Methods of measuring nursing workload in Australia
Article Outline
Continuing and worsening nurse shortages nationally and internationally have reignited the debate in Australia about the methods of measuring nursing workload. As workload is one of the most significant factors in nursing retention, measuring nursing workload reliably is the critical initial step to understanding the relationship between workload, nursing retention and patient safety. In Australia, some states and territories have no measure of nursing workload and those states that have introduced measurement methods are inconsistent in their approach. This paper provides a critical review of the methods of measuring nursing workload with particular reference to Australia. It also explores the strengths and limitations of each approach in terms of its reliability and utility. This review highlights the implications of not understanding fully the impact of excessive workload on patient and nurse safety outcomes.
Key words: Workload , nursing , patient safety , measuring workload
No full text is available. To read the body of this article, please view the PDF online.
References
- . Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches . Journal of Nursing Management . 2004;12(5):299–308
- . Nurses' reports on hospital care in five countries: the ways in which nurses' work is structured have left nurses among the least satisfied workers, and the problem is getting worse . Health Affairs . 2001;20(3):43–53
- . Downsizing the hospital nursing workforce . Health Affairs . 1996;15(4):88–92
- . Studying outcomes of organizational change in health services . Medical Care . 1997;35(11): NS6
- American Nurses' Association 2005 ANA applauds bill prohibiting use of forced overtime among nurses. Retrieved June 1 2005 from the World Wide Web: www.nursingworld.org/pressrel/2005
- American Nurses' Association 1997 Implementing Nursing's Report Card: A Study of RN Staffing, Length of Stay and Patient Outcomes. Washington, ANA.
- Australian Broadcasting Corporation 2004 Stateline Victoria – 23/04/2004: Nurse patient ratio to be overridden by computer system. Retrieved June 1 2004 from the World Wide Web: http://www.abc.net.au/stateline/vic/content/2003/s1093812.htm
- . Australian Nursing Federation and Others & The Honourable Minister for Health and Others . Canberra.: Health and Welfare Services; 2002;
- Australian Nurses' Federation 2000 Summary of nurse-patient ratio agreement. Retrieved April 28 2004 from the World Wide Web: http://www.anfvic.asn.au/news_briefs/news_ratios%20summary.htm
- . Healthcare restructuring: the impact of job change . Canadian Journal of Nursing Leadership . 2001;14(1):14–20
- . Nurse staffing and patient outcomes . Nursing Research . 1998;47(1):43–50
- . A response to California's mandated nursing ratios . Journal of Nursing Scholarship . 2001;33(2):179
- . Psychosocial factors at work and musculoskeletal disease . Scandinavian Journal of Work, Environment & Health . 1993;19(5):297–312
- . Nurses' effect on changing patient outcomes . Image the Journal of Nursing Scholarship . 1995;27(2):95–99
- . Nurse workforce planning in the UK: policies and impact . Journal of Nurse Management . 2004;12:392–399
- . What is the harm in imposing mandatory hospital nurse staffing regulations? . Nursing Economics . 1997;15(2):66–72
- . Policy implications of research on nurse staffing and quality of patient care . Policy, Politics & Nursing Practice . 2000;1(1):5–15
- . Measurement systems in principle and in practice: the example of nursing workload . Journal of Advanced Nursing . 1995;22(2):221
- . Unlicensed assistive personnel in the critical care unit: what is their role? . International Journal of Nursing Practice . 1998;4(4):240
- . The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs . Nursing Research . 2003;52(2):71–79
- . Nursing workload associated with adverse events in the postanesthesia care unit . Anaesthesiology . 1999;91(6):1882–1890
- . Casualisation of the nursing workforce in Australia: driving forces and implications . Australian Health Review . 2003;26(1):201–208
- . Standards for Nursing Care and Relationships Between Skill Management and Patient Outcomes . Science and Training, Canberra: Department of Education; 2001;
- . National Review of Nursing Education . Canberra.: Department of Education Science & Training; 2001;
- Department of Health and Ageing 2004 The State of our Public Hospitals 2004 Report. Australian Government Department of Health and Ageing, Canberra.
- . Casemix and nursing . Australian Health Review . 1999;2(22):56–68
- . Nursing resource definition in DRGs . Nursing Economics . 1997;15(3):124–130
- . Nursing staff mix and patient outcome achievement: the mediating role of nurse communication . International Nursing Perspectives . 2001;1(2–3):74–83
- . The nursing workforce in Canada and Australia: two sides of the same coin . Australian Health Review . 2002;25(2):136–144
- . Professional nursing case management improves quality, access and costs . Nursing Management . 1989;20(3):30–35
- Excel Care 2004 Excel Care Windows. Retrieved June 5 2004 from the World Wide Web: http://www.excelcare.com/holder/Steped%20Inserts-111172.pdf
- Fagin CM 2001 When Care Becomes a Burden: Diminishing Access to Adequate Nursing. Millbank Memorial Fund. Retrieved January 24 2004 from the World Wide Web: http://www.milbank.org/010216fagin.html
- . PAIS dependency system: a validation . Australian Journal of Advanced Nursing . 1990;7(3):24–27
- . The effect of a partnership model on quality and length of stay . Nursing Economics . 1995;13(6):367–372 374
- . Exploring the DRG/nursing equation . American Journal of Nursing . 1985;85(10):1093
- Health Solve Pty Ltd 2004 Health Solve. Retrieved June 15 2004 from the World Wide Web: http://www.healthsolve.com.au/default.htm
- . Nursing workloads: the results of a study of Queensland nurses . Journal of Nursing Management . 2003;11(5):307–314
- . In the wake of cost cutting, nursing productivity and quality improve . Nursing Management . 1988;19(6):36–38 42, 46–8
- . Licensed caregiver characteristics and staffing in California acute care hospital units . Journal of Nursing Administration . 2004;34(3):125
- . Defining and measuring nursing productivity: a concept analysis and pilot study . Journal of Advanced Nursing . 2002;38(4):378–396
- Hovenga EJS 1996 Patient Assessment and Information System (PAIS). Faculty of Informatics and Communication, Central Queensland University, Rockhampton
- International Council of Nurses 2004 Fact Sheet – Nurse: Patient Ratios. Retrieved May 5 2004 from the World Wide Web: http://www.icn.ch/matters_rnptratio.htm
- International Council of Nurses 22nd Quadrennial Congress 2001 Estimating the impact of retirements on nursing supply. O'Brien-Pallas LL, Darlington G, Alksnis C, Denmark
- . The costs of nurse turnover, part 2 . Journal of Nursing Administration . 2004;35(1):41–49
- . Nurse staffing and adverse events following surgery in US hospitals . Image the Journal of Nursing Scholarship . 1998;30(4):315–321
- . Behind the screens: nursing, somology, and the problem of the body . Melbourne: Churchill Livingstone; 1991;
- . Length of stay: significant variables . Journal of Nursing Administration . 1986;16(3):12–20
- . The impact of nursing staff mix models and organizational change strategies on patient, system and nurse outcomes . Toronto.: University of Toronto; 2001;
- . Nurse staffing, care delivery model, and patient care quality . Journal of Nursing Care Quality . 2004;19(1):27–33
- . Maximizing Human Resource Potential, Evidence, Choice and Accountability . Ontario.: Ministry of Health and Long Term Care; 2002;
- . Nurse-staffing levels and the quality of care in hospitals . New England Journal of Medicine . 2002;346(22):1715–1722
- . Hospital restructuring and the work of registered nurses . Milbank Quarterly . 2001;79(1):55–79
- . Management of Nursing Resources Reference Manual: A Business Planning Model . Sydney.: NSW Health; 1998;
- NSW Health 2000 Costs of care: Report of the NSW hospital cost data collection 1998/1999. NSW Health, Sydney.
- . The NSW patient safety and clinical quality program: technical paper . Sydney.: NSW Health; 2004;
- . Who will be there to nurse? Retention of nurses nearing retirement . Journal of Nursing Administration . 2004;34(6):298–302
- . Workforce planning and workplace management . International Nursing Perspective . 2001;1(2–3):55–65
- . Evaluation of a client care delivery model, part 1: variability in nursing utilization in community home nursing . Nursing Economics . 2001;19(6):267
- . Evaluation of a client care delivery model, part 2: variability in client outcomes in community home nursing . Nursing Economics . 2002;20(1):13
- . Measuring nursing workload: understanding the variability . Nursing Economics . 1997;15(4):171–182
- . Minimum effort . Nursing Standard . 2002;16(42):12–13
- . Outcomes monitoring: adjusting for risk factors, severity of illness and complexity of care . Journal of the American Medical Informatics Association . 1995;2(4):243–249
- . NSW Nursing Costing Study . Sydney.: Sydney Metropolitan Teaching Hospitals Consortium; 1993;
- . Business Planning Framework: Nursing Resources . Brisbane.: Queensland Health; 2001;
- . Registered nurse hours worked per patient day: the key to assessing staffing effectiveness and ensuring patient safety . Journal of Nursing Administration . 2004;34(4):167–169
- . Skill-specific staffing intensity and the cost of hospital care . Health Care Management Review . 1997;22(4):61–71
- . Using management data to enhance health care quality . Journal of Management in Medicine . 1995;9(1):
- Royal College of Nursing 2002 Delivering for Scotland: results for nurses in Scotland of the RCN employment survey. London.
- . Minimum staffing ratios: the California workforce initiative survey . Nursing Economics . 2003;21(2):
- . What should we expect from California's minimum nurse staffing legislation? . Journal of Nursing Administration . 2001;31(3):132
- . Nursing-related determinants of 30-day mortality for hospitalized patients . Canadian Journal of Nursing Research . 2002;33(4):71
- Trend Care Systems Pty Ltd 2004 Product Overview. Retrieved June 15 2004 from the World Wide Web: http://www.trendcare.com.au/product_overview.html
- . Benchmarking working time in health care: the case of Excelcare . Australian Health Review . 2002;25(3):134–140
- . Factors affecting nurse staffing in acute care hospitals: a review and critique of the literature . Hyattsville: Division of Nursing, US Dept of Health, Education & Welfare; 1981;
PII: S1322-7696(08)60512-0
doi:10.1016/S1322-7696(08)60512-0
© 2006 Royal College of Nursing, Australia. Published by Elsevier Inc. All rights reserved.
