Patient Acuity Scales: Nursing Staffing and Outcomes Review
This literature review examines patient acuity scales as patient classification tools used to measure illness severity and the nursing care intensity required for individual patients. Drawing on multiple peer-reviewed studies, the paper explores how patient acuity tools influence nurse satisfaction, workload equity, and patient outcomes. Key findings indicate that appropriate staffing—guided by acuity data—reduces adverse events such as infections and mortality, while also improving nurse perceptions of equitable assignments. The review also discusses specific tools such as the CAMEO acuity instrument and concludes that continued development of user-friendly, affordable acuity measurement processes remains a priority for nursing practice and administration.
- Introduction to Patient Acuity: Introduces acuity as a key patient classification tool
- Defining Patient Acuity: Reviews competing definitions and adopts working definition
- Patient Acuity and Nurse Satisfaction: Links acuity tools to equitable assignments and nurse satisfaction
- Impact on Patient Outcomes and Staffing Ratios: Connects appropriate staffing to improved patient outcomes
- Workload, ICU Decision-Making, and Acuity Tools: Explores acuity tools as ICU staffing decision aids
- Nurse-Patient Assignment and Care Individualization: Argues for individualized acuity-based nursing assignments
- The CAMEO Acuity Tool and Future Directions: Examines CAMEO tool and calls for further research
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What makes this paper effective
- Integrates multiple peer-reviewed sources cohesively, consistently linking each study's findings back to the central argument about the value of patient acuity tools.
- Balances dual outcomes — nurse satisfaction and patient outcomes — demonstrating that acuity tools benefit both staff and patients simultaneously.
- Uses direct quotations strategically to anchor empirical claims, while surrounding them with the author's synthesis and interpretation.
Key academic technique demonstrated
The paper demonstrates effective thematic synthesis across a literature review. Rather than summarizing sources one by one, it groups findings by theme — nurse satisfaction, staffing ratios, patient outcomes, and decision-making — and uses each theme to build a cumulative argument for the clinical utility of patient acuity tools. This approach shows graduate-level command of source integration.
Structure breakdown
The review opens by establishing nurses' professional obligations and introducing patient acuity as a classification concept. It then defines acuity, examines its effect on nurse satisfaction, explores the relationship between staffing ratios and patient outcomes, and discusses acuity tools as ICU decision-making aids. The penultimate section addresses individualized care assignments before the final section presents the CAMEO tool as a concrete example and calls for continued research. Each section builds logically on the previous one.
Introduction to Patient Acuity
According to DiClemente (2018), nurses have a moral as well as professional obligation to ensure that patients have access to the best possible level of care. This could be achieved through the deployment of a wide range of ideals, systems, and tools. Patient acuity could be conceptualized as one of the most instrumental patient classification systems (Garcia, 2017). In the words of the author, acuity comes in handy in efforts to "project how many nursing care hours are needed to optimize patients' ability to improve" (Garcia, 2017, p. 477). Studies conducted in the past have clearly demonstrated that patient acuity scales have a positive impact on not only patient outcomes, but also patient satisfaction. Further, these scales help increase staff satisfaction and decrease staff burnout.
Defining Patient Acuity
Patient acuity does not have an assigned definition. In the past, various definitions have been offered by multiple authors in an attempt to define this particular concept. Connor, LaGrasta, Gauvreau, Porter, O'Brien, and Hickey (2019) observe that the lack of a clear and straightforward definition of patient acuity — and thus identification of its key attributes — has largely stifled the effective application of acuity measurements and tools in clinical settings. Brenan and Daly (as cited in Goh, Ang, Chan, He, and Vehvilainen-Julkunen, 2018), in their attempt to offer a concise definition of the concept, indicate that patient acuity could be conceptualized as "the physical and psychological status of the patient and is described as the measurement of the patient's illness severity and the intensity of nursing care required" (p. 694). This is the definition of patient acuity that will be embraced in this review.
References
Carlisle, B., Perera, A., Stutzman, S.E., Brown-Cleere, S., Parwaiz, A., & Olson, D. (2020). Efficacy of using available data to examine nurse staffing ratios and quality of care metrics. Journal of Neuroscience Nursing, 52(2), 78–83.
Connor, J.A., LaGrasta, C., Gauvreau, K., Porter, C., O'Brien, K., & Hickey, P.A. (2019). Scaling the measurement of pediatric acuity using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Tool. Dimensions of Critical Care Nursing, 38(3), 146–152.
DiClemente, K. (2018). Standardizing patient acuity: A project on a medical-surgical/cancer care unit. MedSurg Nursing, 27(6), 355–387.
Firestone-Howard, B., Gonzalez, J.F., Dudjak, L.A., & Rader, S. (2017). The effects of implementing a patient acuity tool on nurse satisfaction in a pulmonary medicine unit. Nursing Administration Quarterly, 41(4), E4–E14.
Garcia, A.L. (2017). Variability in acuity in acute care. JONA, 47(10), 476–483.
Goh, M.L., Ang, E.N., Chan, Y., He, H., & Vehvilainen-Julkunen, K. (2018). Patient satisfaction is linked to nursing workload in a Singapore hospital. Clinical Nursing Research, 27(6), 692–713.
Lee, A., Cheung, Y.S., Joynt, G.M., Leung, C.C., Wong, W., & Gomersall, C.D. (2017). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals of Intensive Care, 7(46), 1–9.
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