From the nurse manager's bookshelf: Patient classification systems

Nurse Leader Insider, July 21, 2016

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Patient classification systems (PCS), or patient acuity systems, are used to determine workload requirements and staffing needs. There are different kinds of PCSs available, but according to Sullivan (2005), the three most commonly used PCSs are as follows:

Descriptive: Subjective systems in which categories are selected that best suit the patient.

Checklist: Subjective systems in which acuity levels of patient are assigned as numerical values based on levels of activities in specific categories; numerical values are added up to give an overall rating.

Time standards: Systems in which charge nurse leaders assign a time value based on various activities to be completed for the patient; the time value is totaled and converted to an acuity level Not all organizations use a PCS system. Some determine acuity levels based on how much patients can do for themselves: The more activities nurses must do with them, the more nursing assistance needed, and the higher the acuity. Whatever system is used, it is used to forecast unit-staffing needs.

Staffing mix and distribution of staffing are determined by current patient needs on each shift (Sullivan, 2005). How many patient care technicians are available to help with baths, hygiene, feedings, walking, and patient transfers? Is a unit secretary or monitor tech needed? How many nurses are available to meet patient care needs? Are the nurses working an eight-hour shift or a 12-hour shift? Are there enough nurses to cover the entire shift?

Charge nurse leaders are responsible for their staffing needs, but they also plan for the next two shifts and communicate those needs to oncoming charge nurses at shift change. Staffing is a team effort, and communication and Coordination and Delivery of Patient Care planning are the keys to success. Discuss the facility and service policies and available resources for managing staffing. This is an important part of the charge nurse leader program as both a workshop presentation and a precepted activity. Consider adding a copy of the policy and facility guidelines and contacts to your charge nurse leader reference manual.

Book excerpt adapted from Charge Nurse Program Builder by Diana Swihart, PhD, DMin, MSN, APN CS, FAAN and Kelly J. Gantt, RN, MBA/HCM, BSN, VHA-CM.

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