Assessment of nursing management and utilization of nursing resources with the RAFAELA patient classification system--case study from the general wards of one central hospital.
BACKGROUND
RAFAELA is a new Finnish PCS, which is used in several University Hospitals and Central Hospitals and has aroused considerable interest in hospitals in Europe.


OBJECTIVE
The aim of the research is firstly to assess the feasibility of the RAFAELA Patient Classification System (PCS) in nursing staff management and, secondly, whether it can be seen as the transferring of nursing resources between wards according to the information received from nursing care intensity classification.


METHODS
The material was received from the Central Hospital's 12 general wards between 2000 and 2001. The RAFAELA PCS consists of three different measures: a system measuring patient care intensity, a system recording daily nursing resources, and a system measuring the optimal nursing care intensity/nurse situation. The data were analysed in proportion to the labour costs of nursing work and, from that, we calculated the employer's loss (a situation below the optimal level) and savings (a situation above the optimal level) per ward as both costs and the number of nurses.


RESULTS
In 2000 the wards had on average 77 days below the optimal level and 106 days above it. In 2001 the wards had on average 71 days below the optimal level and 129 above it. Converting all these days to monetary and personnel resources the employer lost 307,745 or 9.84 nurses and saved 369,080 or 11.80 nurses in total in 2000. In 2001 the employer lost in total 242,143 or 7.58 nurses and saved 457,615 or 14.32 nurses. During the time period of the research nursing resources seemed not have been transferred between wards.


CONCLUSIONS
RAFAELA PCS is applicable to the allocation of nursing resources but its possibilities have not been entirely used in the researched hospital. The management of nursing work should actively use the information received in nursing care intensity classification and plan and implement the transferring of nursing resources in order to ensure the quality of patient care.


CONCLUSIONS
Information on which units resources should be allocated to is needed in the planning of staff resources of the whole hospital. More resources do not solve the managerial problem of the right allocation of resources. If resources are placed wrongly, the problems of daily staff management and cost control continue.
Rainio
Anna-Kaisa
AK
Development Manager, Vasa Central Hospital, Vasa, Finland. anna-kaisa.rainio@vshp.fi
Ohinmaa
Arto E
AE
D000203:Activities of Daily Living; D019985:Benchmarking; D017046:Cost Savings; D003953:Diagnosis-Related Groups / Q000145:classification*; D004180:Direct Service Costs / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D005240:Feasibility Studies; D005387:Finland; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006751:Hospital Information Systems / Q000458:organization & administration; D006801:Humans; D007297:Inpatients / Q000145:classification*; D016294:Models, Nursing; D017146:Models, Organizational; D024802:Nurse's Role; D015401:Nursing Administration Research; D009730:Nursing Assessment / Q000379:methods; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D010562:Personnel Staffing and Scheduling Information Systems / Q000458:organization & administration*; D012456:Salaries and Fringe Benefits / Q000191:economics; D016526:Workload / Q000145:classification*