Numerous considerations go into making nurse staffing assignments. Patient census, acuity, staff experience, licensed and unlicensed staff, unit layout, budget and the needs of the patients all play a role. But one of the most important factors is understanding the actual nursing work required to care for those patients. This is where the nursing process becomes important. The nursing process provides a framework for assessing each patient’s needs, and those needs should be part of the information used to determine a nursing assignment.
The nursing process is built around assessing the patient, identifying needs, planning care, implementing that plan and evaluating the results. Each step provides insight into the amount and type of nursing work required to care for that patient. As patient needs change, the nursing work required can change as well. Nursing assignments should reflect those patient needs and the work involved in their care, rather than being based primarily on patient counts or a list of tasks.
Moving from Task-Based to Nursing Process-Driven Assignments
A task list focuses on what needs to be completed. The nursing process starts with understanding the patient and the care required to meet those needs. That distinction matters when determining how nursing work should be assigned. Consider two patients who each require several medications, assessments and routine care. On paper, their assignments may look similar. In practice, one patient may require significantly more nursing time. This may be because of complex care needs, unit churn, being a fall risk, and other factors that are not reflected in a simple patient count.
The nursing process provides a more complete way to understand those differences. Assessment and ongoing evaluation help identify the patient’s changing care needs, while planning and implementation reflect the nursing work required to meet those needs. When that information is translated into patient classification and workload data, it can become useful in making nursing assignments.
A workload-based approach provides a different way to look at assignments. Instead of focusing only on tasks, it considers the total nursing workload associated with the patients and the unit. This can include patient-specific workload, patient activities, ADTs, and non-patient workload. The resulting workload picture reflects the work that comes from the patient’s needs, as well as the other work required to operate the unit. That gives nurse leaders a more complete picture of what each shift actually requires.
Using the Nursing Process and Existing Patient Documentation to Understand Workload
The information needed to understand nursing workload is often already being documented as part of patient care. Patient assessments, care activities and other documentation provide valuable information about the patient care requirements. Rather than asking nurses to document something specifically for staffing purposes, hospitals can use information already captured to better understand the work those patients need.
AcuityPlus uses existing documentation to automatically classify patients based on their documented care needs. In turn, it creates equitable nursing assignments. This nursing process-focused approach helps measure workload without creating additional documentation or duplicate work for nurses or leaders. Using patient acuity and complexity data provides a workload picture that supports informed, data-driven nursing assignments and resource decisions.
This creates a connection between the nursing process and the assignment process. What nurses document about patient needs can help inform how nursing workload is measured and how resources are assigned.
The Role of Acuity in Assignments
Patient acuity is an important part of understanding a patient’s care requirements, but a nursing assignment involves more than an acuity score. The nursing process provides the clinical context for those needs. The assignment process considers how those needs translate into nursing work and which members of the care team are best positioned to provide it. The environment also needs to be considered. Unit layout, staffing practices, staff experience and the mix of licensed and unlicensed team members can all affect how work is distributed. Organizational goals and budget should also be accounted for when determining how available resources can best support patient care.
These factors provide important context around the patient needs identified through the nursing process. A highly complex patient may require a different level of nursing expertise than another patient with a similar diagnosis. The experience and skill mix of the care team also matter when determining how that work should be assigned.
Together, these factors can help nurse leaders determine how available resources can best support patient care. This approach can also support care teams in practicing at the top of their license or role, with assignments that better align staff capabilities with patient needs.
A Workload-Based Approach Supports Overall Efficiency
The value of workload data goes beyond deciding who cares for which patients on a particular shift. Understanding how workload is distributed can also be important when considering nurse fatigue and patient safety. When hospitals consistently measure workload, they can begin to identify patterns over time. Historical data can help leaders forecast future needs, evaluate productivity and understand where nursing resources are being used. It also creates an opportunity to look at workload alongside patient outcomes and other key measures.
AcuityPlus supports this approach through purpose-built methodologies for inpatient, pediatrics, mental health, perinatal, and emergency care settings. Each methodology is designed to account for the specific factors that influence nursing workload in that care environment. Additionally, AcuityPlus integrates with any EMR, scheduling, and time and attendance systems, so hospitals can bring this information together without adding additional nursing work.
Nurse leaders will always have to balance multiple considerations when making assignments. There is no single number that can make that decision for them. But having better information about the work behind the assignment can help. When patient classification is based on documented care needs and total nursing workload, leaders have a stronger foundation for deciding how resources should be distributed. They can see not only how many patients need care, but what is involved in caring for them.
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