo...it isn't another CNA or PCT or NA that is needed. What is NEEDED are MORE RNs and LESS patients per RN.

In my experience, no matter what "point system" I assigned to a patient, the nurse/patient ratio was the same WITHOUT taking into consideration the level of care each patient required.

Just my brain power of suggestions and comments for you. :nurse:

ksmith1963 · Feb 10, 2004

100 years (when I was nursing with Florence :) ) we used a simple 4 point system. 4 for total care - to 1 for self care. All the nurses put the numbers beside their patients at 10 am (and 4 pm) and then staffing was adjusted based on patient acuity.

The hard part is determining what the criteria is for the numbers.

You will really need all the staff to work on the definitions if you hope to get it to work.

This would be a terrific research project. - and be sure to publish when you're done.

There are a number of patient acuity software vendors available. Do an internet search for the product names.

You'll hear a lot about why acuity systems don't work. But neither does tracking activity by unit census. You can have a unit census that doesn't change from one day to the next (but during the 24 hour period you've had 10 admissions and 5 transfers and 5 discharges) - and all those patients require a lot of work!

Good luck

OB4ME · Feb 11, 2004

100 years (when I was nursing with Florence :) ) we used a simple 4 point system. 4 for total care - to 1 for self care. All the nurses put the numbers beside their patients at 10 am (and 4 pm) and then staffing was adjusted based on patient acuity.
The hard part is determining what the criteria is for the numbers.
You will really need all the staff to work on the definitions if you hope to get it to work.
This would be a terrific research project. - and be sure to publish when you're done.
There are a number of patient acuity software vendors available. Do an internet search for the product names.
You'll hear a lot about why acuity systems don't work. But neither does tracking activity by unit census. You can have a unit census that doesn't change from one day to the next (but during the 24 hour period you've had 10 admissions and 5 transfers and 5 discharges) - and all those patients require a lot of work!
Good luck

Our director staffs our couplet care/ante/gyn unit based solely on unit census. We can, per the guidelines, take 5 gyns, or 4 couplets, 6-8 individual moms or individual babies, or 4-6 antepartum patients. She claims that these are excellent guidelines to go by...After all, many med surg nurses take 8 patients each (And, how many patients do we have when we have 4 couplets? 4 moms and 4 babies = 8 patients!) But, are all of each med-surg nurses' patients fresh post ops, or newly diagnosed, needing TONS of teaching and support? Usually not. And, is the turn-over so high in med-surg? We often start with 4 couplets, send them ALL home, admit a pre-op ectopic pregnancy and send her to surgery (or admit an antepartum pt for observation, give her major IV therapy for dehydration, and send her home by the end of the day), and admit a whole other full load of patients. Day in, day out...It's exhausting.

One difficulty we are finding is that our staff nurses (including the charge nurse) are routinely starting the shift "maxed out" at our 4 couplets, and then they are wanting us to rush through our discharges so that we can take more patients who are sitting, delivered, in L&D. Our suggestion to at least start the unit staffed well enough to have some built in flexibility the first part of the shift, before discharges go home and then flex down if the census went down was quickly shot down. So, they continue to cancel a nurse when it would mean that we are staffed for 3 couplets each, and then refuse to call her in, telling us to hurry and get our discharges out instead.

The other difficulty is with our gyn guidelines. Sure, 5 gyns who are up walking, self care, stable pts would be fine. But, the gyns we are getting are almost all fresh post ops with IVs, antibiotics, PCAs, confused, vomiting from anesthesia, with a myriad of chronic health problems (usually COPD or chronic heart or BP problems) that are often exacerbated by the surgery. To have one RN take 5 of those would be impossible, not to mention unsafe. By the time they become "simple" enough for one RN to take 5, they're going home (usually on post op day 2)

It's really hard to follow those staffing guidelines when you may have a mix of gyns and antes and couplets and moms or babies. And, it's especially difficult to provide good patient care to the patients when you are being rushed by the managers to get them out in order to take more admits.

