Defining adequacy of staffing in general hospital wards: a Delphi study

Abstract

ObjectivesTo gain consensus on the items that determine adequacy of shift staffing.DesignThis was a three-round Delphi study to establish consensus on what defines adequacy of shift staffing in a general hospital ward. A literature review, focus group and five semistructured expert interviews were used to generate items for the Delphi study.SettingMulticentre study in The Netherlands.ParticipantsNurses, head nurses, nursing managers, and capacity consultants and managers working for Dutch hospitals.ResultsTwenty-six items were included in the Delphi study. One hundred and sixty-eight, 123 and 93 participants were included in the first, second and third round, respectively. After three rounds, six items were included (mostly related to direct patient care) and nine items were excluded. No consensus was reached on 12 items, including one item that was added after the first round.ConclusionsThis is the first study to specify items that determine adequacy of staffing. These items can be used to measure adequacy of staffing, which is crucial for enhancing nurse staffing methods. Further research is needed to refine the items of staffing adequacy and to further develop and psychometrically test an instrument for measuring staffing adequacy.

The Nurse Perceived Adequacy of Staffing Scale for general hospital wards: A development and psychometric validation study

“…Of the 27 items entered in the Delphi study, six were relevant to adequacy of staffing, nine were not relevant, and 12 were unsure. These results have been published elsewhere ( van der Mark et al., 2022 ). In two nurse focus groups, the unsure items of adequacy of staffing were discussed in depth.…”

“…A possible explanation of the difference between these groups is that less experienced nurses feel less confident to deliberately deviate from protocol or guidelines because of possible consequences on safety and quality of care delivery ( McNab et al., 2016 ; Allen, 2007 ). Removing the item from the measurement instrument would reduce the content validity; experts agreed on inclusion of this item in defining staffing adequacy most ( van der Mark et al., 2022 ). The DIF on the item also had a negligible impact on the total score, so we retained the item in the NPASS item bank.…”

“…In response to the deficiencies outlined above, we aimed to develop a valid and reliable PAS instrument. We previously defined adequacy of shift staffing by identifying the items involved ( van der Mark et al., 2022 ). In the present study, we used these items to develop an instrument to measure nurses’ PAS and explore the psychometrical validity and reliability of this instrument.…”

Comparação entre sistemas de classificação de pacientes para o dimensionamento do pessoal de enfermagem

“…Estudo multicêntrico realizado na Holanda identificou que seis itens determinam a adequação do quadro de pessoal, sendo o enfermeiro capaz de: completar as atividades de cuidado, prestar cuidados de acordo com protocolo ou diretriz, preparar a alta com o paciente e familiares, educar o paciente, poder fazer pausas e orientar estudantes de enfermagem (22) . Sendo assim, torna--se necessário refletir que o estudo ora descrito foi realizado em um hospital universitário que conta com diversos estudantes, de graduação e pós-graduação, supervisionados pelos enfermeiros, uma atividade não contemplada em nenhum dos SCP utilizados.…”

Contextually appropriate nurse staffing models: a realist review protocol

“…This makes decisions about nurse staffing one of the most critical decisions for health system managers and policymakers. Providing safe and efficient healthcare relies on effective and economical nurse staffing, yet within modern health systems, decision-makers, researchers and nurses struggle to agree on what that means and looks like 3 11. The current state of evidence gives no clear direction on how to make decisions about appropriate nurse staffing levels, including staff/skill mix, which is broadly defined as the combination or grouping of different categories of healthcare workers employed to provide care to clients 12.…”