Nursing & Midwifery Workload and Workforce Planning

1. Nursing & Midwifery Workload and Workforce Planning Approaches to Workload Measurement

2. Workload Measurement • a complex area of professional activity • time and effort invested in developing and refining methods of estimating the ‘right’ number of nurses • methods will calculate number of nursing hours required expressed as whole time equivalent (WTE) • no single ‘right’ way - need to use more than one method • workload tools valuable aid to decision making about staffing

3. Determining what data to collect • managers at different levels require data at different levels of detail • at ward level require detailed data to inform staff deployment, e.g. number of nurses required to cover the workload by W.T.E. and skill mix • NHS organisations require aggregate data to compare: • nursing workload across specialties • in the same specialties between hospitals • for the same case mix type between hospitals • community workload in different localities

4. Uses for Workload Data • historical workload data can be used for: • short-term planning, e.g. rostering • long-term planning, e.g. establishment setting and skill mix • retrospective analysis and audit purposes • practical and operational decisions about patient care, e.g: • how many staff do I need? • what skills are needed to provide effective nursing care? • what staff should be doing what? • how do I ensure workload is equitably distributed?

5. Nursing Activity • direct workload - that which is directly associated with a specific patient; • indirect workload - where it may be patient related but either not specifically to a named patient, or not directly involving the patient; and • associated work - where workload is not patient related at all.

6. Consider the following: • Nurses spend 31-44% of their time in direct patient care activities • Nurses experience an average 8.4 interruptions to or failure of work system per 8 hour shift • medications, orders, supplies, staffing, equipment • Nurses spend 42 minutes of each shift resolving operational failures ( Tucker and Spear 2006) • Think about your own, or someone else’s area of practice and the activities identified in learning activities 2 and 3: (You may also want to consider any Releasing Time to Care information you have) • What activities are carried out that do not add value to patient care? • Consider ways to shift the balance of work so that more time is spent on direct patient care, without employing more staff • Think about staff you have and how you might deploy them in a different or better way

7. Workload Measurement Systems • ‘Top-down’ approaches • norms and formulae • using expert opinion • ‘Bottom-up’ approaches • professional judgement (Telford) approach • nurses per occupied bed • dependency-activity-quality (Acuity-quality) • timed-task/activity approaches • regression-based systems • population benchmarking database

8. Workload Measurement Approach used in NHSScotland • The NHSScotland triangulated approach means that you have three sets of indicators on which to base your judgements. • These are obtained form three sources: • outcome of two workload measurement tools (professional judgement and specific for your area – e.g. adult acute) • present funded establishment data (agreed staffing establishment and skill mix, available from your line manager) • clinical quality indicator evidence – SCN review

9. Workload Measurement Approach used in NHSScotland • Local context includes: • integrated workforce planning • skills base • speciality mix • model of care