Nursing Workload: Validation of a Professional Approach to Identify Patient Acuity

from Caring For Our Future, Spring 2006

By Karen Montgomery, MSA, RN

A consideration for nursing in today’s economically constrained environment is the relationship between adequate staffing and nursing workload. Acuity systems are developed to assist nurse executives in the allocation of nursing personnel and to control costs. The purpose of this study was to compare The Children’s Hospital patient acuity/workload system with the nursing assessment. It was influenced by Houser’s research in developing a model for evaluating demands on nurses (2003).

The study compared a time-and-motion method, presently used at Children’s, and the nurse’s professional assessment. Acuity systems in current use measure the nursing workload, which then predicts nursing care requirements. Most acuity systems are based on tasks, and do not measure non-direct care or give voice to the caring philosophy of nursing.

This correlation design used a survey method to determine the correlation between the system acuity and professional assessment, and to assess the consistency and consensus between nurses. It was important to consider the rudiments that are not associated with direct patient care and the individual nursing workload. The survey also was used to collect four variables to determine the effect of co-variance; environmental demands, adequate staffing, ability to provide an optimal caring environment and the needs of other caregivers.

How reliable are nurses in rating nursing care intensity for a unit by means of professional assessment? The results from the data collection and statistical analysis achieved the purpose of this study –“just ask the nurse.” In other words, the professional assessment is an efficient and reliable method of predicting patient acuity. This study supports the idea that nurse executives can confidently rely on the nurse’s professional assessment for reliably reporting nursing intensity and for making appropriate staffing decisions to balance patient care needs with cost constraints.

Can a consensus among nurses be reached when rating intensity of nursing workload? The results from the data collection and analysis do not support a consensus among nurses when rating intensity of nursing workload. The data demonstrates that, at times, the nurses’ professional assessment rated nursing workload higher than the charge nurse.

The data on the four key variables were collected to determine the effect of co-variance. The environmental demands, adequate staffing, ability to provide an optimal caring environment, and the needs of other caregivers. The four variables had no effect on the professional assessment’s rating of nursing workload. However, these results can be directly affected by The Children’s Hospital being a magnet status hospital with excellent nurse to patient ratios.

The Surgical/Cardiac unit at Children’s actively practices Jean’s Watson Theory of Caring (1989). This may have influenced the data collected on the survey and demonstrates that these nurses provide an optimal caring environment. The data collected supports the theory that patient acuity, staffing, or environmental demands had no affect on the Surgical/Cardiac nurses in maintaining a caring environment.

One observation prompted an additional test to examine a correlation between the variables. This researcher noticed that when the environmental demands increased, the nurses’ professional assessment was slightly higher than that of the system’s acuity rating. The data analysis demonstrated a significant interaction between the professional assessment and the increased environmental demands. This demonstrates that an acuity system based on tasks fails to capture the true nature of nursing workload and does not account for the non-direct aspects of nursing care or the environmental demands.

This study sought to give voice to the profession of nursing, and to provide a new method supported by evidence-based research that is more representative of nursing and the idea of caring from the perspective of caring science, rather than that of traditional time studies. This research validates a new approach in measuring nursing workload and identifying patient acuity.

References

Houser, J. (2003). A Model for Evaluating the Context of Nursing Care Delivery. Journal of Nursing Administration, 33 (1), 39-47.

Watson, J. & Foster, R. (2003). The Attending Nurse Caring Model: integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice.