Nursing Workload Measurement Research Articles

Decision Making for Nurse Staffing: Canadian Perspectives

The effectiveness of methods for determining nurse staffing is unknown. Despite a great deal of interest in Canada, efforts conducted to date indicate that there is a lack of consensus on nurse staffing decision-making processes. This study explored nurse staffing decision-making processes, supports in place for nurses, nursing workload being experienced, and perceptions of nursing care and outcomes in Canada. Substantial information was provided from participants about the nurse staffing decision-making methods currently employed in Canada including frameworks for nurse staffing, nurse-to-patient ratios, workload measurement systems, and "gut" instinct. A number of key themes emerged from the study that can form the basis for policy and practice changes related to determining appropriate workload for nursing in Canada. These include the use of (a) staffing principles and frameworks, (b) nursing workload measurement systems, (c) nurse-to-patient ratios, and (d) the need for uptake of evidence related to nurse staffing.

Accuracy in workload measurement: a fact or fallacy?

As the drive within a market-led National Health Service is towards cost-efficiency and through-put, nurses are now more than ever having to 'prove their worth'. This has led to various workload measurement systems being used throughout nursing. Before examining the accuracy of these measurement tools this paper attempts to define workload and investigates how measurement is limited by an unclear definition of what 'nursing' actually is. There is little argument as to some of the beneficial effects of monitoring workload where changes in practice, rostering, skill mix and establishments have occurred. It is, however, necessary to examine the accuracy of workload measurement within the current framework of nursing to see if it is the promised panacea. The issues surrounding patient dependency and professional judgement are discussed and the seeming unacceptability of such 'soft data' to non-nursing personnel. Both the 'bottom-up' and 'top-down' approaches of workload measurement are explored within the context of equity, neutrality and bias. The conclusion is drawn that accuracy in nursing workload measurement is not possible in the current economic climate and that a compromise solution that uses patient dependency as an assessment tool is the best that can be hoped for without limiting nursing to inflexible and restrictive practices.

The revision of a workload measurement tool to reflect the nursing needs of patients with traumatic brain injury.

Rehabilitation for persons with head injuries is a multifaceted process that requires structure, consistency, and predictability. This article discusses the process followed by nurses on one rehabilitation unit to revise a standard nursing workload measurement tool to reflect the physical, cognitive, behavioral, and psychosocial needs of patients with traumatic brain injury (TBI). Family education and support, a critical component of care, was also addressed. The flexibility of the tool, known as GRASP, allowed the incorporation of neurobehavioral items based on the Rancho Los Amigos cognitive functioning scale and the inclusion of important therapeutic nursing interventions. The revised tool reflects the time required to deliver comprehensive nursing care to TBI patients and, thus, promotes the desired rehabilitation outcomes for patients and their families.

Measurement systems in principle and in practice: the example of nursing workload

There has been a rapid development of measurement systems in the health services in the United Kingdom (UK) over recent years, not always matched by a thorough understanding of the phenomenon being measured and rarely based on any assessment of reliability or validity. A particularly flagrant example of this process is the development of nursing workload measurement systems (NWMS). The estimates from four NWMS were examined. They were substantially different from each other for no obvious reason, and the difference between any of the estimates and the actual nursing hours worked could not be explained in terms of any other aspect of the nursing process. There is no evidence that the NWMS deployed in the UK are anything more than an expensive numbers game; without this kind of investigation of how they actually work in practice, it would be prudent to be wary about any of the measurement systems which have been proposed. Yet many of the measurement systems used in other sectors of the health service are equally untested.

Nursing workload measurement as management information

Goal of the study presented in this paper was to balance the supply and demand of nursing care at nursing units within general hospitals. A ‘management control framework’ is developed, containing the relevant decision levels, the goal variable and the information needed to control the balance between supply and demand. A nursing workload measurement instrument is introduced, and an experiment is set up to test the performance of the framework and the measurement system in the daily practice of eight nursing units in two hospitals, during 20 consecutive weeks. Intervention has taken place in both the staffing and patient planning processes. The effects upon the goal variable has been measured. The variation coefficient of the work pressure is used as an indicator for the stability of the balance. The results of the experiment are presented.

A comparison of nursing care requirements of patients in long‐term geriatric and acute care nursing units

It is commonly assumed that elderly patients in long-term care facilities require less total care and less professional care than patients in active 'treatment' settings. However, no objective data have been available to support or refute these assumptions. This study examined patient classification data obtained from eight acute care medical and surgical units and four long-term care geriatric units over a 1-year period. Results indicated that geriatric patients in long-term care units had differing (as opposed to similar) nursing care needs, nursing care requirements of geriatric patients in several long-term care units differed from those of patients in another long-term care unit, geriatric patients in the selected long-term care units required at least as much nursing care as those in the medical surgical units, and the long-term care units had many patients with extensive nursing care requirements but no patients with very complex requirements when compared with the medical/surgical units. The potential impact of these findings on staffing of long-term care units is considerable. Issues relating to reliability, validity and comparability are discussed. There is a great need to utilize standardized, state-of-the-art methods for nursing workload measurement to facilitate comparisons of nursing care requirements of geriatric long-term care patients with those of patients in other areas.

Measuring Nursing Workload in an Outpatient Department

Estimating outpatient nursing workload on the basis of visit volume loses validity as utilization of services by patients with complex nursing needs increases. In response to this challenge, nursing administrators at all levels must maintain an awareness of new methods to measure and predict outpatient nursing workload. Accurate quantification of the workload is a valuable tool in justifying costs, particularly in the face of health care regulation, and in developing billing systems that reflect actual nursing practice. Using the concept of relative value units (RVU), the authors describe a nursing workload measurement system developed in the outpatient department of a regional cancer center.