Nursing Workload Measurement Research Articles

Facilitators and barriers in oncology clinical practice influencing nurses' completion of GRASP Workload Measurement System to ensure patient-centred care.

Hospital administrators have a great interest in obtaining a valid and reliable nursing workload measurement to help determine the hours of care needed per patient; one such method available is the GRASP Workload Measurement System. At Sunnybrook Health Sciences Centre, nurses' GRASP compliance and accuracy varies and often does not meet the target of 90%. The target assists the organization in estimating ongoing nursing workload and patients' care needs, while ensuring the provision of safe and appropriate care that is fiscally responsible. The objective of the quality initiative reported in this paper was to identify the facilitators and barriers that influence nurses' completion of GRASP. The quality improvement project was conducted using a mixed-method design with a sample of 28 nurses working in oncology acute care and palliative care inpatient units. The Theoretical Domain Framework (TDF), often used in behaviour change studies, was used in designing the questionnaire survey and interview questions that listed pertinent and measurable factors that may influence nurses' GRASP completion. Facilitators included: nurses' knowledge about the role GRASP has in funding and staffing levels, job responsibility, and perception of GRASP as a potential tool to organize work. Barriers identified by nurses included insufficient GRASP knowledge, limited access to workstations and computers, GRASP tool elements not capturing the complexity of the nursing work, time constraints, increased patients' acuity, and care demands. In addition to the Theoretical Domain Framework, the Normalization Process Theory was used to guide the implementation and evaluation of the recommendations to enhance nurses' GRASP compliance and adherence practice.

Multicenter application of a nursing workload measurement scale in adult hospitalization units

ObjectivesThe study aimed to the multicenter application of a nursing workload measurement scale in the internal medicine and surgery adults hospitalization units. MethodsThe study design was a multicenter, observational, and descriptive study. A multicenter application of the MIDENF® nursing workload measurement scale was carried out, which consists of 21 items, and covers the four nursing functions (patient care items, teaching, manager, and researcher), in units of hospitalization of adults of internal medicine and surgery of four different hospitals. Each item contains one or more of the nursing interventions of Nursing Interventions Classification (NIC) and has an assigned time, after comparing the real time it takes to perform each intervention with the North American Nursing Diagnosis Association (NANDA) standardized time. The study was carried out during nine months of the year 2020, measuring two days each month in the three work shifts (morning, evening, and night) to all patients admitted on the days of measurement in the indicated units. ResultsThe descriptive and inferential analysis of 11,756 completed scales, 5,695 in general surgery and 6,061 in internal medicine, showed a greater care load for the two units during the morning shift (227,034 min in general surgery, 261,835 min in internal medicine), especially in the items of “self-care”, “medication”, “common invasive procedures”, “fluid therapy”, and “patient and family support”, while the managerial function was similar during the three work shifts in the two units studied, getting values between 57,348 and 62,901 min. In the analysis by shift and unit, statistical significance was obtained both for the total workload and the four nursing functions(P < 0.001). ConclusionsIt is shown that the use of validated scales with the standardized language of nursing functions, adapted to the units, provides objective information to adjust the nursing staff to the real situation of care in any hospital and unit where it is applied, improving quality and patient safety.

Beyond patient classification: the "hidden" face of nursing workload.

This is a theoretical-reflective essay, which aimed to reflect on the centralization of Patient Classification Systems in workload and hospital nursing staff sizing. The reflexive interpretations were guided by two axes: Patient Classification Systems : constitution and utilities; and "Hidden" nursing activities in workload measurement. The first evidences the importance and the role of these instruments in workload identification and in hospital nursing staff sizing, exemplifying several possibilities to be used by nurses. On the other hand, with the second axis, it is clear that there are many nursing activities that are not sensitive to the application (even if systematic) of these means of patient assessment. Therefore, nursing workload measurement may be underestimated. It was inferred that the complexity of practice environments requires a macro and micro institutional look at the nursing workload measurement, especially when considered for workforce planning/sizing purposes.

Development of a Nursing Assignment Tool Using Workload Acuity Scores.

