HealthJanuary 26, 2016

Better acuity assessment helps balance nurse-patient assignments

Equivalent patient assignments factor into a heap of important hospital measures: quality care, patient and family satisfaction, and nurse job satisfaction among them. Yet equalizing the care load isn’t quite as easy as dividing the number of patients by the number of staff nurses on a shift. Patients are individual, after all, and have highly personalized care requirements. While the patient in E532 may be young, healthy and recovering peacefully from a standard procedure, the patient in E533 may be older with multiple comorbidities, requiring a handful of medications, interventions and, yes, explanations.

Yet “most nurses expect patient assignments to be equitable, with each nurse bearing a fair share of the workload so all patients can receive excellent care,” noted a progressive care unit (PCU) team from Indiana University Health Ball Memorial Hospital in Muncie, IN, in a recent American Nurse Today article.

After realizing their tool for assessing patient acuity was failing to contribute to equal assignments among nursing staff, and that, as a result, nurses were growing increasingly frustrated with their disproportionate workloads, the PCU team was determined to make a change.

This is how they turned things around.

Better acuity assessment

The suggestion to improve the existing acuity assessment tool came from a direct care nurse. The nurse manager and unit-based council took the suggestion seriously, gave it some consideration, and agreed that it was time for a revamp. When a team of staff nurses, charge nurses, the unit manager, a clinical nurse specialist, and a nurse researcher agreed on a potential replacement, they posted a revised version, next to the existing acuity assessment tool, for staff nurses to review and suggest changes.

“Evidence,” the team recalled, “suggested that involving staff in developing an acuity assessment tool would yield a valued, more efficient instrument that could improve nurse satisfaction and job retention.”

The new-and-improved acuity assessment tool the team uses today looks something like this: a list of five acuity categories (complicated procedures required for the patient, education required, psychosocial or therapeutic interventions required, oral medications required, and complicated IV drugs and other medications required), with each category offering four levels (from lowest acuity to highest) the nurse can select from to best describe the patient’s needs.

The old assessment tool simply had nurses rate each patient from 1 to 3 for acuity (with most nurses inevitably choosing  “2”). In comparison, the new tool offers a total acuity score that can range from 1 to 60, providing a much more comprehensive glimpse of the patient’s needs. In addition, nurses started rating projected needs and medications for the patient for the next shift, too, which helped to guide patient assignments for oncoming staff.

Of course, the location of patient rooms, need for continuity of care, and coherence between the nurse’s expertise and the patient’s needs continued to play a role in nurse-patient assignments.  A more expansive view of acuity, however, better balances those assignments among nurses.

Increased nurse satisfaction

“Nurses voiced favorable responses to the new tool,” the PCU team reported, “specifically the benefits of empowerment, assurance of quality care, patient safety and satisfaction, nurse retention, and equitable assignments.”

In fact, nurse satisfaction with the unit’s acuity assessment process rose from a mere 7% with the former tool to 55% with the new tool just one month after its rollout. Four out of five nurses surveyed said completing the new, lengthier acuity tool was not a waste of time, the PCU team noted.

“Nurses’ job satisfaction depends partly on their workload and their perceived ability to deliver high-quality care,” the authors wrote. “When patient assignments aren’t equitable, nurses may feel inadequate and frustrated.” 

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