estimation of nursing staff requirement – activity analysis
TRANSCRIPT
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ESTIMATION OF NURSING STAFF REQUIREMENT – ACTIVITY ANALYSIS
CHAIRPERSON: DR. K LALITHA PROFESSOR
DEPT. OF NURSING
PRESENTED BY: Mrs. AMRITA ROYM.SC NURSING II YR,NIMHANS,BANGALORE
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ESTIMATION OF NURSING STAFF REQUIREMENT
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NEED
• Reduce medical and medication errors• Decrease patient complications• Decrease mortality• Improve patient satisfaction• Reduce nurse fatigue• Decrease nurse burnout• Improve nurse retention and job satisfaction
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FACTORS INFLUENCING NURSING STAFF REQUIREMENT
How care is delivered – processes and roles
Where care is provided – setting and specialty
Projected units of service - Nursing workload
Organizational factors - staffing policies and support systems
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LEVELS OF ESTIMATION
Workforce modeling
Institutional planning
Daily planning/Rostering
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EFFECTIVE ESTIMATION
Nurse driven staffing committee
Nurse to patient ratios in legislation
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APPROACHES TO ESTIMATION
Top-down planning
Bottom-up planning
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METHODS OF ESTIMATION
Hurst’s report (2002)identifies five key workforce planning methods which appear most often in the literature as: – Professional judgment (Telford) – Nurses per occupied bed (NPOB )– Patient dependency method– Timed-task/activity approaches – Regression-based systems
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Professional Judgment
The Telford consultative approach was first developed in 1979.
This simple method uses professional judgment to agree the most appropriate size and mix of ward nursing teams.
It involves the nurse-in-charge assessing the number of nurses required per shift and from this calculating the number of working hours needed per week.
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Professional Judgment
The key advantages of this method are its simplicity and low cost.
It is also quick to use and applies to a range of specialties.
The main disadvantage of this method is that it does not explain the link between quality and staffing levels.
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Nurse per occupied bed method
This method uses the bed occupancy to predict the nurses required.
Its key feature is its ability to adjust nursing establishments due to ward bed complement changes.
Staffing and grade mix formulas use data which is collected systematically (ex: bed occupancy, payroll).
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Nurse per occupied bed method
The major drawbacks are:– This method relies on the assumption that
baseline staffing has been rationally determined. – The system is not good when there are patient
dependency changes or a high bed throughput.– Routinely collected data may be prone to error as
there is no built-in ‘sanity check’. – The approach does not cater for local variation in
deployment.
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Patient dependency method
Dependency can be defined as the measurement of the intensity of nursing care required by a patient.
This system regulates the number of nurses on a shift according to the patients' needs, and not according to raw patient numbers.
Patients are categorized according to their level of ‘dependency’.
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Patient dependency method
Commonly used patient classification systems are:– The safer nursing care tool (SNCT) – developed by
the university college London hospitals– The AUKUH acuity/dependency tool – developed
by the association of UK university hospitals– The care dependency scale – developed by
European research group in healthcare (EURECARE)
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Timed-task/activity method
This approach considers the number of variables which impact on nurses’ time.
Each patient’s daily direct nursing care needs are recorded from a locally developed checklist of timed interventions.
An overhead is added to account for indirect care and breaks are deducted.
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Timed-task/activity method
This method is easily computerized and can form part of a nursing information system - an example of this is GRASP.
The advantage is that it is based on activity related to the specific mix of patient needs, rather than categorizing patients into dependency groups with fixed parameters.
However this method is time hungry and time spent on maintenance of detailed care plans may add considerably to the overall nursing workload.
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Regression analysis method
This statistical analysis (based on multiple regression) approach uses predictors such as bed occupancy, planned admissions to forecast number/mix of staff needed.
The method is good for situations where prediction is possible – for example day surgery.
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Regression analysis method
An example of this is Teamwork (developed by NW Regional Health Authority in the late 1980s).
It is a quick cost-effective method and is cross-speciality friendly.
Disadvantages are that it is complex to set up and its need to employ a professional statistician.
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ACTIVITY ANALYSIS
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THE FIRST PART OF ACTIVITY ANALYSIS
DATA COLLECTION
ACTIVITY
PERSON
PLACE
ARTIFACT
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THE SECOND PART OF ACTIVITY ANALYSIS
ACTIVITY IMAGE
ACTION OPERATIONS
CONTEXT ACTORS
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ACTIVITY/TASK ANALYSIS IN NURSING
• Activity analysis is a way of estimating or evaluating the size and mix of ward nursing teams.
