Acuity based staffing...any ideas?!

[jenthelen]

Hi all. I am on the nursing care committee at my hospital and we have been tasked with designing an acuity based staffing system appropriate for the whole hospital (we are very small, with med surg, tele, sicu, cicu and l&d floors). I have been researching but have not been able to find a single useful tool or method used by any hospital that assigns staffing based on acuity. Do any of you have a model you would mind sharing or could anyone point me toward a research article or something that would be of assistance? I would greatly appreciate anything provided!

Jen

[Frankreich]

Hi all. I am on the nursing care committee at my hospital and we have been tasked with designing an acuity based staffing system appropriate for the whole hospital (we are very small, with med surg, tele, sicu, cicu and l&d floors). I have been researching but have not been able to find a single useful tool or method used by any hospital that assigns staffing based on acuity. Do any of you have a model you would mind sharing or could anyone point me toward a research article or something that would be of assistance? I would greatly appreciate anything provided!

Jen

The web is full of articles and information regarding this topic. Acuity based system have been around for nearly 30 years. Most organizations have their nursing leaders/RN work with a computer software company that designs a sytem to meet the specifics of your health-care settings. Many EMR have an acuity sytem built in for staffing purpose.

Check out the link below for some basic information.

http://www.ohca.com/docs/alfrcf/CBC_Acuity_Matrix.pdf

[jenthelen]

Thanks, Frankreich. I will bring that example to the meeting and continue searching. Unfortunately, I am not certain our org has the resources to hire anyone to do it the way it probably should be done. Appreciate your help. Thanks again.

[oldntiredRN]

Way back 20 something years ago( some where in the 1990's) when I worked a med/surg/onc floor- we did acuity based staffing. We didn't have computer documentation, softwae or computer programs. We had an acuity sheet, which was a check off list for each patient. On the check off sheet- everything from soup to nuts was on that sheet. Since it was med/surg/onc- the list which filled the page( with a carbon copy behind it)was taylored to every possible thing a patient on a Med/surg/onc unit could have attachedto them, infusing,stuck in them surgically example: frequency of vital signs, blood trandfusions and how many units, chemotherapy agents, JP drains, NGT tubes, feeding pumps, dressing changes- simple, complex frequency( daily, every shift, prn)IV- central lines, pre ops, new post ops, 1:1 nursg observation, back them we could apply restraints( that boosted our acuity up sky high) EVERTHING. You get the idea.

To each line checked off- example NGT tube a number was assigned----3. This paper was attached to a clip board at the foot of the patient's bed and was filled out by each nurse assigned to that patient on each shift. The night shift completed the acuity check sheet, tallied up the numbers in each shifts column and handed them in to the night shift supervisor. I do not remember what the exact metrics( or the arrival of the mean, mathmatical division) were; but, I am thinking an overall score of 20-24 for the floor would buy the floor another RN for day shift.

Each floor/unit had a check sheet- this check sheet was customized for the type of unit it was example- the particulars for an ICU would include- vaso active drips, vents, q 5 min VSS or q 15 min VSS, recovery of post op from anesthesia, again you get the idea- everything ICU.

When the greedy money counters took over healthcare- that check sheet fell by the way side. When that happened, our shift supervisors would come around to the charge nurse( which we had also, a better idea from the days of old that has been forgotten) and ask"How many blood transfusions, chemo's, post ops, admissions, discharges and 1:1's?" but then again- that is when Nursing supervisors were actually NURSING( RN accountable, took ownership, and responsiblity like an RN and acutally cared) supervisors notlike the fiscal but kissing managers they are now a days. I would have to say- this acuity system was a much better way to staff a floor/unit. And if the floor/unit didn't feel they were adequately staffed- it was the floors responsibility to figure out why the acuty sheets were not being filled out properly. There were actually numbers to back up why the staffing numbers were the way it was. I may add this was an RN union hospital and the State Dept of health was called every time the staffing was poor. the State DOH would come in and investigate. This can still be done today as we all have a state DOH in each one of our states and yes, they do have a 24 hour hotline to call when facility staffing is considered by the nursing staff to be unsafe.This has not changed in 20-30 years. it's just a matterof the now a days nursing staff to pick up the phone and call the state hotline. Complaining about it amounst ourselves or on the forums is not going to get this issue solved nor is the management of ANY of our healthcare facilities going to miraculiously come to their senses. I personally don't think managment has any sense anymore but that's JMO.Managment only sees money/profits!! Management also knows that if the State DOH does come in and finds the compaint of the nursing staff for a particular shift to be unsafe staffing, the state FINES that healthcare facility a hefty sum of money- back in the 1990's that sum, in my state, was $60,000 for EACH occurance!! If 3 floors/units called the state DOH with a complaint of short staffing on 1 particular night, that was found to be short staffing, that facility was fined $180,000!! And yes, we did do some calling back then. The news of the hospital being fined, used to spread through the hospital like wildfire. No, I am not in California with the mandatory staffing ratio's. This was long before the mandatory staffing ratio's were ever implemented. This is why California fought for and was successful at getting those staffing ratio's and can take legal action against a facility for unsafe staffing. California got this on their state DOH books by reporting it and fighting for it, not by silence. My state still has not obtained mandatory staffing ratio's. But then again, my state has about chased out all their old nurses from these facilities who would remember this time in nursing history and I have to wonder if this is not one of the reasons why it was done- so managment could hold on to their unsafe staffing,with out opposition, hold on to their money again without opposition and hold the nursing license hostage.!!!