Assignments Matter: Results From a Nurse-Patient Assignment Survey

Monday, 30 October 2017

Stephanie B. Allen, PhD, MSN, MS, BSN, ASN
Lienhard School of Nursing, College of Health Professions, Pace University, Pleasantville, NY, USA

Hospital organizations are continually looking for ways to improve patient, nurse and organizational outcomes. Finances are tight and reimbursement no longer exists for adverse patient events. Hospital units, in particular, are driven to improve outcomes while containing costs. One area where this is possible is the nurse-patient assignment. The nurse-patient assignment has the potential to affect patient, nurse and organizational (financial) outcomes making it an ideal process for quality improvement efforts (Birmingham, 2010).

The nurse-patient assignment is the matching of the nurse and patient for a specified time for the provision of nursing care. Assignments provide the structure for nursing care delivery in most inpatient hospital settings and provide the specificity needed to identify and match individual nurse characteristics to specific patient needs. Positive outcomes can be achieved with a proficient nurse-patient assignment.

Research has shown that more educated nurses and better work practice environments improve patient safety outcomes (Aiken, Clarke, Sloane, Lake, & Cheney, 2009). Other outcomes affected by level of nurse education include: mortality, odds of readmission and length of stay (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Yakusheva, Lindrooth, & Weiss, 2014). The nurse’s tenure on the unit has also been associated with a shorter length of stay (Bartel, Beaulieu, Phibbs, & Stone, 2014). Other researchers have suggested that individual factors such as patient acuity and nurse competence affect patient safety outcomes (Lang, et al., 2004; West, Mays, Rafferty, Rowan, & Sanderson, 2009).

To date research on the nurse-patient assignment has been scarce and no research exists that actually describes the complex process of making nurse-patient assignments. Purposes, decision factors and steps of the process have been identified (Allen, 2012; Allen, 2015). Anecdotal evidence suggests that the majority of charge nurses learn to make nurse-patient assignments through non-formalized methods.

The process of making nurse-patient assignments is not routinely taught in undergraduate education because novice nurses don’t make assignments. Issacson & Stacy (2004) described a single instance of senior nursing students making patient assignments for junior students during a medical-surgical clinical rotation. The process also isn’t taught in graduate curricula because nurse managers and administrators don’t make assignments either. Although nurse-patient assignments are identified as an activity of the charge nurse, training programs and role descriptions do not describe how to make nurse-patient assignments (Admi & Moshe-Eilon, 2010; Eggenberger, 2012; Sherman, 2005; Thomas, 2012). Although charge nurses typically make assignments, there are no protocols addressing where they learn how to do so, or information about whether they receive guidance in the process.

Anecdotal and unpublished evidence suggests that nurses learn this important process through on-the-job training. The efficaciousness of this process is unknown. Until we know how nurses are taught to make assignments we cannot expect to implement evidence-based practice changes to improve the process. Clearly, evidence is needed to guide the assignment process.

This session will describe the results of a descriptive study about the nurse-patient assignment process. The specific aims of this study were to learn who makes nurse-patient assignments, how they learn to make them and if satisfaction with their assignment affects absenteeism and turnover. The three research questions were: (1) What percentage of a sample of registered nurse has ever made nurse-patient assignments? (2) How do registered nurses learn to make nurse-patient assignments? And (3) Is nurse satisfaction with assignments related to absenteeism and turnover?

58 medical-surgical nurses from across the country completed this 35-question online survey. Results indicated that 91% of RN’s who completed the survey have made nurse-patient assignments. The vast majority (94%) did not learn to make assignments during their primary RN education. The majority also began making assignments within 2 years of graduation (34% within 1 year, 58% within 2 years). 74% of nurses surveyed knew someone who transferred or left their position because of unhappiness with their nurse-patient assignments. Finally, 97% stated their daily nurse-patient assignment was extremely or very important to their overall job satisfaction.

Nurses begin making nurse-patient assignments earlier in their career than previous thought. This evidence suggests that the nurse-patient assignment process is should be included in undergraduate curricula. Nurses also indicated how important their daily assignment is to their overall job satisfaction. This finding is relevant for all those who work in inpatient settings. The nurse-patient assignment process is an essential aspect of nurse satisfaction and needs to be better understood by clinicians and educators.