Nursing Change Proposal: Staffing by Acuity

Subject: Nursing
Pages: 5
Words: 1364
Reading time:
5 min
Study level: College


Nursing workload based strategies are used to forecast staffing requirements. Staffing on the level of acuity enables nursing managers to schedule nurses units’ shifts by emphasizing the actual needs and requirements of the patients. This strategy of staffing has since replaced the traditional methods of establishing nurse staffing needs of the units about the daily census. Numerous health care facilities make use of patient data for apportioning nursing costs to DRGs through the various procedure. In this case, the PCS is used normally. There is the conversion of patient statistics into the number of hours required during the stay of the patient. These hours translate into monetary costs. Then, the patients are categorized into DRGs, and finally, the nursing costs are determined (Rowland & Rowland, 1997).

Another alternative of obtaining workload data suggests assigning nursing duties for patients in each classification of DRG into three groups. These include functions dependent on the physicians, essential daily functions common to all patients, and independent functions of nursing. Cost evaluation can then be enumerated for each of the various functions. This is done concerning patient care units, and about each DRG.

This form of workload analysis will offer an essential pricing approach but requires the additional collection of data. The ANA continues to raise doubts about the value of HPPD as a unified unit of nursing care hours. It has been noted that there should be an inclusion of other elements indicating individuality. The patient acuity and patient turnover are included in this factor (American Nursing Association, 2009).

Assessment and Plan

The number of patients that a single nurse can attend to depends on the acuity of the patient. It all rolls down to the actual patient and how much care the patient’s condition may require. This explains the acceptance of acuity models of staffing. The basic needs of a staff shift should be evaluated based on certain aspects. This should include the patient’s acuity. This framework allows the nursing leaders and managers to allocate resources and time to patients whose acuity illustrates that they need significant attention from the nurses. Before the program can be launched, nursing managers should assemble all stakeholders into committees that will review the various patient acuity standards.

These standards will be used to formulate the patient acuity nurse staffing model by developing standards and allocating weights to various patient types. The nursing department should deliberate on the amount of time the individual nurse usually takes while attending to various types of patients within the normal daily routine. This should be before the launching of the program. For example, cases that deal with newborn children or cardiac arrest victims among others (Marquis & Huston, 2009).

Once the program has been established and appropriately implemented, it will make the work of the nursing leaders and managers easy concerning the rolling out and scheduling of nursing shifts. Every day, approximately two hours before the end of each nursing shift, nurses will be required to make entries in the patient diaries about their patient’s conditions during their working shifts. This information is then entered into a computerized system.

They choose attributes regarding the patients from lists, which have already been created in the system. For instance, whether an individual is due to receive a blood transfusion, or a patient may require or need total care. In addition, it can be whether a patient should be placed in isolation and many other requirements. This program allocates a weight in each case, which determines a patient’s acuity requirement (Fitzpatrick & Wallace, 2006).

The charging nurse responsible for the next shift will review the entries that will assist in determining her staffing needs about the acuity of the patients. On different occasions, the unit may have many sick individuals with high acuity. This may require a significant number of nursing staff. In some circumstances, the patients present may all have a low acuity with most of them waiting to be discharged so that they can go home. Each nursing unit has various levels of acuity for the patient cases. An electronic computer system is very essential to the success of the program. In this case, they are used by the charge nurses to evaluate the acuity of patient’s after eight hours regularly (Hoeman, 2008).

This program reveals what happened during the previous shifts and helps them make anticipations for the next shifts. In areas such as the early phases of labor, there is no need for a lot of nurse time allocation. Patients are injected with an IV and left to rest. However, in the second phase, allocation of nursing time is required as the patients need medication for pain, monitoring, and emotional support. During the actual delivery, more nursing staff are required.

This illustrates how the system tracks the acuity of the patients, which helps in the justification of staffing. A manager may look at a staffing report and see that 8 nurses were assigned to 10 patients, and feel that this is over-staffing. However, the acuity report will illustrate that most of the patients had a high acuity. The system is highly valued by nurses due to its ability to allow nurses and nursing leaders to be able to determine their staffing requirements. It assists the nurses to determine and priorities the acuity needs of the patient and how the patient is progressing. These decisions are made by the nurses themselves and not by their managers (Brown, 1992).


Some of the factors that will facilitate the implementation of a program of patient acuity include fiscal services. This should work in conjunction with nurse leaders for the development of nursing acuity data. A new billing system should be established and used in patient acuity data. Finally, acuity information and data should be collected on a regular daily basis preferably after a certain period such as after every eight hours.

The fiscal, service department ought to make sure that the data acquired from the nursing department on patient acuity is reliable and accurate and well documented. Fiscal services should openly articulate their goals to the nursing department and make sure that the necessary resources are availed. To enhance the timeliness, documentation, and accuracy of the acuity system, the nursing service may be required to implement various things. These include hiring a coordinator for patient acuity, developing new acuity weights and forms, implementing in-service training programs, and employing a rigorous data evaluation process concerning the acuity system (Rowland & Rowland, 1997; Hoeman, 2008).

The second factor required for smooth implementation of an acuity system would be the capture of patient information about the nursing requirements. In most hospitals, the bill for nursing services is generalized in the room and boarding fees are usually generated automatically by the midnight room call. Subsequently, hospital charging systems are not required to get patient acuity data. It is highly suggested that the finance department should come up with modern systems that will facilitate the entry of patient acuity data.

It will be very advantageous if a separate patient acuity system could be developed in each nursing unit or service. In addition, it is good to have separate patient acuity codes for different nursing units or services. This will account for the various nursing and care features that may be directly or indirectly related to each service or unit (Fitzpatrick & Wallace, 2006; Marquis & Huston, 2009).

Thirdly, the patient acuity data should be collected and entered into the patient’s acuity system daily. Data processing, nursing, and fiscal, service personnel ought to work in tandem to establish an appropriate functioning process for inputting acuity information into the patient acuity system on a daily and regular basis. After this is achieved, the management will be capable of calculating the average acuity of a patient measured per day per patient, and per the duration of the stay by the nursing service, by DRG, or by major diagnostic sections (Rowland & Rowland, 1997).


Ensuring that every patient gets the required appropriate levels of nursing health care is the responsibility of the nurses and nurses’ leaders. Using the patient acuity model would enhance the efficiency of the nursing staff to provide adequate and appropriate care.


American Nurses Association. (2009). Nurse Staffing Plans and Ratios. Web.

Brown, M. (1992). Nursing management: Issues and ideas. Gaithersburg, Md: Aspen Publishers.

Fitzpatrick, J.J. & Wallace, M. (2006). Encyclopedia of nursing research. New York: Springer Pub.

Hoeman, S.P. (2008). Rehabilitation nursing: Prevention, intervention, and outcomes. St. Louis, Mo: Mosby/Elsevier.

Marquis, B.L., & Huston, C.J. (2009). Leadership roles and management functions in nursing: Theory and application. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Rowland, H.S., & Rowland, B.L. (1997). Nursing administration handbook. Gaithersburg, Md: Aspen Publishers.