The director keeps comparing us to a med-surg floor, trying to make us look wonderfully staffed...but the fact is, we're in a different ballpark. We have lots of first time moms who need TONS of teaching...The goal should not simply be to get them to sign a paper saying that we reviewed everything and point them towards the door. And, our gyns are not stable gyns that would fit the 1:5 ratio. (Oh, and then I love it when the nurses have something like 3 couplets and 1 gyn, and they want them to take another gyn because the 1 gyn they have is "like half a couplet")

As charge nurse, I am really caught between a rock and a hard place trying to come up with ideas which make financial sense (so that our director will listen), while keeping things safe and keeping staff morale up. Because one thing is for sure, if this doesn't get resolved in an appropriate manner, we're looking at losing half our staff RNs...and where would our budget go if we had to go back to relying on registry and travel staff?

Certainly, there are benefits and drawbacks to staffing per census only and to staffing per acuity only (Then it can get abused, and you get the nurse who absolutely refuses to take a 5th couplet, in a real crunch, just because she's maxed at her 4 couplets, even though her 4 couplets are all "easy" care-wise, and she's spent the whole shift at the desk reading a book...lol!). However, since our director is directing while far removed from the floor, and doesn't really see what our nurses are running their tails off doing...I think that we need to start actively tracking what our nurses are so busy doing, in a way that she can see. Maybe our tracking will show that we simply need another aide to help ambulate pts and deliver care supplies, etc...Maybe we need an LPN to help with meds...Maybe we need to totally re-do our staffing guidelines. We may see that by tracking it on paper?

D. Gardner RN · Feb 7, 2005

Hi I'm in the process of doing a paper for school and it looks like to me that there is NO actual tool for determing acuity and them making assign,ments according to this info. Is this the case at your place of work?

I'm looking to create a form for tracking pt acuity, in order to determine appropriate staffing. I've heard that some units have a form with something like a point system, where, for example, a pt on fall precautions or on certain drugs requiring increased RN attention are valued as more than a patient who is doing relatively well and able to do most self care. We'd like this form to be something that our charge RN would use each shift to track the actual acuity of the patients currently on the floor, to better determine when the staff RNs can take admissions vs are maxed out. We would also track these forms over a longer period of time to determine whether we have the right staffing mix. (Are our nurses getting overwhelmed and unable to take admissions, because they don't have enough CNA help? Or do we actually need another RN?)
Our unit is a new couplet care (postpartum)/gyn floor, currently experiencing some growing pains.
Does anyone have anything that works well for them, that I could take a look at, to help me design our acuity tracking sheet?

D. Gardner RN · Feb 7, 2005

I agree with you 1000% and from what I'm seeing from other messages, this is a problem evrywhere. Does anybody care?

I need info. that I'm doing on a paper on the subject. Tell me more about some of the things that have been tried in your place of employment.

As a RN.......acuities have never proven to work anywhere I've ever worked. They are a waste of time, and too many trees are being unnecessarily killed for the paper that is required for that task.
What really works is an up close and personal eyeball view of the reality of the nurse/patient ratio. And, nooooooo...it isn't another CNA or PCT or NA that is needed. What is NEEDED are MORE RNs and LESS patients per RN.
In my experience, no matter what "point system" I assigned to a patient, the nurse/patient ratio was the same WITHOUT taking into consideration the level of care each patient required.
Just my brain power of suggestions and comments for you.

purplemania, BSN, RN · Feb 7, 2005

google search for patient acuity and you will find some things. I found forms provided by the US Navy Hospitals and private hospitals, but they don't have much in common. This suggests to me that the problem is too individualized to create an effective generic form. You might try the Calif. BON or an ANA chapter in Ca. They have been struggling with nurse-patient ratios for quite a while related to the law that was passed (then put on the shelf by AHnold). Remember to share what you learn.