To determine a just and consistent practice for creating nursing assignments. Traditional methods of assigning patients to nurses may lead to unbalanced nursing workload. This article describes the ongoing, hospital-wide effort to evaluate and implement a nursing assignment tool based on electronic health record (EHR) functionality and auto-calculated nursing workload scores. EHR records of individual patient workload scores from all hospital units were collected from August 2017 to June 2018. A nurse-specific total workload score was summed for each staff. Then, each hospital unit's mean nurse workload score and standard deviation, along with the unit's nurse-to-patient ratio, were used to calculate levels of high, medium, and low nursing workload measurement (NWM). Mean patient-specific workload scores varied greatly across hospital units. Unit-specific nurse-to-patient ratios were factored into NWM scores to create ranges for assignments that were relatively consistent across the institution. The use of objective, electronically generated nursing workload scores, combined with traditional nurse-to-patient ratios, provides accurate real-time nurse staffing needs that can inform best practice in staffing. The confirmation of individual patient workload scores and an appreciation for the complexity of EHR vendor rules are necessary for successful implementation. Automation ensures patient safety, staff satisfaction, and optimal resource allocation.

Design and application of time series algorithm model in information assisted sensing system of nursing measurement in neurology

Abstract Objective This paper studies the measurement indicators of nursing workload in neurology department, discusses the development and development law of nursing workload, provides scientific basis for nursing staff deployment, and guarantees high-quality and safe nursing services. Methods By using time series algorithm model, the paper calculates the nursing workload of neurology department and establishes the measurement index of nursing workload of neurology department. Improve the nursing workload information system, automatically generate and extract daily nursing workload, and construct a time series model of daily nursing workload. Results Through literature search and on-site observation, preliminary measurement of nursing workload measurement indicators, consultation with expert meetings to develop an expert consultation form for nursing workload measurement indicators, and application of SPSS 19.0 for time series analysis to construct a time series model for daily nursing workload. Results The best fit models of the time series of the two wards in neurology department were both exponential smoothing models. The predictive value of the ward A smoothing model for the total nursing workload from January 1 to 3, 2014 was 317.39. 316.14, 295.94 points (upper limit: 366.39, 375.95, 364.88 points; lower limit: 268.40, 256.33, 227.00 points). The prediction value of the B Ward Index Smoothing Model for the total nursing workload from January 1 to 3, 2014 is 450.03, 449.38, 445.58 points (upper limit: 503.76, 512.04, 515.05 points; lower limit: 396.30, 386.71, 375.11 points). Conclusion Time series analysis can predict the nursing workload on the one hand, and adjust the number of nurses on the day of work according to the short-term predicted value of the nursing workload on the time series model; on the other hand, it can evaluate the rationality of the existing manpower allocation strategy.

Model to estimate the nursing workload required by trauma victims on intensive care unit discharge.

To validate a model to estimate the nursing workload required by trauma victims on intensive care unit (ICU) discharge. Identifying a reliable model of nursing workload measurement that can assist professionals. A prospective cohort study conducted in 2010 (first phase) and 2015 (second phase) with 342 trauma victims admitted into the ICU of four hospitals located in São Paulo, Brazil. The original model was created during the first phase and included the Simplified Acute Physiology Score and New Injury Severity Score variables. Coefficients of determination (R2 ) were calculated to identify the reliability. The original model presented high reliability (R2 =44%) in the hospital of origin, and unsatisfactory performance (R2 <4%) in the other institutions. An improvement in R2 was observed after adjusting the coefficients for each hospital. For the Nursing Activities Score prediction of survivors for ICU discharge, trauma centres must validate the original model with coefficient adjustments for their population, or preferably derive their own models. Although models are useful in predicting discharge of these ICU patients, for treatment continuity after critical care and for organising services, the study showed that they should be evaluated prior to use for nursing management.

A study on nursing workload measurement based on relative value

Objective To test the applicability of the relative value used to measure Chinese nurses′ workload, and measure part of single workload of nursing procedures. Methods Time, physical effort, mental effort and medical risk were used as the four dimensions to evaluate nurses′ workload. Based on these dimensions, a set of questionnaires covering 117 common nursing procedures were designed and 58 nurses form 58 hospitals were surveyed. Establishing three different regulation modals, of which the applicability and stability were evaluated through the good of fit. Results Median of the relative value of different dimensions was used to indicate the average level of the various nursing procedures′ workload. The results showed that the median of relative value between 100 to 199 accounted for the largest share, up to 88.89% of 104 items. The median of relative value between 200 to 299 accounted for 7.69%(9 items). The median of relative value between 0 to 99(3 items)and more than 300(1 item)accounted for a small proportion. The lowest point of workload was blood pressure measuring, having a relative value of 90(70, 100) while the PICC catheterization accounted for the highest point of workload, being 370(200, 500) Three kinds of modals were valid(Model Ⅰ, F=10 626.16, P<0.001; Model Ⅱ, F=17 108.22, P<0.001; Model Ⅲ: F=6 694.16, P<0.001), while the good of fit of these regulation modals was between 0.8 to 0.9. Time, physical effort, mental effort and iatrogenic risk were the key variables of nurses′ workload. Conclusions The applicability of the relative value to measure nurses′ workload is fairly satisfactory, and the relative value points based on multi-dimension will enjoy a promising future. Key words: Nursing care; Workload; Measurement; Relative value; Questionnaire survey

