The impact of an ambulatory infusion center patient acuity scale on nursing satisfaction with workload: A mixed method study

Abstract

Patient acuity is a concept used in the healthcare setting and is a driver of nurse staffing and patient scheduling. Much of the work on patient acuity has focused on the inpatient setting, but because care is transitioning to the ambulatory setting these departments must ensure nursing care is provided in a manner that decreases cost and increases patient and team satisfaction. The purposes of this sequential explanatory mixed method study were to validate a patient acuity scale for the ambulatory pediatric oncology population, determine if registered nurses (RNs) working in a pediatric ambulatory oncology infusion center experienced satisfaction with patient assignment workload using a patient acuity scale, compared to nursing assignments created using nursing judgment and clinical experience, and explore the perceptions of RNs who received patient assignment using the patient acuity scale. Job satisfaction is a critical issue for RNs and can be linked to adequate nurse to patient ratios and nurse staffing levels. Pre-and post-test assessment of the NASA Task Load Index assessed satisfaction with patient assignment workload and data were analyzed with the Chi-square with Fisher’s exact test, Manny Whitney U, and Wilcoxon Signed Rank test in SPSS v.26. A semi-structured interview was also used and evaluated by qualitative content analysis. Twelve RNs were included. Pre and post-test scores with a Z value of -2.510 and a 2-tailed asymp. significance of .012 demonstrated a statistical significance between the dependent variable of satisfaction with workload and independent variable of patient acuity. Emergent qualitative interview themes included leadership engagement, nurse staffing levels, and satisfaction. Discussion from interviews supported the use of the acuity scale but revealed additional mitigating operational factors that impacted satisfaction.