title: Value-added care: a new way of assessing nursing staffing ratios and workload variability.
abstract: OBJECTIVE
  To thoroughly understand the implications of California regulatory staffing ratios on nursing units, the present study examines the relative amounts of time allocated to workload activities among registered nurses.
  
  
  BACKGROUND
  Nursing is a synergistic, intuitive process and may not be capable of being translated into minimum patient-to-nurse ratios that work across an entire region or state. A fundamental step in evaluating the appropriateness of prescribed ratios lies in assessing how registered nurses spend their time while caring for patients. Once workload intensity is assessed, additional factors can be identified to design mandated staffing levels for acute care settings.
  
  
  METHODS
  Variability in workload intensity was assessed using the Robert Woods Johnson Foundation "Transforming Care at the Bedside" work flow methodology approach in evaluating value-added care and assessing the amount of time nurses spent on direct care and other categorical activities.
  
  
  RESULTS
  The results revealed a marked variation in the medical-surgical unit compared with the 2 telemetry units regarding the amount of time spent by registered nurses on value-added, necessary, and non-value-added activities, as well as variability in the amount of time that registered nurses spent on direct care, indirect care, documentation, waste, and other activities.
  
  
  CONCLUSIONS
  By evaluating patient quality of care in acute care settings, we can return to a basic aspect of how nurses spend their time caring for patients-the activities that not only involve direct care but also benefit the patient.
authors.affiliation: UCLA School of Nursing, Nursing Administration Graduate Program, Los Angeles, USA. upeniekshealthservicesconsulting.com
authors.forename: Valda V
authors.initials: VV
authors.lastname: Upenieks
authors.forename: Jaleh
authors.initials: J
authors.lastname: Akhavan
authors.forename: Jenny
authors.initials: J
authors.lastname: Kotlerman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Esser
authors.forename: Myha J
authors.initials: MJ
authors.lastname: Ngo
mesh_terms: D002140:California; D004526:Efficiency; D006801:Humans; D009740:Nursing Staff / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence; D017064:Process Assessment, Health Care; D013647:Task Performance and Analysis; D016526:Workload