title: A nursing care classification system for assessing workload and determining optimal nurse staffing in a teaching hospital in China: A pre-post intervention study.
abstract: We aimed to evaluate the effectiveness of a nursing care classification system for re-assessing nurse workload and determining staffing needs. Adequate bed-nurse ratios help manage hospital cost-efficiency, quality of care and patient safety. A prospective pre-post intervention study was conducted from January 2010 to December 2012 in 16 medical-surgical units of a tertiary teaching hospital. Nursing tasks were classified into four grades of care reflecting actual workload. Units were re-staffed accordingly and bed-nurse ratios compared with government-authorized bed-nurse ratios. Patient satisfaction, hospital stays and mortality were evaluated pre- and poststaffing changes. Average bed-nurse ratio (1:0.41) exceeded the national standard (1:0.40) in 16 units, but was inadequate in five units. Re-staffing increased average bed-nurse ratio from 1:0.41 to 1:0.48. Patients' satisfaction increased from 96.9% to 97.6%, and hospital stays decreased significantly. Nursing care classification effectively distributes nurse staffing to match patients' care levels, improving patient outcomes.
authors.affiliation: Nursing Department, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Yu
authors.affiliation: Department of Health Administration, Faculty of Health Service, Second Military Medical University, Shanghai, China.
authors.forename: Yuqin
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Physics and Mathematics, College of Basic Medical Sciences, Second Military Medical University, Shanghai, China.
authors.forename: Qingwen
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Nursing Department, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Gendi
authors.initials: G
authors.lastname: Lu
authors.affiliation: Department of Health Administration, Faculty of Health Service, Second Military Medical University, Shanghai, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Xu
mesh_terms: D002681:China; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D061214:Patient Safety; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D011787:Quality of Health Care; D016526:Workload / Q000145:classification*
keywords: classification system; medical-surgical unit; nurse; patient outcomes; staffing; workload assessment