Nursing workload of trauma victims: an integrative literature review

Trauma victims, due to the severity of the injuries,present a high demand for care during hospitalization. However, it is not clearin the literature the nursing workload measurement instruments used in thispopulation, nor the results found. In this context, the aim of this study is toinvestigate studies that analyze the nursing workload required by traumavictims according to the instrument applied and the results identified. It is aliterature review carried out in the Scopus, Medline, LILACS, SCIELO, and IBECSdatabase during October 2018. The studies inclusion criteria in this reviewwere: be available in full for free access and be an original article publishedin English, Portuguese or Spanish that exclusively addresses trauma victims.The following health descriptors were used to the search: nursing , workload and wounds and injuries and the keyword trauma , combined withboolean operators “or” and “and”. As the result, eight studies were selected tothis review. The Nursing Activities Score (NAS) was the most applied nursingworkload measurement instrument, highlighting the results on the positiverelation between workload and severity of the victims. One study showed theimportance of preventing delirium in reducing the nursing workload. Duringchildren resuscitation, higher-level activations and events without previousnotification increased the demand of care of the nursing team. The analysisshowed that the most frequently performed nursing interventions in ICU traumavictims were: monitoring and titration, laboratory investigations, medicationapart from vasoactive drugs, hygiene procedures, mobilization and positioning,administrative and managerial tasks, and quantitative urine output measurement.The studies included in this review allowed to conclude that NAS was theinstrument of choice to measure the nursing workload required by trauma victimsand that more researches need to be done in different countries and thepossible relationship between care demand and aspects of trauma, including theseverity of the injuries/trauma, need to be better explored.

Construction of nursing labor power allocation model based on patient classification and labor hour calculation

Objective To explore the nursing labor allocation model based on patient classification combined with nursing labor hour calculation in Class Ⅲ Grade A hospitals. Methods The patients in the general hospital were divided into 6 grades: special grade, Ⅰa, Ⅰb, Ⅱa, Ⅱb and Ⅲ. The daily direct and indirect nursing labor for patients of different grade were calculated, combining traditional grading nursing with Barthel Self-Care Ability Score. Results A nursing labor allocation model based on patient classification and nursing workload and man-hour measurement in internal and surgical wards of Class Ⅲ general hospitals was constructed. Conclusions Nursing labor allocation model based on patient classification and nursing workload and man-hour measurement can truly reflect the difference of nursing workload between internal and surgical wards. It can guide the clinical scientific, rational and effective allocation and use of nursing manpower. Key words: Nursing administration research; Patient classification; Nursing workload; Man-hour calculation; Manpower allocation

Intrahospital transfers and the impact on nursing workload.

To determine the rate of patient moves and the impact on nurses' time. Bed shortages and strategies designed to increase patient flow have led to a global increase in patient transfers between wards. The impact of transferring patients between wards and between beds within a ward on nurses' workload has not previously been measured. A two-stage sequential study. Retrospective analysis of hospital data and a prospective observational-timing study. Secondary analysis of an administrative data set to inform the rate of ward and bed transfers (n=34,715) was undertaken followed by an observational-timing study of nurses' activities associated with patient transfers (n=75). Over 10,000 patients were moved 34,715 times in 1year which equates to an average of 2.4 transfers per patient. On average, patient transfers took 42min and bed transfers took 11min of nurses' time. Based on the frequency of patient moves, 11.3 full-time equivalent nurses are needed to move patients within the site hospital each month. Transferring patients is workload intensive on nurses' time and should be included in nursing workload measurement systems. Nurses at the site hospital spend over 1700hr each month on activities associated with transferring patients, meaning that less time is available for nursing care.

