Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Suzanne E. Zentz


As the largest sector of healthcare, nurses are the primary providers of patient care. By 2025, it is estimated that there will be a shortage of over 250,000 registered nurses (RNs) (American Association of Colleges of Nursing, 2011). Factors contributing to the nursing shortage include increased complexity of patients and decreased staffing that leads to decreased job satisfaction (Fox & Abrahamson, 2009). Over half of neonatal intensive care nurses reported missing at least one nursing task per shift when staffing was inadequate or patient acuity was high (TubbsCooley, Pickler, Younger, & Mark, 2015). The purpose of this evidence-based practice (EBP) project was to evaluate the effects of incorporating patient acuity into nursing assignments on nursing satisfaction and workload measures over a 3-month period. Kanter’s (1996) theory of structural empowerment and the Iowa model (2015) were used to guide the project on two medical units at a large pediatric hospital. Assignments for RNs were made by charge nurses who considered total patient acuity and each nurse’s proficiency level when making assignments. Nurses were surveyed using the Nurse Workload Satisfaction Questionnaire (NWSQ) pre- and post-implementation. In addition, two workload measures – pain reassessment within 30 minutes and medication given within 1 hour of scheduled time – were monitored throughout the study. Using paired t-tests, NWSQ scores showed a statistically significant increase in overall RN satisfaction. The mean pre-intervention NWSQ scores (M = 35.14, SD = 8.245) were compared to the mean post intervention NWSQ scores (M = 29.23, SD = 6.195, t = 2.833, p = .014). Other statistically significant improvements were found in the relational portion of the NWSQ, which gauges colleague relationships. There were no changes in the success rate of the two workload measures. Findings from this project support the incorporation of patient acuity into the nursing assignment process.