• It is especially useful in wards where patient numbers and mix fluctuate.
• In practice each patient’s direct care nursing needs for the day are recorded on a locally developed check list of nursing interventions.
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ACTIVITY/TASK ANALYSIS IN NURSING • There are four main activities: – The patient’s care plan is completed or updated each day.
– The total hours for all patients generated by all the care plans in the ward are aggregated.
– All wards’ nursing hours are collated enabling the manager to
distribute nursing staff equitably.
– Validity checks are done by experienced staff to ensure consistency in the selection and recording of nursing interventions.
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Table 1. Timed-task/Activity Nursing Interventions Nursing activity Set Up Maintain
1. Maintaining a safe environment 117 612
2. Physical and psychological comfort 199 571
3. Breathing 51 1592
4. Eating and drinking 35 485
5. Eliminating 95 388
6. Personal cleansing and dressing 240 253
7. Communicating 10 207
8. Controlling body temperature 33 114
9. Mobilizing 16 122
10. Sleeping 30 16
11. Spiritual 20 30
12. Social care 41 20
13. Special needs and requests 40 140
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STRENGTHS
Generates results that can be corroborated by other methods
Easily computerized so that the method becomes part of a nursing information system.
Commercial systems, such as GRASP, are readily available.
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STRENGTHS
The base information is easily updated by periodic reviews of nursing interventions.
Adopting the system in other care settings is possible without destroying its integrity.
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DRAWBACKS
• This method is time hungry and time spent on the preparation and maintenance of detailed care plans may add considerably to the overall nursing workload.
• The effort needed to maintain detailed care plans for each patient in every shift adds considerably to the ward ‘overhead’.
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DRAWBACKS
• Commercial systems are the most expensive of all the methods described, but are largely capital rather than recurrent costs.
• Systems are time consuming to set up and implement.
• The system does not lend itself to application across a variety of ward settings and does not accommodate diversity within a ward well.
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DATA COLLECTION FOR ACTIVITY ANALYSIS
• The frequently used tools in activity analysis are observation flowcharts and checklists.
• emi-structured interview schedule and focused group interviews are also used.
• One of the tools utilized to record nurse’s activity was developed by Professor Keith Hurst.
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ACTIVITY ANALYSIS ALGORITHM Table 2. Activity Method Base Data
Variable Medical wardNo. of wards 83occupancy 25
Dep 1 19%Dep 2 42%Dep 3 28%Dep 4 11%
Daily minutesDep 1 46Dep 2 106Dep 3 197Dep 4 336
Direct care 42%Meal break 10%Time out 22%
Grade mixG/H/I 4%
F 11%E 21%D 33%C 12%
Nursing assistant 19%
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ACTIVITY ANALYSIS IN INDIA
Type of Activity Number ofActivities
Percentage of
Activities1. basic patient care2. Complex Patient Care 3. Administration 4. Education 5. Clerical 6. Housekeeping 7. Maintaining Supplies and Equipments8. Non Productive
83892561
1322332
116
6.266.84.1*
9.91.72.48.7
Total 1335 100
Table 3. Number and Percentage Distribution of Activities performed by staff nurses in a medical ward
Note: * indicates < 0.5%
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ESTIMATION OF STAFFING IN MENTAL HEALTH
SERVICES
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COMMONLY EMPLOYED METHODS
• According to Royal College of Psychiatrist’s report, three methods commonly employed to determine nurse staffing levels within acute mental health services are: – Professional judgment– Patient dependency; and – Activity analysis
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ACTIVITY APPROACH IN MHNThe list of procedures included:
PROCEDURE STANDARD TIME
Activities of daily living 60 minNeurological assessment / intervention 60 minSeating / wheelchair assessment 60 min Sensory evaluation 60 min Musculoskeletal assessment / intervention 60 minLife skills 75 min
Education 45 minCase conference 90 minSupportive intervention 60 min
An activity approach adopted by Wright, Scott and Cockerill (1993) :
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WORKLOAD INDICATORS OF STAFFING NEED (WISN) METHOD – WHO
• In 1998 the World Health Organization (WHO) published an approach to adjusting staffing levels to effect a fair and optimal distribution of staff at health facilities at all levels, from local to national.