Construction of the gall-stone patients' nursing workload measurement project using Delphi method

Objective To construct the gall-stone patients' nursing workload measurement project by Delphi method,so as to measure single disease workload scientifically and reasonably. Methods The gall-stone patients' nursing workload measurement project were designed on the basis of consulting literature and experts discussion, then two rounds of consultations were made with experts by using the Delphi method. Results The valid recovery rate of questionnaires of two rounds consultations were all 100% (22/22). The expert authority coefficient was 0.886 1. Nursing workload measurement project, directly related to the gall bladder calculi 54 nursing projects, including technical 46, unskilled 7; indirectly related to the gall bladder calculi 36 nursing projects, including technical 17, unskilled 19. Conclusions The measurement project of gall-stone patient determined by Delphi method has high reliability, which is significant to the scientific measuring of nursing single disease workload. Key words: Cholecystolithiasis; Delphi technique; Nursing workload; Measurement project

Nursing activities and factors influential to nurse staffing decision-making

Objective: There is limited published research supporting the effectiveness of nursing workload measurement to comprehensively measure nursing workload and to formulate nurse resource need. Predictive accuracy is impaired due to variation in direct and indirect care-related activities across measurement instruments. This study aimed to (1) identify common nursing activities considered by nurse managers for staffing decision-making, (2) systematically review such nursing activities in relation to existing nursing workload instruments and Nursing Intervention Classification taxonomy, and (3) describe challenges perceived by managers in staffing decision-making.Methods: A survey was developed from an inclusive review of 20 nursing workload instruments collectively measuring 502 nursing activities. Nurse managers in 13 medical-surgical and two intensive care units at a Midwest healthcare organization identified nursing activities considered daily for staffing decision-making.Results: Twenty-one activities were commonly considered by at least 90 percent of managers (n = 13) for daily staffing decisionmaking, although none of the instruments reviewed included all 21 activities.Conclusions: Lack of a standardized framework for nursing workload measurement might have led to nurse managers’ different perceptions about appropriate determinants of these measurements. A standardized approach for measuring nursing workload would facilitate benchmarking for estimating nurse resource need. Further research is needed to design a systematic infrastructure that ensures staffing to meet patient care need. A process is also needed to alleviate the challenges in staffing decision-making that nurse managers face, such as fluctuations in census and patient acuity, nurse competency-based patient assignments, and limited information resources for staffing estimation.

Development and early application of the Scottish Community Nursing Workload Measurement Tool

This article describes the development and early application of the Scottish Community Nursing Workload Measurement Tool, part of a suite of tools aiming to ensure a consistent approach to measuring nursing workload across NHS Scotland. The tool, which enables community nurses to record and report their actual workload by collecting information on six categories of activity, is now being used by all NHS boards as part of a triangulated approach. Data being generated by the tool at national level include indications that approximately 50% of band 6 district nurses' time is spent in face-to-face and non-face-to-face contact and planned sessions with patients, and that over 60% of face-to-face contacts are at 'moderate' and 'complex' levels of intervention (2012 data). These data are providing hard evidence of key elements of community nursing activity and practice that will enable informed decisions about workforce planning to be taken forward locally and nationally. The article features an account of the early impact of the tool's implementation in an NHS board by an associate director of nursing. Positive effects from implementation include the generation of reliable data to inform planning decisions, identification of issues around nursing time spent on administrative tasks, clarification of school nursing roles, and information being fed back to teams on various aspects of performance.

Research on the nursing dynamic management according to TISS-28 in the elderly ICU

Objective To measure the daily nursing workload by simplified therapeutic intervention scoring system and provide information for reasonable dynamic management of nursing manpower and improving nursing service satisfaction of patients in elderly ICU.Methods 113 patients in elderly ICU were selected from July 2012 to June 2013.The Therapeutic Intervention Scoring System 28(TISS-28) was used to measure the nursing workload,reasonably arranged the nursing staff according to the daily total nursing workload.The average daily working time and service satisfaction were compared before and after the application of dynamic management of nursing manpower.Results After the application of dynamic management of nursing manpower,the average daily working time of nurses decreased,satisfactory degree of patients with nursing service increased,and satisfactory degree of medical workers with nursing manpower management also increased.Conclusions Measurement of nursing workload by TISS-28 can provide the basis for the dynamic management of nursing manpower in elderly ICU and improve satisfaction degree of medical workers. Key words: Intensive care unit; Simplified therapeutic intervention scoring system; Nursing manpower management; Nursing work time; Satisfaction degree

Research in measurement of nursing workload in ICU in municipal hospitals by using different

Objective To measure the nursing workload in ICU,and provide the basis for the scientific distribution of human resources and reasonable scheduling in ICU.Methods ICU patients of the First and Third People's Hospital of Zigong from July to September,2011 were selected.The TISS-28 and NAS were applied to measure the nursing workload in the ICU.The number of staff nurses on each day and on each shift was recorded.Results The total nursing workload and the per capita nursing workload for each day in a week showed no significant difference,and the per capita nursing workload of different shifts and the needs of nurse-patient ratio of different patients in ICU were significantly different.Conclusions The allocation of nursing staff should be balance for each day in a week and different shifts for each day.The configuration of the nursing human resources should be based on actual nursing workload,no only considering the species of the diseases,the disease condition,self-care ability and cooperation of the patients,but also the proficiency of nurse skills. Key words: Nursing activities score; Scoring system of therapeutic intervention; Intensive care unit; Nursing workload; Nurse-patient ratio

