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Planning Nurse Staffing with a Patient Acuity System

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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.