We thank Riman and Kahn for their much needed contribution to the research into the challenges facing nurse staffing and patient outcomes. We agree that understanding how nurse-patient assignments are created will allow development of tools and methods to improve assignments for nurses and patients. We developed an evidence-based practice project to further understand the impact of assignments on patients.

In our unit, no criteria were available to guide charge nurses in decision-making for nurse-patient assignments. Reports by nurses of the intensity or business of assignments affecting patient care led to conversations about finding creative solutions.2,3  We decided to use a patient intensity tool (PIT), and we measured the impact of this tool on health care–associated pressure injuries (HAPIs) and central line [catheter]–associated bloodstream infections (CLABSIs).

The PIT served as a guideline for charge nurses when they made assignments. We grouped patients into categories of intensity...

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