QI PROJECT

1. A Quality Improvement Project on Improving the Surgical Unit Nurse-Patient Assignment
Process.

2. 1.0 Introduction
Lack of proper nurse-patient assignment endangers the safety of patients, medical results, and the entire process of care
provided by nurses. Nurse-patient assignments in medical facilities occur frequently and are considered vital nursing
roles(Mensik & Nickitas, 2015). In medical facilities, the role of managing patient assignments is tasked to shift charge
nurses. Managing patient care assignments by shift charge nurses is done by the utilization of simplified instincts, trends of
ease, and identification of chronological records with very little input from both the patient and nurse taking charge (Allen,
2018). the process of matching nurses with patients for a specific time is important in the nursing profession. The
assignments are made by nursing managers or heads of charge nurse units, and they pose significant effects on the patients,
assigned nurses, and the general medical results. Therefore comprehending the features of nurses match with patients’
requirements leads to improved safety of clients, reduced deaths, and low rates of infections in the medical facility (Allen,
2018)

3. 1.1 Description of the problem
Cases of improper care providence to patients are due to a lack of formal processes of patient-nurse assignments.
According to (Mensik & Nickitas, 2015), high ratios of nurse-patient have been associated with increased cases of low and
poor patient safety results. Lower rates of mortality are in medical facilities with a manageable nurse-patient workload.
Patient needs, nurse availability, and skills have effects on proper nurse staffing, the availability of nurses has influenced the
patient-nurse ratio and the safety of care provided is predetermined by the relevant nurse staffing levels (Ladd, 2022). In
surgical units of medical facilities, nurse-patient assignment processes are done with inaccurate procedures. The process is
done without the use of tools for measurement of set procedures to be followed or which patients should or should not be
assigned to the available nurse. During the assignment process, nurse skills and competencies are less evaluated and
considered. The process of nurse-patient assignment should be detailed to recognize and match nurse-patient features which
may impact patient results and safety. The process should be able to evaluate, redesign and identify areas where
improvements should be done to ensure standardization of the entire assigning process.

4. The concern for patient safety has continued to be an issue in medical facilities, particularly in medical-surgical units. The
nurse-patient assignment process is unique to each client and nursing staff. Therefore understanding the process of nurse-
patient assignment in surgical units is important in improving the goals, process steps, and the process impacts on nursing
and the safety of patients.
2.0 Literature Review
According to (Acar & Butt, 2016) the allocation process of the nurse-patient assignment is based on the requirements of
the patient care with no other considerations on activities to be completed within the shift. Workload distribution between
nursing professionals in a healthcare setting is critical for nurse and client well-being and comfort. Activities involving
providing direct, indirect, and non-patient treatment during a shift must all be taken into account to manage the duties of
the nurses (Acar & Butt, 2016). The nurse-patient assignment process entails manual activities where charge nurses have to
go through decision-making within a short period

5. A Quasi-experimental study conducted by (Al-Dweik & Ahmad, 2019), ascertains that healthcare Challenges such as
high turnover, the burden of workload, and inequitable assignments are faced by nurses in medical centers leading to
nursing discontentment at the workplace. The study findings indicate that Workload balance is increased by linking
nursing shift assignments to the acuity scores of patients. This leads to achieving nursing assignments equitably and also
their satisfaction level. A qualitative approach study using two focused groups conducted by (Al-Dweik & Ahmad),
showed that the nurse-patient assignment process can be improved by matching the assignment shifts with patients’
acuity scores. This promotes an efficient balancing of work and improves the quality of care provided. (Choi & Miller,
2018), conducted a descriptive study on “ Registered Nurse Perception of Patient Assignment Linking to Working
Conditions and Outcomes”. The findings of the study showed different results. The nurses with appropriate nurse-
patient assignments reported a positive work environment compared to nurses with inappropriate assignments. These
findings show that relevant nurse-patient assignments are significantly related to a high quality of care, and a high level
of job satisfaction in comparison to nurses assigned inappropriately. Nursing supervisors or management staff must
guarantee not only the satisfactory quality of registered nurse care but as well suitable nurse-to-patient assigned tasks to
establish care surroundings that have a considerable impact on nurse and client results (Choi & Miller, 2018).

6. A study to determine and develop methods that can reduce time spent by nurses during the assignment process and
scheduling of patients in oncology clinics utilizing different nursing care delivery models, (Liang & Turkcan, 2016),
ascertains that to solve nursing assignment issue, a functional delivery model which is a multiobjective model design with
objectives to minimize patient waiting time can be used.
2.1 Literature Gap Identified.
From the literature review, the studies have focused on the general nurse-patient assignment process, nurse and patient
perspectives, and the utilization of the acuity-based system in the management of the nurse-patient assignment process. The
literature doesn’t clearly show the utilization of nurse-patient assignment tools and models. The studies do not show a
contrast in utilizing different nurse-patient assignment tools and models in improving the process. Generally, there has been
a considerable quantity of research to review. A significant amount of literature, despite relying on studies and scholarly
articles, was not generalizable to the surgical unit.

