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I read the article "Perception of Adequacy of Staffing" (August 2009: 65–71) by Claudia Schmalenberg and Marlene Kramer with great interest and expectations because the topic is so relevant to present day problems and to job satisfaction or the lack thereof in our daily practice. I agree that numbers alone do not tell the whole story and that staff nurses’ "perceptions of the factors in the work environment that affect adequacy of staffing must be assessed and measured and included in the model."
In our medical-surgical intensive care unit, we need a better solution to the staffing issue, and I am sure our problem is not unique to our hospital alone. Many years ago, our patient-nurse ratio was based on unit acuity; our 20-bed critical care unit was staffed primarily with a nursing care coordinator and an assistant nursing care coordinator, or an alternate when both were off, and 9–10 clinical nurses for days and 8–9 clinical nurses at night in addition to the assistant nursing care coordinator or alternate. A few years ago those numbers dropped to one less clinical nurse per shift. It could be even fewer if someone called in sick. Recently, 2 beds in our unit were blocked because the hospital expanded and other areas opened. Since then our staffing was again cut by 1 to 2 fewer nurses per shift depending on the current unit census, regardless of unit acuity.
Our unit has a very diversified patient mix, including acute stroke and intra-aortic balloon pump cases, as we can handle most cases except patients who have just had open heart surgery. The staff members are also part of the hospital code and rapid response team, so one or more staff will be assigned to answer those requests to any areas of the hospital, including other critical care and procedural areas and the emergency department. At least more than half of those cases will end up in our unit. Patients from other critical care areas can stay where they are except stroke cases, which get transferred to our unit.
While nurses are responding to codes and rapid response teams, their patients are monitored by the remaining nurses in the unit. Most days, 2 to 6 codes are called. A nurse could be gone from 30 minutes to 2 hours. Because we are staffed according to start of the shift census and not acuity, covering codes can be problematic and stressful to all staff members. Needless to say, morale is running low in our unit.
We do have committees and nursing council meetings but the problems persist. Maybe acuity should be more defined especially in critical care areas where the acuity of the patient mix is ever changing? Or are we looking at a future of health care reforms and cost-cutting measures taking place? Where do we go from here?
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