(1356) Nurses’ Perceptions of the Nurse-Patient Assignment Process in Critical Care: A Qualitative Study

Introduction: Nurse-patient assignments may be an important determinant of patient outcomes and nurse satisfaction in the intensive care unit (ICU). However, the factors influencing the assignment process and the experience of the nurses involved are poorly understood. We sought to better understand the assignment process from the perspective of ICU nurses in order to inform potential interventions designed to optimize nurse-patient pairings.

Methods: We performed a focused ethnographic study in three diverse ICUs in a multi-hospital health system. We used two qualitative data collection methods: direct observations of the assignment process and semi-structured interviews with key stakeholders. We iteratively collected, transcribed, coded and analyzed data until we achieved theoretical saturation. Data are presented as relevant categories and themes.

Results: We performed 33 interviews and 12 observation episodes from March 2023 to May 2023. Our analysis identified six key domains relevant to the assignment process: (1) the charge nurse's education, resources, and experience significantly inform the assignment decision-making; (2) the assignment process is multi-stage, involving planning during pre-assignment, active delegation during the actual assignment, evaluation in post-assignment; and varies across day and night shifts; (3) hospital-level factors such as case-load and resource availability create both constraints and opportunities; (4) ICU level factors, including nurse availability, unit layout, and patient transitions, directly shape the assignment scenarios; (5) nurse-level factors like expertise, specialties, continuity of care, and satisfaction influence individual assignment suitability; and (6) patient-level factors, including acuity, stability, task load, and family dynamics, dictate nurse-patient compatibility. Notably, nurses indicated perceived biases and lack of structured procedures as opportunities for improvement.

Conclusions: The assignment process is multi-layered, necessitating iterative consideration of factors at the patient, nurse, ICU, and hospitals level. These findings underscore the need for system-level efforts to refine the process, possibly through targeted interventions, to enhance nurse retention and improve patient care.