Predicting the effect of nurse–patient ratio on nurse workload and care quality using discrete event simulation

Abstract

Aim A novel nurse‐focused discrete event simulation modelling approach was tested to predict nurse workload and care quality. Background It can be challenging for hospital managers to quantify the impact of changing operational policy and technical design such as nurse–patient ratios on nurse workload and care quality. Planning tools are needed—discrete event simulation is a potential solution. Method Using discrete event simulation, a demonstrator “Simulated Care Delivery Unit” model was created to predict the effects of varying nurse–patient ratios. Modelling inputs included the following: patient care data (GRASP systems data), inpatient unit floor plan and operating logic. Model outputs included the following: nurse workload in terms of task‐in‐queue, cumulative distance walked and Care quality in terms of task in queue time, missed care. Results The model demonstrated that as NPR increases, care quality deteriorated (120% missed care; 20% task‐in‐queue time) and nursing workload increased (120% task‐in‐queue; 110% cumulative walking distance). Conclusions DES has the potential to be used to inform operational policy and technical design decisions, in terms of impacts on nurse workload and care quality. Implications for Nursing Management This research offers the ability to quantify the impacts of proposed policy changes and technical design decisions, and provide a more cost‐effective and safe alternative to the current trial and error methodologies.

Patient–Nurse Ratio is Related to Nurses’ Intention to Leave Their Job through Mediating Factors of Burnout and Job Dissatisfaction

“…Given that direct labor costs are the major budget items, hospitals face the dilemma between reducing or limiting direct labor costs and providing better care quality [1]. Although some hospitals reduce nurse staffing to minimize cost, nurse staffing has been reported to be influential not only in hospitalized patients’ prognoses and safety [2,3,4] but also in hospitals’ financial performance [5].…”

“…Although some hospitals reduce nurse staffing to minimize cost, nurse staffing has been reported to be influential not only in hospitalized patients’ prognoses and safety [2,3,4] but also in hospitals’ financial performance [5]. Furthermore, studies show that hospitals with better nurse staffing can alleviate nurses’ workload [1,6], attract nurses to practice [7], and diminish workplace injury and illness rates [8]. When experiencing the predicament of a nursing shortage, following the lead of the state of Victoria in Australia, many governments have made legislations for nurse staffing [9,10,11,12].…”

Factors That Influence Nurse Staffing Levels in Acute Care Hospital Settings

“…In a multicenter study in California, a better work environment lowered the odds of administration of the wrong medication by 45%, followed by 39% for pressure ulcer occurrence and 32% for falls with injury (Cho et al, 2016). Therefore, adjusting the NSL would enable efficient nursing human resources management, thus reducing morbidity rate, mortality rate, and hospital stays, while generating much higher cost effectiveness (Ma et al, 2015; Qureshi, Purdy, Mohani, & Neumann, 2019)…”

Developing an Approach to Quantify Nurse Workload and Quality of Care Using Discrete Event Simulation

“…Since 75% of the care delivered in hospital settings are by nurses (Nursing Task Force, 1999), this thesis simulated the healthcare unit system from the perspective of nurses. This new perspective offers a novel insight as most studies have been limited to physicians and doctors (Qureshi, Purdy, Mohani, & Neumann, 2019) The process of care consists of cognitive, social/behavioural and physical performance components of care processes. For instance, the process to administer medication that encompasses several steps and involves multiple departments.…”