using patient acuity to determine nursing assignments

[Alrn]

Need to know if you have used patient acuity to determine nursing assignments on a med surg unit. What criterea did you use? Would like a copy. What are the pros & cons?

Thanks.

Alan

:)

[rstewart]

Need to know if you have used patient acuity to determine nursing assignments on a med surg unit. What criterea did you use? Would like a copy. What are the pros & cons?

Thanks.

Alan

:)

Cons? Well, I personally consider the entire staffing by acuity issue a con by management. On it's face it seems like a reasonable way to staff; In practice it does not work.

First of all, in my experience the acuity assessment tool results are frequently ignored. The tool may indicate you should have X amount of nurses, but there are no consequences when fewer are provided. Filling out the acuity assessment forms under those circumstances becomes a meaningless, time consuming exercise which serves no purpose.

Secondly, staffing by acuity not address the reality that within the course of a shift significant changes in total workload can occur. Consider the case where the unit/floor has an overall very low acuity according to the tool so each nurse has to take care of more patients. Assuming the indicated staffing is adequate in the first place (not always the case) one would expect that as soon as their physician sees these low acuity patients, they are going to have orders to transfer to a lower level of care or are discharged home as appropriate. Now after the additional work of transfering/discharging these patients home is completed if the beds remained empty or were refilled with patients with similar acuities as those who were transfered/discharged and the staffing grid reflected adequate time to complete a large volume of admission initial assessments/paperwork staffing by acuity might have some validity. But simply put, when census and/or acuity ramps up, rare is the facility where additional staffing is added to meet that need.

That is why mandated adequate fixed ratios are the only way to insure against "shifts from hell".

[suzanne4, RN]

I work in a hospital in CA. We use the acuity system, computerized, and it works just fine. I think that it depends alot on the management of where you are working. Some have no idea as to what is actually going on, what patient loads are like, etc. Then that is management's fault, not the fault of the tool.

[lsyorke, RN]

I've used multiple acuity tools. The reality is they don't get used! It ends up being another piece of paper to fill out in an already busy day. Like Rstewart said the changing patients throughout the day really make it an unrealistic goal. I can start with 7 low acuity patients in the morning and discharge 4 of them(with all the pounds of paperwork!) then get in 4 high acuity patients that if they were reflected would now change the nurse patient ratio to 4:1 instead of 7:1. It would be great for the next shift, but we're sucking wind! My experience is that management doesn't use it after a few months.