One of the challenges all nurses experience is figuring out the best ways to manage nurse staffing for patient assignments. With the ever-evolving care that patients require and the additional responsibilities that are now part of a patient’s stay in a hospital, more and more organizations are looking to explore new opportunities that aren’t part of the status quo.
An Overview of Nurse Staffing Grids
For the longest time, staffing grids have been the standard for how many nurses staff (licensed and unlicensed) to a department’s needs at a given time. It is based solely on the number of patients in the department. The midnight census is used to develop an average daily census which, in turn, is calculated into hours of nursing staff. These grids are often developed with budgetary factors in mind as well.
While this is a way to manage and calculate the needed staff, it misses the mark when it comes to departments that have a heavy admission, discharge or transfer rate, or churn of a department. Additionally, the midnight census is only accurate up to a point, with some assumptions in play. One of those being that a patient will be there at midnight most of the time for every day they are cared for in the hospital. Patient volumes can now be captured down to the hour (or even minute for that matter), and many organizations have begun moving to an adjusted length of stay model that accounts for all the time a patient is present in a department.
This data is more accurate. An example of that accuracy is when a patient arrives at 2:00 a.m. on day one and stays until 7:00 p.m. on day two. In a traditional model, this patient would only hit one midnight census. However, by being more granular, the patient was there exactly 22 hours on the first day and 19 hours on the second day. The patient would need nursing care and hours both days, not simply the one assumed by a midnight census.
The Ratio Approach to Nurse Staffing
A second approach to staffing and managing nursing is moving directly to a ratio approach. It is similar to a grid but focuses more on the concept that each nurse receives a set number of assignments.
For example, a nurse may receive five Med-Surg equivalent patients, and a nursing assistant may receive 10 to 12. This comes with its own challenges. If one of the assigned five patients has written discharge options, an RN may flex to six patients, or another nurse may have to take on a sixth patient.
Some organizations report that there becomes a rush to discharge patients so that the ratios are maintained. This leads to less quality discharge teaching which can lead to readmissions. Set ratios also mean that all patients on a unit are viewed the same as there is no ability to flex in one direction or another.
The Power of an Acuity-Driven Solution
The final approach to staffing and managing nursing assignments is utilizing an acuity solution that objectively determines what the workload is for every single patient multiple times a day. This allows for an ebb and flow of workload that focuses on the patients and their needs rather than assuming the workload for every patient is identical. This type of solution allows leaders to understand where the spikes of workload are, and it also gives them the resources to communicate with their staff about these challenges.
By simply adjusting how a department looks at the average daily census and using an adjusted length of stay—instead of midnight census—there is less focus on rushing to get patients out of the emergency department. This allows for more focus on ensuring the hand off is done in a safe, calculated manner since there is no pressure to get the patient moved before midnight for the “credit”.
Additionally, using a comprehensive acuity solution equips you with a better picture of the care needed for the patients on a specific unit in comparison to another unit using the same solution.
Streamline Your Nurse Staffing Practices
While staffing grids and ratios have been standard practices for creating assignments, using an acuity solution that accounts for total nursing workload is a better way forward. Connect with us to learn how AcuityPlus is helping hospitals improve their staffing practices.
Connect with us to learn more about AcuityPlus.
Blog by: Walker Schlundt, BSN, RN, Product Specialist
