Sentara nurses create innovative tool to improve staffing and patient care

In 2015, nurses Kristen Danley and Clare Danley were working in the same unit at Sentara Leigh Hospital. As patients came and went, and needs fluctuated, they noticed that staffing decisions had a big impact on both nurse and patient satisfaction.

Working with researchers and other healthcare professionals, they developed the Patient Acuity Nursing Tool (PANT), a homegrown algorithm to optimize nursing assignments, improving care for patients and workload for nurses.

Each nurse is typically assigned the same number of patients by a charge nurse. Before PANT was implemented, there was no single standard for those decisions, and sometimes patient assignments complicated care.

For example, a nurse could end up with multiple patients who needed close supervision, such as individuals who were confused or at risk of falling. At the same time, another nurse might have a group with lighter needs.

“We were talking about how difficult some days are, how the workload doesn’t seem even,” Clare said. “And so we were like, there’s got to be a better way.”

They met with fellow nurse Nicole Triplett and conceived the idea of rating patients based on their care needs, then using that rating to make assignments.

After successfully pitching their idea to hospital leadership, they worked with a multidisciplinary team to launch the staffing tool that is now used in more than 100 nursing units across Sentara’s 12-hospital health system.

PANT has also received national recognition in the nursing field, recently being featured in the American Association of Critical Care Nurses, the Academy of Medical-Surgical Nurses, and the scholarly journal MEDSURG Nursing.

"It’s really a more efficient way of distributing patient assignments and patient load to nurses,” Dianne Rozier, a clinical nurse manager, said of the tool.

Charge nurse Chrystal Stratton uses the Patient Acuity Nursing Tool (PANT) to make assignments at Sentara Leigh Hospital.

‘Your voice really does matter’

Kristen, Clare, and Nicole are proud to be part of PANT’s development.

“It’s really cool to think that this was just an idea that bedside nurses had about how to make things easier, how to make their shift easier, and keep patients safe,” Kristen said. “And it’s grown into this huge, system-wide initiative.”

One takeaway, for Kristen, is that “your voice really does matter.”

"If there’s something you want to change, it can happen,” she said. “Sentara has so many resources and networks. They can bring your ideas to fruition.”

For nurses, by nurses

Jennifer Kreiser, now vice president and chief nursing officer at Sentara Norfolk General Hospital, was chief nursing officer at Sentara Leigh Hospital at the time and part of the leadership team that supported PANT’s development.

She points out that PANT can help reduce the risk of nurse burnout, a widespread problem. In a November 2022 national study, 43 percent of nurses reported feeling burned out. 

“When nurses perceive workloads are unevenly distributed or they don't have sufficient time to meet both physical and psycho-social needs of their patients, risk increases for turnover and burnout,” Jennifer said.

“As we continue to have a nursing shortage and look for ways to retain bedside nurses, the PANT platform is a data-driven tool that maximizes patient and nursing outcomes.”

‘Straight from the bedside’

Sentara researchers developed the PANT algorithm with input from nurses. Designed to capture the time needed for quality patient care, it incorporates factors like a patient’s medication needs, wound care, and required maintenance of medical devices.

The charge nurse uses the PANT score at the start and end of each shift to make assignments, with the goal of giving nurses similar workloads.

“It was an idea straight from the bedside,” said Nicole.

It doesn’t require any extra work from nurses. Rather, it relies on existing documentation.

Building PANT: An iterative process

PANT was piloted at Sentara Leigh Hospital in 2016, then expanded across Sentara’s 12-hospital system in 2017. The PANT algorithm has gone through many iterations.

“With each of these iterations, we’ve added,” said Kelsey Jones, who has served as the coordinator of the PANT project since 2018.

Initially, PANT incorporated 150 factors that influence a nurse’s workload. Now there are over 280.

The project has been a team effort from the beginning. Two thousand nurses were surveyed to create the PANT rating. Clinical nurses, electronic health record system analysts, health services researchers, biostatisticians, a nurse scientist, and other healthcare professionals have all been involved in developing and refining the project.

Kelsey said PANT is “incredibly important” to day-to-day operations. The tool “enables our team members to be more informed about the intensity of patient care needs.”

For Kelsey, “Quantified nursing care reinforces the value of nursing care.”

“I am both proud and humbled by the work our team has accomplished with the creation of PANT. Sharing this best-practice tool is only the start.”