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Document Type

DNP - University Access Only

Award Date


Degree Name

Doctor of Nursing Practice (DNP)


Graduate Nursing

First Advisor

Robin Arends


nurse satisfaction, overtime, Ambulatory Nursing Intensity System, PES-NWI


Background: Evidence-based intensity staffing tools are necessary to provide balanced nurse workload and safe staffing assignments. Nursing intensity combines indirect, direct, and nursing care time to meet patient needs.
Methods: Nurses completed the pre-intervention PES-NWI questionnaire. The Ambulatory Nursing Intensity System was implemented for 90 days. Following implementation, 2019 and 2021 overtime hours were collected, the PES-NWI questionnaire was repeated, and nursing feedback was obtained.
Results: PES-NWI survey score results were analyzed utilizing the Wilcoxon signed-rank test. While the overall PES-NWI survey average scores increased from 2.81 to 2.88, the increase was not statistically significant. One out of the eight individually measured questions showed statistical significance. Question 26 specifically addressed that nursing care is based on a nursing rather than medical theory model.
Discussion: Results of this project were skewed due to increased staffing demand and inconsistent tool use. Nurse satisfaction did improve despite increased overtime hours in 2021. The increased overall hospital patient numbers and COVID may have also impacted project implementation and results.
Implications: The implementation of an evidence-based staffing intensity model has the potential to improve the quality and cost of staffing workflow in the ambulatory setting with sufficient nurse staffing and consistent use.

Library of Congress Subject Headings

Nursing services -- Personnel management.
Ambulatory medical care.

Number of Pages



South Dakota State University


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