Publication Date
Spring 2026
Degree Type
Doctoral Project
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
First Advisor
Wei-Chen Tung
Keywords
Nursing workload, patient assignment equity, coefficient of variation, charge nurse education, NASA‑TLX, quality improvement
Abstract
Inpatient nursing shift assignments often rely on clinical judgment, which can lead to inequitable workload distribution on mixed‑acuity units. This quality improvement project evaluated assignment equity using the coefficient of variation (CV) of nursing workload acuity scores and examined the relationship between workload balance and perceived assignment burden. A single‑group pretest–posttest design was implemented on a cardiac adaptable acuity unit at Stanford Health Care over a 12‑week period, encompassing 168 shifts from December 14, 2025, to March 7, 2026. The intervention, implemented with 11 charge nurses, combined structured charge nurse education with an optimized Epic Reporting Workbench tool incorporating dynamic effort categorization stratified by level of care. Assignment equity was measured using CV calculated from assignment‑time workload scores, and perceived workload was assessed with the NASA Task Load Index. Mean CV decreased from 22.52% to 18.26% post‑intervention (p < .001), representing an 18.9% relative reduction with a medium effect size. Improvements were consistent across shift types and levels of care, and perceived workload decreased concurrently. These findings suggest that acuity‑informed decision support paired with targeted charge nurse education can meaningfully improve assignment equity and reduce perceived assignment burden in inpatient settings. The single-site design, small sample size, and short study duration may limit the generalizability of the findings, underscoring the need for future research to promote equitable workload distribution and reduce nurse assignment burden in diverse inpatient settings.
Recommended Citation
Albaniel, Moses, "Advancing Equitable Nurse Assignments Through Nursing Workload Score Categorization in an Adaptable Acuity Unit at an Academic Health Center" (2026). Doctoral Projects. 203.
DOI: https://doi.org/10.31979/etd.uuvd-xsnd
https://scholarworks.sjsu.edu/etd_doctoral/203
