I am new to the forum, and joined out of sheer frustration and a need to vent! I am in Iowa, working as a staff RN at a Level 2 hospital/referral center. I work in a Women's Health area where we do L&D,PP, Nsy, IMN, ICN, Gyn.and Peds. We do 800-900 deliveries a year, and so are fairly busy. Our staffing is based on our accuity system. Aprox. a year ago, our hospital incorporated the Van Slyke model of accuities.Since that time our nurse/patient ratio has taken a turn downhill! It is so frustrating! When we complain to the nurse managers that our accuities do not adequately reflect what is going on we get a "canned" answer of: "Yes it does, the time studies you did proove that". The time studies were done prior to initiating the Van Slyke model. Does anyone else here have any experience with this model, or something similar? I am so afraid that something bad will happen with the bare bones staffing we have the majority of the time! I do keep a personal journal with the staffing when it is bad, just to have documentation. I have been in nursing 20 years, and this is the worst it has ever been! Thanks!
NOt familiar with your model of acuity, but we used one years ago in ICU...like yours it did NOT reflect the time we actualy had to spend with the pt for the various procedures. We did our own documentation to show that and presented it, the result, they did away witht the acuity levels. Thank God!!
they are talking of getting rid of our system as it doesn't work anyway. But by golly those house supervisors want those numbers to add up I don't know what they will do if our system goes away. (we just go a new Director of nursing and they didn't use that at her old hospital..I used to work there it was nice..she's also trying to change everything to how things were there which won't work either)Many years ago I was on a committee to review our system for my unit. All items were based on time it takes to do anything "on average" for that type of patient. It was all do tasks with very little built in for actually talking to patients or doing the caring thing just the task things.
Don't you just LOVE those accuities!! I work in the ER, and if a patient states he/she has arm pain, its a low accuity, even if this arm pain turns out to be a massive MI. they take their numbers/accuity from the stated complaint vs the final diagnosis!! Keeps the staffing ratio down.
like I said we are talking of getting rid of our system. We usually just make up the numbers anyway. We have a "cheat sheet" instead of filling out the form for every one. I work L&D if it's a non-stress test they get 1.8 if a vag delivery without complications 9.8 and it doesn't matter for use anyway they NEVER pull us help we have to cover ourself as is so the numbers don't matter. Most units in our hospital send their numbers 2 hours before end of shift so the powers that be can figure staffing for the next shift. We send ours at shift change to let them know what we've been doing all day and what we plan to do not that help is on the way.
For staff assignments, I have not seen a acuity system work. we have changed our system 3-4 times in the last 5 years. We did time studies. Now the problem with time studies is it does not take in consideration of some aspects of care or the biggest problem is nurses filling it out correctly. Most of the time nurses hang them selves as they did in our unit. Not filling out the time study, because "it's stupid." well stupid look at our system we have because we completed the study. AHHHHHHHHHH
Well I have found out no acuity system can take the place of good old charge nurse judgement. The only problem is, payments from insurance companies DO NOT ACCEPT GOOD JUDGEMENT.
We have a staffing guideline sheet. It's just that, a guideline. My NM HAS NEVER, EVER got bent out of shape if we used more nurses than the "numbers" thought we should have. All he asks for is justification, so he can 'splain it to Corporate. To my knowlege, corp has never thrown a fit, and if they did, my NM did his job - took the kick in the pants and kept it to himself!!!!
In appreciation of this, we sometimes go UNDERSTAFFING by CHOICE if we have a really senior, strong team and things are relatively quiet. It's an unwritten you-scratch-my-back-we'll-scratch-yours rule. Absolutely will not work well everywhere, but it works GREAT at my place!!!!
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