How many patients one nurse can care for is a difficult question to answer with certainty. Some days more. Some days less. Any nurse will tell you it all comes down to the individual patient and how much care they need.
This is why acuity-based staffing models are so popular. A shift’s staffing needs are based on the patients’ level of care complexity. Saint Joseph Hospital in Chicago implemented a software program—Res-Q from Concerro—to track and predict nurse staffing needs based on acuity. The program allows nurses to assign relative weight to patients that indicate how much care those patients need. For example, whether they require ventilation or have a central line.
Saint Joseph’s is part of the Resurrection Health Care system, which assembled committees across the system to develop standards and assign weights to different patient types.
Mary Anne Harper, clinical manager of maternal child services, explains that before launching the program, her department discussed the amount of time nurses spend on the various patient types in maternal-child nursing, e.g., a normal newborn. The weights assigned were reviewed and agreed upon by the entire system.
Once the program was implemented, she says it was fairly easy to roll out to nurses. Two hours before the end of their shift, nurses enter information about their patients into the computer system. They select attributes for patients from lists already entered, such as whether patients are receiving blood transfusions or have total care needs, whether they are in isolation, and so on. The program assigns a weight to each patient that indicates the acuity needs.
“The charge nurse on each shift will review after everyone has entered,” says Harper. “They run a report to determine needs. How many people are level 1 acuity, how many people are level 2, etc. The charge nurse looks at the numbers and determines her staffing needs.”
Harper says the charge nurse may find the unit has a lot of patients with high acuity, which may mean they need more nurses. Sometimes they may have low acuity—for example, if a lot of patients are simply waiting to go home—and may need fewer nurses.
Each unit has varying levels of acuity. Harper’s maternal-child unit has seven different levels because it includes women in labor, women in delivery, C-sections, the operating room, and post-partum patients.
Harper says her unit relies on the software to support why they do things. “Charge nurses do acuity assessments every eight hours to examine staffing needs. The program helps them identify what happened on the shift and anticipate what may happen on the next,” she says.
“In my area, someone in early stages of normal labor doesn’t need as much nursing time,” she says. “We put (the) IV in, put them on the monitor, etc. When they get into second stage, they need more time, such as monitoring, pain medications, and emotional support. Then when delivery occurs, we need more people.”
The system tracks patients as they get more or less acute and Harper says it helps to justify staffing. A manager may look at a report that showed eight nurses for 10 patients on one shift, which sounds like a lot, but the acuity report will demonstrate the patients were all high acuity.
Harper says the system is appreciated by nurses because it allows nurses to determine their staffing needs. “It’s the nursing staff that identifies the needs of the patient and what’s going on with the patient,” she says. “It’s their decision. It’s not a higher-up decision. They are the ones who select the patient acuity. Staff nurses put this together—it’s not the managers who decided it.”
Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits www.StrategiesForNurseManagers.com and manages The Leaders' Lounge blog for nurse managers. Email her at rhendren@hcpro.com.