Measuring nursing workload in neonatal intensive care.
OBJECTIVE
To determine if a suitable method of measuring nursing workload could be developed in neonatal intensive care units (NICUs).


BACKGROUND
Nursing is a multifunctioning activity and previous methods measuring the demand for nurses do not put enough emphasis on the individual capabilities. The reporting of NICU activity has traditionally been related to bed occupancy and the number of infants requiring ventilator support. A classification system based on activity, hours of care and nursing staff ratios has been used; however, it does not consider the clinical ability of the individual nurses.


METHODS
A 5-month prospective study was undertaken in which nurses in two NICUs scored their patients' level of dependency and professional assessment of the level of intensity of care required by the infants in each shift. In addition, serial measures of severity of illness scores for each patient were collected.


RESULTS
The study identified methods of measuring workload that consider the individual nurse's ability and contributing organizational factors. We found that the estimates of nursing hours using the two traditional dependency measures did not match the current practice or take into account the skill of the nurses. A method in which the nurses indicated the intensity of nursing care required by their patients was suitable one for capturing their individual capabilities. System factors were also found to contribute to the nursing workload.


CONCLUSIONS
It is not sufficient to use patient acuity or severity of illness alone. Other factors such as the nurse's assessment of the intensity of care required and the organizational factors are important components of workload estimates.
Spence
Kaye
K
The Children's Hospital at Westmead, Sydney, Australia, The University of Melbourne, Australia. kaye@chw.edu.au
Tarnow-Mordi
William
W
Duncan
Glen
G
Jayasuryia
Nelun
N
Elliott
Jenny
J
King
Jenny
J
Kite
Fiona
F
D000203:Activities of Daily Living; D001291:Attitude of Health Personnel; D001509:Bed Occupancy / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000592:standards; D003299:Cooperative Behavior; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration; D015931:Intensive Care, Neonatal / Q000458:organization & administration* / Q000523:psychology; D007400:Interprofessional Relations; D017283:Neonatal Nursing / Q000458:organization & administration*; D024802:Nurse's Role / Q000523:psychology; D015401:Nursing Administration Research / Q000379:methods* / Q000592:standards; D009730:Nursing Assessment; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000523:psychology; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011446:Prospective Studies; D012720:Severity of Illness Index; D013597:Systems Analysis; D013996:Time and Motion Studies; D016526:Workload / Q000523:psychology / Q000706:statistics & numerical data*