Problem: On a 41-bed mixed surgical unit in a community hospital, patient assignments have historically been based on unit layout geography. This practice has resulted in unbalanced workloads which, per the literature base, can influence patient outcomes such as increased falls and missed turning and repositioning (T&R). At the project site, fall rates increased from seven falls in 2020 to 16 falls in 2022, and T&R compliance was 40.5% in August 2023. Literature shows patient outcomes and quality of care were significantly improved after implementation of the Perroca patient acuity tool (PPAT). Purpose: This quality improvement (QI) project aims to apply the PPAT based on tailored unit needs, educate unit nurses, assess PPAT compliance, measure patient outcomes, and improve workload balance during a 15-week period. Methods: Prior to implementation, nurses were educated by utilizing mock patient scenarios. During the intervention period, nurses completed the acuity tool by scoring an average daily census of 30 patients from one (lowest acuity) to three (highest acuity). Using the acuity scores, charge nurses evenly distributed the highest acuity patients among the oncoming nurses. Random audits were conducted twice a week to evaluate tool utilization compliance. Fall rates and T&R data were assessed weekly to evaluate patient outcomes. Results: On average, staff utilized the acuity tool 81.8% of the time and charge nurses used the tool 76.7% of the time to make nurse assignments. Fall rates improved by 25% post implementation. Average T&R compliance was 26.1%. Conclusions: Findings suggest that fall rates improved post-implementation. However, there was no improvement in average T&R compliance. Anecdotally, nurses appreciate more equitable assignments. Implications for practice include further research utilizing artificial intelligence to promote equity among patient acuity and nursing assignments. Key words: Patient acuity, nurse assignments, workload, falls, turn and reposition.