Barriers against required nurse estimation models applying in Iran hospitals from health system experts' point of view.
BACKGROUND
One of the strategies for accessing effective nursing care is to design and implement a nursing estimation model. The purpose of this research was to determine barriers in applying models or norms for estimating the size of a hospital's nursing team.


METHODS
This study was conducted from November 2015 to March 2016 among three levels of managers at the Ministry of Health, medical universities, and hospitals in Iran. We carried out a qualitative study using a Colaizzi method. We used semistructured and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in the area of policymaking in human resources in the Ministry of Health, 10 decision makers in employment and distribution of human resources in treatment and administrative chancellors of Medical Universities, and 12 nursing managers in hospitals). The data were analyzed by Atlas.ti software version 6.0.15.


RESULTS
The following 14 subthemes emerged from data analysis: Lack of specific steward, weakness in attracting stakeholder contributions, lack of authorities trust to the models, lack of mutual interests between stakeholders, shortage of nurses, financial deficit, non-native models, designing models by people unfamiliar with nursing process, lack of attention to the nature of work in each ward, lack of attention to hospital classification, lack of transparency in defining models, reduced nurses available time, increased indirect activity of nurses, and outdated norms. The main themes were inappropriate planning and policymaking in high levels, resource constraints, and poor design of models and lack of updating the model.


CONCLUSIONS
The results of present study indicate that many barriers exist in applying models for estimating the size of a hospital's nursing team. Therefore, for designing an appropriate nursing staff estimation model and implementing it, in addition to considering the present barriers, identifying the norm required features may positively impact on norm acceptance and implementation.
Ph.D. Candidate, Department of Health Management, Policy & Economics, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Seyed Saeed
SS
Tabatabaee
Professor, Environmental Health Engineering Research Center, Health Services Management Department, Kerman University of Medical Sciences, Kerman, Iran.
Mahmood
M
Nekoie-Moghadam
Associate Professor, Health Sciences Research Center, Department of Health Management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Ali
A
Vafaee-Najar
Associate Professor, Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Mohammad Reza
MR
Amiresmaili
Hospital; Model; Nurse; Qualitative Research