Problem: The pediatric oncology unit at a tertiary care hospital in Maryland lacked a streamlined method for measuring patient acuity. This led to unequal patient assignments and increased staff turnover. At that time, 26% of staff nurses on the unit had less than one year of experience, compared to 18% three years earlier. High patient acuity, combined with unbalanced patient assignments compromised quality of care, resulting in adverse healthcare outcomes such as medication errors, extended lengths of stay, higher healthcare costs, and increased nurse turnover. Purpose: This quality improvement initiative implemented the evidence-based Oncology Acuity Tool (OAT). The tool was used at the end of each shift to predict patient acuity for the upcoming shift, resulting in more equitable nursing assignments. A more balanced workload was attained by carefully considering patient needs during the assignment process, which enhanced patient care and nurse satisfaction. Methods: Implementation occurred from August to December 2024, lasting 15 weeks. All 42 RNs on the unit received training on the Oncology Acuity Tool (OAT). They were directed to assess patients’ acuity levels based on anticipated needs for the upcoming shift. All oncology, hematology, and bone marrow transplant patients were eligible for evaluation with this tool. Results were evaluated using a double-check method involving project champions who verified the acuity scores to ensure accuracy, reliability, and validity. Acuity scores were included on the nursing assignment sheet for the next shift, guiding nurses to organize assignments with 2-3 patients and a total acuity score of 15. Results: Process measures indicated that RNs completed the OAT over 94% of the time. The average acuity scores per nurse were calculated, aiming for a target of 15. Before the implementation of the OAT, average acuity scores varied significantly, averaging around 12. After the OAT was implemented, scores became more consistent, averaging 14 across nurses, which closely aligned with our target. Conclusions: The findings suggested that consistently completing the OAT led to more equitable patient assignments among nurses. These results indicate that the OAT should continue to be utilized in practice, as it contributed to more manageable patient assignments.