Workforce and workload: Are nursing resources used effectively?

Abstract

This paper describes key findings and implications from analyses of activity and workload of nurses of different grades and support workers based on data collected using Nursing Information Systems for Change Management (NISCM). 'Activity' refers to the amount of time on a shift spent on different tasks, and 'workload' refers to the number of patients in a variety of wards by demand/dependency group. The activity evidence is based on data from 5,208 staff recording their activity in 535 shift blocks in 19 hospitals and the workload evidence is based on data from 38,585 shifts across 90 wards in 17 hospitals. Four of the seven main findings have been selected for presentation here: variations, division of labour, skill-mix issues and flexibility. The findings show that there appears to be substantial systematic variation between hospitals in the grade mix of nursing staff and that there is little difference in the types of task undertaken by different grades of staff. As overall staffing increases, there is little increased specialization between staff groups and little flexibility in the deployment of nursing staff according to patient demand. The overall aim of the paper is to promote discussion relating to the development of appropriate and relevant strategies for changing skill-mixes in hospitals.

Defining and identifying common elements of and contextual influences on the roles of support workers in health and social care: a thematic analysis of the literature

“…There is also evidence that practitioner roles are highly context specific [16]. Given the same title or grade, a nurse in one setting may carry out different roles and duties to those in a different setting [17].…”

Health care managers’ perspectives on new nursing and midwifery roles: perceived impact on patient care and cost effectiveness

“…Such changes are also occurring in healthcare systems throughout the world (Ross 1999, Chang & Wong 2001, Nkowane & Saxena 2004, Schober & Affara 2006. The global ageing population, worldwide shortages of staff, the increase in chronic disease, the growth of day surgery, the expansion of primary care and the continued reduction on the length of hospital stay all contribute to changing patterns of health care need and demand (Read et al 2001, Jenkins-Clarke & Carr-Hill 2003. In the UK, the development of these roles has been influenced by a number of other background factors.…”

Changing Territories of Health Care Professionals in Primary Care

“…Despite efforts to define nursing as a specific field, however, there is growing overlap in functions and activities of physicians, nurses and other NPCs [37]. Regardless of their level of education or experience, a study of nursing in the U.K. found that the different nursing groups regularly engage in the same range of direct and indirect nursing care [38]. In fact, the blurring borderlines between professional territories imply convergence of the "medical paradigm" and "nursing paradigm" and illustrate lack of agreement over the proper skill mix.…”