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Nursing Management

October 2012, Volume 43 Number 10 , p 36 - 42


  • Chantelle Dykstra RN, CMSRN
  • Elizabeth Bridges PhD, MN, BSN, CCNS


In the acute care setting, charge nurses must make fair and manageable nursing assignments every 4 to 12 hours. This can be difficult, time consuming, and involve many factors that affect perceived workloads.1 The charge nurse uses his or her experience and information received from the off-going staff to create assignments. The resultant patient assignment for each RN is predicted to be manageable, safe, and fair.Despite the best efforts of a charge nurse, this doesn't always happen. Nurses may report feeling completely overwhelmed by their workloads, feeling like the workload is unevenly distributed, and express that the care needs for specific patient combinations are too heavy. The term "too heavy" is subjective, and nurses don't have a standardized way to measure their workloads or express what factors contribute to this feeling.This article addresses the issue of "load leveling" using a tool developed by nurses to quantify workloads in the acute care setting. Workload scores produced by the tool are used to create patient assignments. Load leveling refers to the even distribution of perceived workload among all staff. The overall goal of this project was to increase the percentage of nurses reporting manageable patient assignments.In 2010, nurses at an academic medical center in the Pacific Northwest addressed the issue of load leveling by developing a tool to reflect the perceived workload intensity a patient would require. The goal of this project was to level the workload, create a transparent method for equitable and balanced patient assignments for all staff, and ultimately enhance staff satisfaction and retention by decreasing the frequency of shifts during which workloads were perceived as unmanageable.This project involved identifying factors that affected nurses' perceptions of their workloads, combining these factors into a tool known as the Intensity Index, using the Intensity Index to identify a target range reflective of a manageable workload, and

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