• The WISN method is based on a health worker’s workload, with activity (time) standards applied for each workload component.
• The WISN method takes into account differences in services provided and in complexity of care in different facilities.
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WORKLOAD INDICATORS OF STAFFING NEED (WISN) METHOD – WHO
Two types of results : differences and ratios are provided by the WISN method.
– The difference between the actual and calculated number of health workers shows the level of staff shortage or surplus for the particular staff category.
– The ratio of the actual to the required number of staff is a measure of the workload pressure with which the staff is coping.
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WORKLOAD INDICATORS OF STAFFING NEED (WISN) METHOD – WHO
The advantages of WISN method are:
• Simple to operate, using already collected, available data
• Simple to use, applicable to staffing decisions at all health service levels
• Technically acceptable to health service managers
• Comprehensible to non-medical managers
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WORKFORCE ESTIMATING SYSTEMS IN VARIOUS COUNTRIES
COUNTRY WORKFORCE PLANNING SYSTEMSUSA Mandatory nurse to patient ratios
Australia Australia introduced nurse-patient ratios in December 2000
Scotland Professional judgment is the method of workforce planning in Scotland.
Belgium In 1987, legislation in Belgium fixed basic staffing levels for hospital wards.
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WORKFORCE ESTIMATING SYSTEMS IN VARIOUS COUNTRIES
COUNTRY WORKFORCE PLANNING SYSTEMSIreland Patient dependency systems. The most prevalent
system - Criteria for Care.
England • ICU’s / HDU’s – Intensive Care Society’s Standards 2013 • CCU’s - Safer Nursing Care Tool • Pediatrics – Royal College of Nursing Skill Mix• Maternity – Birthrate Plus 2007
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ESTIMATION OF STAFFING IN INDIA
The Indian nursing council norms:
Chief Nursing Officer : 1 per 500 bedsNursing Superintendent : 1 per 400 beds or aboveD.N.S. : 1 per 300 beds and 1 additional for
every 200 bedsA.N.S. : 1 for 100-150 beds or 3-4 wardsWard Sister : 1 for 25-30 beds or one ward. 30%
leave reserveStaff Nurse : 1 for 3 beds in Teaching Hospital
in general ward & 1 for 5 beds in non-teaching Hospital +30% Leave reserve
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ESTIMATION OF STAFFING IN INDIA
For OPD and Emergency : 1 staff nurse for 100 patients (1:100) + 30% leave reserve
For Intensive Care unit : 1:1 or (1:3 for each shift) +30% leave reserve.
It is suggested that for 250 bedded hospitals there should be One Infection Control Nurse (ICN).
For specialised departments, such as Operation Theatre, Labour Room, etc. 1:25 +30% leave reserve.
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COMPARISON OF NORMS OF VARIOUS COMMITTEES WITH NIMHANS
S.NO
CATEGORIES BAJAJ COMMITTEE
HIGH POWER COMMITTEE
NIMHANS REMARKS
1. NS 1:200 beds 1:200 beds HoD -1 ADEQUATE
2. DNS 1:300 beds 1:300 beds Faculty – 5 ADEQUATE
3. ANS 7:1000 + 1/1000 beds
1:150 WS or 7:1000 beds
17 Nursing
tutors for 973
beds
SURPLUS
4. WARD SUPERVISOR
8:200 beds + 30% leave reserve
1:25 beds + 30% leave reserve
45 ward
supervisors
for 973 beds
ADEQUATE
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COMPARISON OF NORMS OF VARIOUS COMMITTEES WITH NIMHANS
S.NO
CATEGORIES BAJAJ COMMITTEE
HIGH POWER COMMITTEE
NIMHANS REMARKS
5. STAFF NURSES FOR OPD
1:100 + 30% leave reserve
1:100 + 30% leave reserve
1 WS + 7 SN(20 bedded)
ADEQUATE
6. STAFF NURSES FOR ICU
1:1 (1:3 for each shift) + 30% leave reserve
1:1 (1:3 for each shift) + 30% leave reserve
2 WS + 15 SN (14 bedded)
ADEQUATE
7. STAFF NURSES FOR SPECIAL WARDS
8:200 beds + 30% leave reserve
1:25 beds + 30% leave reserve
1 WS+ 12 SN(60 bedded closed wards)
ADEQUATE
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