Abstract
BackgroundManagement decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. Furthermore, these management decisions must address the nursing care requirements of the particular patients within an organizational unit. In order to determine optimal nurse staffing needs, the extent of nursing workload must first be known. Nursing workload is largely a function of the composite of the patients' individual health status, particularly with respect to functioning status, individual need for nursing care, and severity of symptoms. The International Classification of Functioning, Disability and Health (ICF) and the derived subsets, the so-called ICF Core Sets, are a standardized approach to describe patients' functioning status. The objectives of this study were to (1) examine the association between patients' functioning, as encoded by categories of the Acute ICF Core Sets, and nursing workload in patients in the acute care situation, (2) compare the variance in nursing workload explained by the ICF Core Set categories and with the Barthel Index, and (3) validate the Acute ICF Core Sets by their ability to predict nursing workload.MethodsPatients' functioning at admission was assessed using the respective Acute ICF Core Set and the Barthel Index, whereas nursing workload data was collected using an established instrument. Associations between dependent and independent variables were modelled using linear regression. Variable selection was carried out using penalized regression.ResultsIn patients with neurological and cardiopulmonary conditions, selected ICF categories and the Barthel Index Score explained the same variance in nursing workload (44% in neurological conditions, 35% in cardiopulmonary conditions), whereas ICF was slightly superior to Barthel Index Score for musculoskeletal conditions (20% versus 16%).ConclusionsA substantial fraction of the variance in nursing workload in patients with rehabilitation needs in the acute hospital could be predicted by selected categories of the Acute ICF Core Sets, or by the Barthel Index score. Incorporating ICF Core Set-based data in nursing management decisions, particularly staffing decisions, may be beneficial.
Highlights
Management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets
Since nurse staffing represents a considerable proportion of the total staffing costs in acute care hospitals [2], management decisions regarding quality
The aim of the current study was to examine the factors leading to variation in the nursing workload in the acute hospital setting in order to provide a basis for better management decision-making
Summary
Management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. These management decisions must address the nursing care requirements of the particular patients within an organizational unit. Various criteria are available to determine whether the scale and composition of nurse staffing are adequate to meeting the needs of patients and staff [7]. These criteria include factors such as nurses’ educational level, ward size or number of beds, acute versus chronic status of patients, and the time required for individual nursing interventions. Irrespective of the method employed for calculating staffing requirements and for accurate prediction of the consequent workload, the relevant factors determining workload must first be determined [8]
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