Nursing & Midwifery Workload and Workforce Planning Approaches to Workload Measurement

Workload Measurement a complex area of professional activity time and effort invested in developing and refining methods of estimating the ‘right’ number of nurses methods will calculate number of nursing hours required expressed as whole time equivalent (WTE) no single ‘right’ way - need to use more than one method workload tools valuable aid to decision making about staffing

Determining what data to collect managers at different levels require data at different levels of detail at ward level require detailed data to inform staff deployment, e.g. number of nurses required to cover the workload by W.T.E. and skill mix NHS organisations require aggregate data to compare: nursing workload across specialties in the same specialties between hospitals for the same case mix type between hospitals community workload in different localities

Uses for Workload Data historical workload data can be used for: short-term planning, e.g. rostering long-term planning, e.g. establishment setting and skill mix retrospective analysis and audit purposes practical and operational decisions about patient care, e.g: how many staff do I need? what skills are needed to provide effective nursing care? what staff should be doing what? how do I ensure workload is equitably distributed?

Nursing Activity direct workload - that which is directly associated with a specific patient; indirect workload - where it may be patient related but either not specifically to a named patient, or not directly involving the patient; and associated work - where workload is not patient related at all.

Consider the following: Nurses spend 31-44% of their time in direct patient care activities Nurses experience an average 8.4 interruptions to or failure of work system per 8 hour shift medications, orders, supplies, staffing, equipment Nurses spend 42 minutes of each shift resolving operational failures ( Tucker and Spear 2006) Think about your own, or someone else’s area of practice and the activities identified in learning activities 2 and 3: (You may also want to consider any Releasing Time to Care information you have) What activities are carried out that do not add value to patient care? Consider ways to shift the balance of work so that more time is spent on direct patient care, without employing more staff Think about staff you have and how you might deploy them in a different or better way

Workload Measurement Systems ‘Top-down’ approaches norms and formulae using expert opinion ‘Bottom-up’ approaches professional judgement (Telford) approach nurses per occupied bed dependency-activity-quality (Acuity-quality) timed-task/activity approaches regression-based systems population benchmarking database

Workload Measurement Approach used in NHSScotland The NHSScotland triangulated approach means that you have three sets of indicators on which to base your judgements. These are obtained form three sources: outcome of two workload measurement tools (professional judgement and specific for your area – e.g. adult acute) present funded establishment data (agreed staffing establishment and skill mix, available from your line manager) clinical quality indicator evidence – SCN review

Workload Measurement Approach used in NHSScotland Specific tool Professional judgement Funded and actual establishment Local context Quality Local context includes: integrated workforce planning skills base speciality mix model of care