Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Susan Dean-Baar


Susan Dean-Baar, PhD, RN, CENP, FAAN

Cathy Koetting, PhD, DNP, APRN, CPNP, PMHS, FNP-C

Annamarie Kraft, MSN, RN


Problem: Nurses commonly report dissatisfaction with their workload levels due to inequity of shift assignments. Imbalanced workload distribution has been shown to lead to missing or delayed care. Increased nursing workload has been linked to increased fall rates, healthcare associated infections, and avoidable deaths. Research has shown that patient classification is more accurate when an instrument is used. The purpose of this quality improvement project was to implement a patient acuity tool to aid nurse-patient shift assignments on a medical-surgical unit. The project aimed to provide a standardized and objective method of measuring patient acuity.

Methods: The project took place on a 30-bed medical-surgical unit of a Midwest suburban hospital employing 26 registered nurses. Nurses were asked to complete a pre-intervention survey regarding nurse perception on workload distribution. During the eight week intervention period, nurses on the unit were asked to complete an acuity tool for each patient assigned to their care. According to the tool, each patient was assigned an acuity level 1-4. Charge nurses utilized patient acuity levels to balance workload in nurse-patient assignments for the oncoming shift. After the intervention period, nurses were asked to complete a survey assessing perception of workload distribution as well as satisfaction with acuity tool implementation.

Results: Acuity tools were completed for every patient on the unit on 43% of shifts while no tools were completed on 42% of shifts. The average patient acuity on shifts with complete acuity information was 2.08. The average difference in nursing workload score range was 2.17. Significant increases were found in nursing perception of fair and even workload distribution (p=0.023) as well as the RN’s assessment of patient acuity being reflected in patient assignments (p=0.001). Nurses on the study unit found the acuity tool easy to use and effective at evenly distributing patient acuity.

Implications for Practice: This project along with existing research indicates that the use of an objective acuity tool assists in distributing workload evenly with regards to nurse-patient assignments. Steps need to be made to increase compliance in order to experience the full benefits of acuity tool use. Increased education, surveillance, and leadership involvement could be beneficial to increase compliance.

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