The most-commonly used systems were well understood by senior managers and team leaders, but less so by clinical staff. Workload pressures Factors noted as creating extra workload pressures included 'patient and public expectations', 'provision of mentoring' and 'teaching of student nurses'. Eleven of the 18 had used one within the past year, but four had last used one more than two years ago and two did not know when one had last been used. There are few validated dependency scores, and none have been developed to look at the dependency in an aetiologically heterogeneous group of patients with a wide range of liver disease severity. In the main, they were not interested in using 'Based on Historical Budgets' Figure 4.
Seven respondents reported that the system was formally recognised by their organisation, but only two stated that the recommended staffing levels had been fully implemented. On revision of the pilot score, other variables were considered that may help distinguish patients from each other by looking both at dependency and disease severity. Similarly, when using ranges for each parameter, there is also a difference despite the same score being recorded. Patient dependency and classification systems as well as patient dependency scoring systems for severity of illness are measures indicating mortality and morbidity although Adomat points out that these dependency measure may not be real indicators or determinants of the nurse-patient ratio that help in measuring nursing input. Descriptive comments on the nature of the protected time ranged from 'one day a month', through 'varies depending on workload', to 'time allocated for meetings and appraisals'. The contribution each item made to the total score was reviewed to see whether any items were redundant.
Setting: A maternity unit of a university-affiliated tertiary referral hospital. Details were sought of the allowance, and comments included: 'built into the establishment'; 'expectation that this will be done within normal working hours - time management key factor'; and 'one hour at beginning and end of day but can be lost if work pressures demand'. As well as providing a practical audit tool, it may be useful in deciding which patients to refer for tertiary care, although this is an application that has yet to be tested rigorously. For copies of the instruments and computer programme please contact. The practices least used included annualised hours, staff pool and zero hours contracts.
Four advised that a workforce planning system or strategy was proposed, and two organisations reported plans to recruit workforce personnel to support this. The Patient Intensity for Nursing Index: a validity assessment. Even when resources are concentrated within designated paediatric units, morbidity, length of stay and mortality may vary considerably over time within and between units. The systems were used mainly by charge nurses, senior managers and senior paediatric nurses, and less by human resources staff. Nursing workload and workforce planning systems Most familiar tools The most familiar tools were 'Based on Historical Budgets', 'National Recommendations', 'Nurse per Occupied Bed' and 'Telford or similar'. Hospital ward layout and nurse staffing. Adverse events in a paediatric intensive care unit: relationship to workload, skill mix and staff supervision.
Respondents were asked to provide details of what they felt was the minimum allowance for caseload management and planning for each professional group listed. Location of use is shown in Table 4. The practices most-commonly used 'frequently' most weeks in at least some areas were 'change duty roster' and 'bank'. Relationships between patient dependency, nursing workload and quality. Adomat and Hewison evaluate the three main assessment systems used in critical care units to effectively determine the necessary nurse-patient ratio that can provide the best quality service in the wards.
Any changes in the overall dependency are able to be identified and the information gained will help to form the basis of the staffing levels required to manage the care of the residents. As we have already suggested through a study by Adomat and Hicks, patients in high dependency units may require more frequent nursing care and higher nurse-patient ratios than critical care units where patients may be supported by artificial methods. The Cronbach's α for the total score was 0. One indicated that they were human resource staff, but provided no details of whole time equivalents. Three reported using the data generated from patient dependency scoring systems to inform workload and workforce planning and a further four used this 'sometimes'.
Tools currently used Within early care, day care, ante-natal, post-natal, intrapartum care and community settings, 'Based on Historical Budgets' was the most-commonly used system. Most interested in using The tools respondents were most interested in using were 'National Recommendations', 'Acuity Quality Method', 'Nurse per Occupied Bed' and 'Telford or similar'. Systems were used mainly to estimate required new nursing establishments and to review establishments in light of changes within a catchment area. The systems or tools used for patient classification and categorization were developed solely for the purpose of more efficient distribution of patient across hospital sections, although now the same systems are used for workforce planning, distribution of workload, determining nurse-patient ratio in critical care settings. The systems were understood mostly by senior midwives and senior managers, but appeared to be understood less by midwives.
Second, the extremely ill patients required a significant amount of blood product support blood, platelets, fresh frozen plasma and cryoprecipitate. Although the optimum staffing ratio for patients is unknown for such units, the Department of Health and Intensive Care Society recommend a level of one nurse for every two patients. Of the 15 who provided details of an allowance, all of whom reported 20% predictable absence allowance, 12 reported that it was fully funded and three partially funded 'eroded due to changes in complexity'; '17 of 20% with major review under way'; 'variable funded allowance average 12%'. Eight of the systems were formally recognised by the relevant organisation and five reported that the recommendations had been fully implemented. All purchased items can be downloaded from this area. This will always be the case when trying to use 1 score for all, and any generally applied system suffers from this.
Tools currently used Within all the clinical specialties listed and under the 'other' category, the most-commonly used system was 'Based on Historical Budgets', with 'Telford' the second ranking system in adult acute admissions, elderly acute admissions, adult continuing care, elderly continuing care, and intensive psychiatric care. Two more were planning to use a new quality rating scale in the near future. Staffing requirements for Level 1 patients were calculated by a number of methods, the most common of which was to use a nurse to patient ratio of 1:1 or 1:2. The flexible working practices most-commonly used 'routinely' every week were 'bank' and 'extra basic hours'. Second most-commonly used tools excluding 'Based on Historical Budgets' Respondents were also asked to list the second most-commonly used tool Table 4.
This assumption however has been refuted by studies which shows that such clear criteria may not be sufficient for nurse management and staffing level decisions and other factors have to be considered. All reported that senior managers were accountable for the tools, in conjunction with charge nurses, senior paediatric nurses and Directors of Nursing. Two of the remaining three cited 'still under review' and 'financial constraints' as reasons for non-implementation. There was less clarity on whether the system detailed an establishment which met the needs of the clinical area, with seven either reporting uncertainty or disagreement with this statement. The authors suggest actions for nurse administrators and researchers who must address frequent queries as to the adequacy of nursing staffing. Five of the items encephalopathy, plasma sodium, intravenous glucose requirement, varices and organ dysfunction were nondiscriminative, contributing only 9% to the total score.