A review of workload measures: a context for a new staffing methodology in Western Australia

Abstract

Objectives: This paper critically reviews various approaches to measuring nursing workload to provide a context for the introduction of a different approach to staffing. Nurse hours per patient day (NHPPD), which classifies wards into various groupings, was applied to all public hospitals in Western Australia.

Results: This method was introduced in response to industrial imperatives to determine reasonable workloads for nurses. As a result, the limited evaluation has focused only on the impact on workload management; reporting target versus actual nurse hours, staff retention and nurse feedback. This method improved ward staffing significantly without imposing restrictive nurse-to-patient ratios and facilitates the use of professional discretion within ward groupings to enable diversion of resources to match reported acuity changes.

Conclusion: While successful in attracting nurses back into hospitals and increasing nursing numbers, there is no empirical evidence of the impact this method had on patient outcomes or whether the guiding principles used in the development of this method are appropriate. The model would also benefit from further refinement to be more sensitive to direct acuity measures.