Worried about skill mix

AJJKRN · Feb 7, 2017

Do you have trends to pull from to see the average daily census and peaks/lulls? Do you utilize a staffing matrix?

achapman763 · Feb 8, 2017

Yes, I currently have a staffing matrix/grid. We don't currently utilize any trends to see what the average census would be for that day. Do you have a program that you are utilizing for that? Or is it manual process?

AJJKRN · Feb 8, 2017

To the best of my facility uses software called ClariVia that tracks staffing schedules, staff to patient assignments, patient acuity, and census.

HouTx, BSN, MSN, EdD · Feb 10, 2017

The tried and true method of determining skill mix is to actually do some work sampling.... do determine the quantity & type of patient care that is being delivered. I did a lot of this in previous jobs. There are a lot of Google resources out there that will help you conduct your own sampling. Over the years, I discovered that 'typical' MedSurg patient care normally requires only 25% RN - to cover the "RN only" interventions & tasks. Oddly enough, the advent of EHRs has increased that percentage, so now it's about 30% because of the need for more documentation time.

Acuity should be driven by both the workload and intensity of the care. A high acuity unresponsive comatose patient has a high workload, but the majority of the work does not need to be done by an RN... OTOH, a newly diagnosed, walkie-talkie cancer patient may not need much physical assistance, but the majority of the "care" would need to be delivered by an RN (teaching, support, etc.). Unfortunately, most commercial systems only utilize workload as a determinant of acuity, thereby completely discounting a huge amount of the practice of nursing.

srercg6 · Mar 4, 2017

several medical organizations utilize documentation programs that figure acuity based on charting. Problem is that many nurses can't sit down and chart until mid-later in shift. Biggest problem is that the acuity numbers the programs come up with do NOT account for how many or how much time is actually spent with that one patient. They account for big things like "isolation", "tubes", "feeding", "dressing changes", and if they are a fall risk etc. BUT the programs do not consider a patient who sits on their call light all night taking time away from other patients. Patients who use the hospital as a hotel, that kind of thing - and the nurse has to cater to them now days, or they get accused of being "mean", "rude", etc. Patients like that will seek to retaliate and get the nurse in trouble if the nurse doesn't cater to their every whim - so those patients, although maybe not medically acute - are both higher acuity than are designated by many methods, and also a safety risk to other patients.