7. 2.2 Synergy Model For Patient Care
The logical reason for this quality improvement Project is based on the Synergy Model For Patient Care. This is a Model
of professional practice developed by the American Association of Critical Care Nurses (AACN) (Cordon et al., 2021).
Patient needs and characteristics, according to the model, influence nurse competencies. When the needs of patients,
clinical units, and systems are matched with the competencies of nurses, synergy occurs. Patient needs are evaluated in one
to five levels using different categories. The categorical levels present different characteristics that help nurses in
determining the needs of patients. Included in the categories are vulnerability, predictability, stability, resource availability,
decision-making participation process, care participation process, resiliency, and complexity. Nursing, or nursing care,
exemplifies the combination of skills, expertise, and sentiments required to achieve the requirements of the client. Nursing
care categories include clinical judgment, advocacy, moral agency, caring practices, collaboration, systems thinking,
response to diversity, facilitation of learning, and clinical inquiry.

8. Figure 2.0 Synergy Model For Patient Care

9. 2.3 Aims of the Quality Improvement Project
i. To improve workflow and care for patients and assigned nurses to improve nursing assignments and their duties.
ii. To improve the nurse-patient matching process to ensure patients are assigned competent and experienced nurses.
To improve the level of patient satisfaction through nurse availability, properly timed, and consistency of care provided
to patients
2.4 Theoretical Framework
To address the problem, the Need theory was utilized. The theory is based on a that Nurses care for patients until they
have the capability of taking care of themselves again (Ahtisham & Jacoline, 2015). According to the theorist, Nurses
provide temporary assistance to people who have no resilience, and understanding to meet the 14 basic needs.

10. Figure 2.1 Henderson 14 needs as applied to Maslow’s hierarchy of needs

11. 3.0 Context
The project was conducted in a hospital with more than 50-bed capacity and more than 10 medical-surgical units. The
hospital had more than 100 registered nurses, of which 20 nurses are regarded as charge nurses. The hospital provides
primary supervision for duties for the shift-by-shift workflow, patient care, and safety. The supervision is provided at
intervals of 12 hours shifts where there are changes in patients’ needs as new patients are admitted to the surgical unit. 4.0
Interventions
4.1 Planning Phase
This phase started with problem identification. A review of literature relating to the problem in question was then
conducted to identify a gap to address in the current project. From the literature review, it was identified that the literature
doesn’t clearly show the utilization of nurse-patient assignment tools and models, therefore this lead to the adoption of the
Synergy Model For Patient Care to address the identified problem.

12. 4.2 Implementation Phase
Throughout the implementation phase, nurses were required to calculate the complexity of patients and the scores reported at
the end of their shift in the surgical unit. During the shifts, the nurses utilized a patient scoring tool for rating the patients and
identification of their level of complexity. This enabled charge nurses to design a staff competency guide for the nurses by use
of the scores.
5.0 Measures And Evaluation
The outcomes were measured using primary and secondary information. Primary data included nurses’ knowledge about the
problem and was measured using the Nursing Workplace Satisfaction Questionnaire (NWSQ. Secondary information for
measurement and evaluation was obtained from the hospital and other third-party tools.
6.0 Ethical Considerations
The project applied the principles of beneficence to protect all the participants from any dangers, their confidentiality, and
their personal autonomy by allowing the options of whether to participate or not. The project was aimed at benefiting both
nursing staff and patients in medical facilities.

13. References
Acar, I., & Butt, S. E. (2016). Modeling nurse-patient assignments considering patient acuity and travel distance
metrics. Journal of Biomedical Informatics, 64, 192-206. https://doi.org/https://doi.org/10.1016/j.jbi.2016.10.006
Ahtisham, Y., & Jacoline, S. (2015). Integrating Nursing Theory and Process into Practice; Virginia's Henderson Need
Theory. International Journal of Caring Sciences, 8(2).
Al-Dweik, G., & Ahmad, M. The Effect of Patients' Acuity Level on Nurses Shift Assignment in Jordan: A Qualitative
Approach. J Nurs Meas(2), 404-418. https://doi.org/10.1891/JNM-D-18-00101
Al-Dweik, G., & Ahmad, M. (2019). Matching Nursing Assignment to Patients' Acuity Level: The Road to Nurses'
Satisfaction. J Nurs Meas, 27(1), E34-e47. https://doi.org/10.1891/1061-3749.27.1.E34
Allen, S. (2018). The nurse-patient assignment process: What clinical nurses and patients think. Medsurg Nursing,
27(2), 77-82.
Choi, J., & Miller, P. (2018). Registered Nurse Perception of Patient Assignment Linking to Working Conditions and
Outcomes. J Nurs Scholarsh, 50(5), 530-539. https://doi.org/10.1111/jnu.12418
Cordon, C., Lounsbury, J., Palmer, D., & Shoemaker, C. (2021). Applying the Synergy Model to inform the nursing
model of care in an inpatient and an ambulatory care setting: The experience of two urban cancer institutions,
Hamilton Health Sciences, and Grand River Regional Cancer Centre. Can Oncol Nurs J, 31(2), 186-194.
https://doi.org/10.5737/23688076312186194
Ladd, C. (2022). Implementing Patient Acuity Scale on a Medical-Surgical Unit.
Liang, B., & Turkcan, A. (2016). Acuity-based nurse assignment and patient scheduling in oncology clinics. Health
Care Management Science, 19(3), 207-226. https://doi.org/10.1007/s10729-014-9313-z
Mensik, J., & Nickitas, D. M. (2015). Why nurse staffing matters: A moral imperative. Nursing Economics, 33(3), 186.