Harnessing ward-level administrative data and expert knowledge to improve staffing decisions: A multi-method case study.

The aim of this study was to investigate the impact of changes to bed configuration and patient mix on nurses' workload in a single ward. Multi-method case study. The study was undertaken in an acute 28-bed ward in a tertiary referral public hospital in Queensland, Australia. Ward-level administrative data were obtained for a 2-year period, 12 months before bed configuration changes in October 2015 and 12 months after. These data included patient activity (bed occupancy, transfers, length of stay and casemix) and nurse staffing (budgeted and actual staffing levels, employment status and skillmix). Semi-structured interviews were conducted with ward nurses (N = 17) to explore the impact of the bed configuration changes on their workload. Administrative data showed that the bed configuration changes resulted in more complex and dependent patients, increased patient transfers and greater variability in casemix. The interview data found these changes to patient complexity and activity intensified workloads, which were further increased by staffing decisions that resulted in greater reliance on temporary staff. Hospitals already possess the data and expert knowledge needed to improve staffing and bed management decisions without the need for additional, costly workload systems. Determining appropriate nurse staffing in light of the complexities and variation of patient needs at the ward level remains a challenge. This study identified increases in patient complexity, dependency, variability and churn that increased workload. Staffing grew but hidden factors associated with temporary staffing and skillmix further intensified nurses' workload. Harnessing existing data and the expertise and experience of nursing unit managers (NUMs) would help staff wards more efficiently and effectively, providing reasonable workloads and appropriate skillmix that can enhance the safety and quality of patient care. To facilitate this, NUMs need access to accurate, timely, data and authority in staffing and bed management decisions.

Duffield C ，Roche MA ，Wise S ，Debono D ... -  《-》

Does daily nurse staffing match ward workload variability? Three hospitals' experiences.

Gabbay U ，Bukchin M 《-》

Comparison of nurse staffing based on changes in unit-level workload associated with patient churn.

This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes. Secondary data analysis of unit-level data from 32 hospitals, where nursing units are grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Use of the discharges and transfers adjustment to midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Nurse managers should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements.

Hughes RG ，Bobay KL ，Jolly NA ，Suby C ... -  《-》

Evaluating palliative care ward staffing using bed occupancy, patient dependency, staff activity, service quality and cost data.

Roberts D ，Hurst K 《-》

Temporary nursing staff - cost and quality issues.

This paper is a report of a comparative study of temporary and permanent staff work activity, cost and quality of care. Temporary nurse staffing can consume significant proportions of the health service wages bill, and this is unlikely to fall owing to recruitment and retention problems, high sickness absence and the tendency for staff to work 'casually'. If temporary workers are here to stay, then what impact do they have on inpatient care? For example, do ward nursing quality and costs change when temporary staff are employed? Ward patient dependency, nursing activity, workload, staffing and data on quality were collected using non-participant observation, document analysis, staff and patient interviews in 605 United Kingdom general and specialist wards between 2004 and 2009. These wards were divided into two groups: 368 employing only permanent staff during data collection and 237 with permanent, and temporary staff in the ward team at the time when the observations were made. Workloads and time out (sickness absence, etc.) in wards employing temporary staff were greater than in units with permanent staff only, thereby justifying hiring short-term staff. Wards with temporary and permanent staff were more expensive to run and working styles were different. Overall quality scores, however, were no different in the two types of ward. Ward managers need to monitor temporary staffing and the effect they have on nursing activity and quality. Similar studies in mental health, learning disability and community nursing would generate additional insights.

Hurst K ，Smith A 《-》