Construction and implementation of a role-competency-based three-level nursing deployment pool in a maternal and child health hospital: an uncontrolled before-and-after quality-improvement evaluation

Abstract

Abstract Background Short-term nurse redeployment relieves temporary staffing imbalances, but cross-specialty assignment may be limited by gaps in role-specific competencies. We evaluated the implementation of a role-competency-based three-level internal deployment model for a structured response to staffing gaps in a maternal and child health hospital. Methods A single-site uncontrolled before-and-after quality-improvement evaluation was conducted, with 2023 as the comparison year and 2024–2025 as the implementation period. Pool selection and cross-specialty training were completed in late 2023, and the electronic deployment module and incentive mechanism launched in January 2024. Outcomes included centrally recorded Level 2/Level 3 deployment requests and fulfillment, annual staffing-allocation survey scores, patient satisfaction, and structured head-nurse assessments. Results The Level 1 pool included 1,385 nurses in 2024 and 1,397 in 2025; the Level 2 and Level 3 pools included 176/126 nurses in 2024 and 182/133 in 2025. Among centrally documented Level 2/Level 3 requests, 334/382 were fulfilled in 2024 and 424/468 in 2025. Patient satisfaction with nursing technical skills did not differ detectably between deployed- and regular-nurse groups in either year (2024: 90.0% vs. 91.7%, Fisher exact p = 1.000; 2025: 93.3% vs. 90.0%, p = 0.743). The adequate-staffing score was 10.61 points higher in 2024 than in 2023 (95% CI 10.05 to 11.17; Hedges g = 1.58; Holm-adjusted p < 0.001) and 9.54 points higher in 2025 (95% CI 8.94 to 10.14; g = 1.33; Holm-adjusted p < 0.001). The competent-team score was 1.12 points lower in 2024, and the reassignment item was lower in both implementation years, indicating mixed staffing perceptions. Conclusion The competency-gated three-level deployment pool established a structured cross-unit staffing pathway. Higher perceived staffing-adequacy and working-hours/intensity scores were observed during implementation, although competent-team and reassignment scores showed a mixed pattern. As this was an uncontrolled evaluation without measured clinical safety or individual workload outcomes, causal or clinical benefit cannot be established; prospective evaluation of patient, nurse, and donor-ward outcomes is warranted. Nevertheless, the documented request-fulfillment activity demonstrates the model’s operational application and offers a practical framework for organizing responses to short-term staffing maldistribution. Clinical trial number Not applicable.

The authors' abstract, as published at the source. BMC Nursing, 2026 · DOI ↗