Allocating the resources needed to deliver quality care is a primary responsibility of nurse managers and chief nursing officers. But when it comes to nurse staffing, it can be difficult to know exactly how to assign and distribute the human resources – nurses, in other words – that patients depend on. Staffing ratios are a start, but we all know that no one can define with certainly how many patients one nurse can care for. It all comes down to the needs of the individual patient on any given day. And that’s where the concept of patient acuity comes into play.
What is an acuity-based staffing system?
Acuity can be defined as the measurement of the intensity of nursing care required by a patient. An acuity-based staffing system regulates the number of nurses on a shift according to the patients’ needs, and not according to raw patient numbers. Patients may range from needing minimal care on the day of their discharge to needing a dedicated nurse around the clock after a complication puts them in the ICU. In today’s digital world, computers and specialized software can support nursing managers who are using an acuity-based staffing model.
The staffing challenge:
When a nursing unit is chronically short-staffed, nurses are forced to keep up a blistering pace in order to ensure patients receive timely care. Over time, this can result not only in burnt-out nurses, but in dissatisfied patients and even in medical errors. Time and time again, research has demonstrated that the understaffing of nurses results in higher rates of poor outcomes, including hospital-acquired infections. This research has been used to argue in favor of laws that set minimum staffing levels, and it can also be used to make an argument for acuity-based staffing systems (although this belief system has been criticized as not being substantiated with hard evidence).
There is also a perception that patient acuity is rising, meaning hospitalized patients need more care – although this has yet to be proved with targeted research. There’s good reason to believe this may be the case, however, as only the sickest patients are admitted at all, while most others receive care – and even surgery – as outpatients. If you’ve been a nurse for a long time, you may remember a time when surgical patients were actually admitted to the hospital the night before their surgery – this was an example of a patient population with low acuity.
Acuity-based staffing systems can help a nurse manager determine the best core staffing pattern for every shift, based on patient data. At one time, acuity-based staffing relied on paper checklists that were filled out by each nurse or the unit manager, to help assess the needs of each patient on the floor. Today, specialized software makes the process faster and more accurate. Nurses can quickly enter their patient data into the computer, then the charge nurse or unit manager can run a report. It may be that there are many patients with high acuity, or it may be just the opposite (e.g. most of the patients are ready for discharge).
When the report indicates that patient acuity is likely to be high on the next shift or the next day, the unit manager may decide a “float nurse” is needed. The acuity system can also help the manager decide exactly where to place the float nurse and others, so that the patients with the greatest needs are in the care of the most seasoned nurses or those with specialized skills. This reflects the need to focus not just on tasks, but on the cognitive skills and knowledge that are crucial to expert nursing care – patient assessments, nursing interventions, and patient advocacy, for example.
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