Measuring the nursing workload per shift in the ICU

In the intensive care unit (ICU) different strategies and workload measurement tools exist to indicate the number of nurses needed. The gathered information is always focused on manpower needed per 24 h. However, a day consists of several shifts, which may be unequal in nursing workload. The aim of this study was to evaluate if differences in nursing workload between consecutive shifts can be identified by a nursing workload measurement tool. The nursing activities score (NAS) was registered per patient for every shift during a 4-week period in a prospective, observational research project in the surgical-pediatric ICU (SICU-PICU) and medical ICU (MICU) of an academic hospital. The NAS was influenced by the patient characteristics and the type of shift. Furthermore, the scores were lower during night shifts, in weekends and in MICU patients. Overall, the mean NAS per nurse per shift was 85.5 %, and the NAS per 24 h was 54.7 %. This study has shown that the nursing workload can be measured per working shift. In the ICU, the NAS differentiates the nursing workload between shifts, patients and units.

Development and content validity of the new version of a patient classification instrument

The purpose of this study was to reconstruct Perroca's patient classification instrument; and to assess the content validity of the new version. A group of experts comprising ten nurses appraised the instrument, using the Delphi technique. Data collection took place from March 2008 to February 2009 by means of structured questionnaires sent by electronic mail. The new version contained nine nursing care areas. Agreement levels on the instrument structure amounted to > 90%, and ranged between 80 and 96% in the nursing care areas. The refinement of classification instruments is of great importance to generate valid and reliable data, supporting management decision making on nursing care planning as well as nursing workload measurement.

The Linkage of Nursing Assessment and Nursing Workload

The automated linkage of nursing assessment, nursing interventions, nursing workload measurement, and outcomes supports the user in practice and increases the explanatory power of nursing data, e.g. in DRG systems. Practice relevant data should therefore be available for the different needs for information by policy, management, research and training. To this end, two projects have gradually linked the outcome-oriented nursing assessment instrument AcuteCare (ePA-AC) and the nursing intervention and workload measurement system LEP Nursing 3 with each other.

Development of a nursing workload measurement instrument in burn care

Existing workload measurement instruments fail to represent specific nursing activities in a setting where patients are characterized by a diversity of cause, location, extent and depth of burns, of age and of history. They also do not include educational levels and appropriate time standards. The aim of this study was to develop a reliable measurement instrument for nursing workload in burn care, in order to match quality of patient care with staffing needs. In the first phase, a time study by semi-structured interviews and observations was used to assess direct and indirect care activities. A total of 34 nursing activities were identified, defined, connected to educational levels and attached to time standards. Two independent raters completed a test computer program by assessing performed nursing activities in 36 patients. This yielded intra-class correlations of 0.82, indicating good reliability. In the second phase, a computer program was developed to process quantity and quality of available staff and the sum of time standards of nursing activities per patient per day and to calculate the balance. After 1 year of running this program, the database was used to distinguish patients’ care demand into five care categories. This instrument justifies the investment of time by nursing staff needed for daily activities in the burn unit. It provides quick insight into the balance between care demand and staffing needs and can be used to optimise resource planning.

Investing in the Research Process: Nursing Health Services Research Unit - University of Toronto Site

Linda O'Brien-Pallas, RN, PhD, FCAHS is a Professor in the Faculties of Nursing and Medicine at the University of Toronto and Director, Co-Founder and Co-Principal Investigator of the Nursing Health Services Research Unit (University of Toronto site). Dr. O'Brien-Pallas is acknowledged globally for her pioneering and innovative research in health human resources modelling, quality of work life for nurses and nursing workload measurement. The rigour of her research has been praised by respected researchers at international conferences, and her expertise is sought by governments and stakeholders at all levels in Canada and throughout the world. She is frequently called upon by the World Health Organization and the International Council of Nurses to provide high-level consultation on matters including midwifery and health human resources planning. Dr. O'Brien-Pallas has provided leadership to many boards and committees and is a co-founder of the Dorothy M. Wylie Nursing Leadership Institute, which received the 2003 Ted Freedman Award for Innovation in Education. She has received numerous awards for her research and innovative contributions to nursing, including the Canadian Nurses Association's prestigious Jeanne Mance Award in 2006.