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.
Patient Acuity and Nurse Satisfaction
There are quite a number of factors that could affect nurse satisfaction. Some of the factors highlighted in the past include, but are not limited to, resource adequacy, organizational policies in place, interactions between co-workers, and professional autonomy. According to Carlisle, Perera, Stutzman, Brown-Cleere, Parwaiz, and Olson (2020), past studies that have reviewed data related to nurse satisfaction indicate that adequate staffing and proper assignment of tasks also has a positive impact on the ability of nurses to enjoy their roles. For this reason, there exists a valid reason to embrace systems and standards that ensure nurses are not overwhelmed by tasks and that patient assignments are equitable. This could be achieved by scoring patient needs using data sourced from relevant workload indicators and patient characteristics from a clinical perspective. A patient acuity tool could come in handy in these efforts.
It should also be noted that, as far as staff satisfaction is concerned, Firestone-Howard, Gonzalez, Dudjak, and Rader (2017) find that nurse-to-nurse communication as well as perceived professional autonomy are greatly enhanced by patient acuity tools. More specifically, their findings indicate that "the utilization of the PAT has the potential to result in an improvement of nurse satisfaction and perceptions that patient assignments are all equitable" (Firestone-Howard, Gonzalez, Dudjak, and Rader, 2017, p. E13). This is particularly the case given that, according to Minnick et al. (as cited in Firestone-Howard, Gonzalez, Dudjak, and Rader, 2017), nurses' perceptions of increased workload are affected by the nature and design of the work environment — including not only non-routine events, but also case difficulty. It is worth noting that patient acuity scales have been associated with a greater ability to quantify, and promote equitability in, RN assignments.
Impact on Patient Outcomes and Staffing Ratios
Patient satisfaction and outcomes are affected by a wide range of factors, including diagnosis quality, treatment decisions, and strategies put in place to monitor care. One often-overlooked factor in patient outcomes is nurse staffing levels. According to Garcia (2017), available evidence indicates that patient outcomes can be impacted by appropriate staffing, and that inappropriate staffing can result in greater workload. Firestone-Howard, Gonzalez, Dudjak, and Rader (2017) observe that workload greatly impacts patient outcomes, and that developing a greater understanding of the relevance of workload in this regard would be instrumental in charting how workload is influenced by patient acuity tools.
For instance, in a study conducted by Cimiotti et al. (as cited in Firestone-Howard, Gonzalez, Dudjak, and Rader, 2017), a significant correlation was found between the rate of surgical site and urinary tract infections and the patient-to-nurse ratio — specifically, both types of infections increased as the patient-to-nurse ratio increased. Furthermore, findings from a study by Mitka (as cited in Firestone-Howard, Gonzalez, Dudjak, and Rader, 2017) indicate that healthcare institutions report fewer readmissions following improvements in nurse staffing ratios. Lee, Cheung, Joynt, Leung, Wong, and Gomersall (2017) also point out that their study findings clearly demonstrate that increased workload and staffing ratio — even for a single day — is linked to a significant increase in death risk among critically ill patients. Their findings are aligned with those of previous studies linking increased mortality to high workload and staffing ratios.
According to Carlisle, Perera, Stutzman, Brown-Cleere, Parwaiz, and Olson (2020), there is ample evidence indicating that the safety of care at the unit level is often impacted by nurse staffing ratios. With this in mind, the deployment of patient acuity tools could have a positive impact on workload — thereby resulting in improved patient outcomes. In the words of Firestone-Howard, Gonzalez, Dudjak, and Rader (2017), "utilizing a patient acuity system, it is possible to increase the levels of staffing efficiency and effectiveness in the hospital setting, thereby resulting in increased quality of care by deploying the appropriate nursing staff for patient care" (p. E6). This assertion is further advanced by Garcia (2017), who points out that nurse leaders seeking optimal staffing practices should embrace the utilization of real-time acuity data.
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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