Implementing a Patient Acuity Tool To Guide Nursing Assignments and Decrease RN Turnover

Project Topic:

Implementing a patient acuity tool to guide nursing assignments

Hospital, City and State:

Holyoke Medical Center, Holyoke, Massachusetts

Unit:

• Medical Telemetry

CSI Participants:

• Kailey King, BSN, RN
• Courtney Letendre, BSN, RN
• Celina Rios, BSN, RN

Project Goals/Objectives:

1. Create a more balanced nurse workload and improve communication by creating an acuity tool
2. Increase Healthy Work Environment Assessment Tool (HWEAT)1 aggregate score to 5.00
3. Decrease Medical-Telemetry RNs turnover annually 50%
4. 100% implementation of acuity tool

Project Outcomes:

1. Acuity tool created and implemented 100%
2. Increased HWEAT aggregate score 4.76 (Moderately Healthy) and all six standard scores
3. Increased Nurse turnover from 4 RNs to 8 RNs during project time period

Project Overview:

The Nursing Acuity Tool is a data-driven workforce optimization solution that aims to optimize patient care and prevent nurse burnout by aligning assignments with real-time patient acuity rather than just census. The tool uses clinical data—such as diagnosis complexity, medication frequency, mobility needs, and level of monitoring—to generate an objective acuity score for each patient. These scores are then used to assign work based on total workload demand rather than room geography alone, ensuring fairness and transparency across the care team. Furthermore, real-time information enables charge nurses and leaders to make informed decisions regarding staffing when workload thresholds are met.

By aligning nursing workload with the complexity and intensity of patient needs, the tool optimizes patient care delivery. More balanced assignments of high-risk or high-demand patients prevent the situation where one nurse has a heavier assignment compared to another, ensuring consistent monitoring, timely medication administration, and earlier intervention when conditions change. Balanced assignments improve patient outcomes, reduce errors, and allow nurses to dedicate meaningful time to assessment, education, and care coordination.

The tool also directly addresses key drivers of our nurse burnout. Moving beyond geography-based assignments ensures that no individual nurse consistently carries a disproportionate share of high-acuity patients. This equitable approach reduces physical fatigue, cognitive overload, and moral distress, fostering a healthier work environment where nurses feel supported, valued, and better equipped to provide safe, high-quality care.

As a result of implementing the tool, we noted increased unit teamwork and communication among staff. CSI members are seen as a resource for other units throughout the hospital. We strengthened our relationships between unit staff, charge nurses and bed management. The tool led to modified assignments for patients with high acuity leading to increased staff satisfaction and increased positive patient outcomes. There is potential for other units to adopt the tool.