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Estimation of nursing staff requirement – activity analysis
1. ESTIMATION OF NURSING
STAFF REQUIREMENT –
ACTIVITY ANALYSIS
CHAIRPERSON: DR. K LALITHA
PROFESSOR
DEPT. OF NURSING
PRESENTED BY: Mrs. AMRITA ROY
M.SC NURSING II YR,NIMHANS,BANGALORE
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3. NEED
• Reduce medical and medication errors
• Decrease patient complications
• Decrease mortality
• Improve patient satisfaction
• Reduce nurse fatigue
• Decrease nurse burnout
• Improve nurse retention and job satisfaction
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4. FACTORS INFLUENCING NURSING STAFF
REQUIREMENT
How care is delivered – processes and roles
Where care is provided – setting and specialty
Projected units of service - Nursing workload
Organizational factors - staffing policies and
support systems
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8. METHODS OF ESTIMATION
Hurst’s report (2002)identifies five key
workforce planning methods which appear
most often in the literature as:
– Professional judgment (Telford)
– Nurses per occupied bed (NPOB )
– Patient dependency method
– Timed-task/activity approaches
– Regression-based systems
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9. Professional Judgment
The Telford consultative approach was first
developed in 1979.
This simple method uses professional judgment
to agree the most appropriate size and mix of
ward nursing teams.
It involves the nurse-in-charge assessing the
number of nurses required per shift and from
this calculating the number of working hours
needed per week.
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10. Professional Judgment
The key advantages of this method are its
simplicity and low cost.
It is also quick to use and applies to a range
of specialties.
The main disadvantage of this method is that
it does not explain the link between quality
and staffing levels.
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11. Nurse per occupied bed method
This method uses the bed occupancy to predict
the nurses required.
Its key feature is its ability to adjust nursing
establishments due to ward bed complement
changes.
Staffing and grade mix formulas use data which
is collected systematically (ex: bed occupancy,
payroll).
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12. Nurse per occupied bed method
The major drawbacks are:
– This method relies on the assumption that
baseline staffing has been rationally determined.
– The system is not good when there are patient
dependency changes or a high bed throughput.
– Routinely collected data may be prone to error as
there is no built-in ‘sanity check’.
– The approach does not cater for local variation in
deployment.
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13. Patient dependency method
Dependency can be defined as the
measurement of the intensity of nursing care
required by a patient.
This system regulates the number of nurses on a
shift according to the patients' needs, and not
according to raw patient numbers.
Patients are categorized according to their level
of ‘dependency’.
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14. Patient dependency method
Commonly used patient classification
systems are:
– The safer nursing care tool (SNCT) – developed
by the university college London hospitals
– The AUKUH acuity/dependency tool – developed
by the association of UK university hospitals
– The care dependency scale – developed by
European research group in healthcare
(EURECARE)
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15. Timed-task/activity method
This approach considers the number of variables
which impact on nurses’ time.
Each patient’s daily direct nursing care needs are
recorded from a locally developed checklist of
timed interventions.
An overhead is added to account for indirect
care and breaks are deducted.
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16. Timed-task/activity method
This method is easily computerized and can form part
of a nursing information system - an example of this is
GRASP.
The advantage is that it is based on activity related to
the specific mix of patient needs, rather than
categorizing patients into dependency groups with
fixed parameters.
However this method is time hungry and time spent
on maintenance of detailed care plans may add
considerably to the overall nursing workload.
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17. Regression analysis method
This statistical analysis (based on multiple
regression) approach uses predictors such as
bed occupancy, planned admissions to
forecast number/mix of staff needed.
The method is good for situations where
prediction is possible – for example day
surgery.
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18. Regression analysis method
An example of this is Teamwork (developed by
NW Regional Health Authority in the late 1980s).
It is a quick cost-effective method and is cross-
speciality friendly.
Disadvantages are that it is complex to set up
and its need to employ a professional
statistician.
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22. ACTIVITY/TASK ANALYSIS IN NURSING
• Activity analysis is a way of estimating or
evaluating the size and mix of ward nursing
teams.
• It is especially useful in wards where patient
numbers and mix fluctuate.
• In practice each patient’s direct care nursing
needs for the day are recorded on a locally
developed check list of nursing interventions.
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23. ACTIVITY/TASK ANALYSIS IN NURSING
• There are four main activities:
– The patient’s care plan is completed or updated each
day.
– The total hours for all patients generated by all the
care plans in the ward are aggregated.
– All wards’ nursing hours are collated enabling the
manager to distribute nursing staff equitably.
– Validity checks are done by experienced staff to
ensure consistency in the selection and recording of
nursing interventions.
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24. Table 1. Timed-task/Activity Nursing Interventions
Nursing activity Set Up Maintain
1. Maintaining a safe environment 117 612
2. Physical and psychological comfort 199 571
3. Breathing 51 1592
4. Eating and drinking 35 485
5. Eliminating 95 388
6. Personal cleansing and dressing 240 253
7. Communicating 10 207
8. Controlling body temperature 33 114
9. Mobilizing 16 122
10. Sleeping 30 16
11. Spiritual 20 30
12. Social care 41 20
13. Special needs and requests 40 140
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25. STRENGTHS
Generates results that can be corroborated by
other methods
Easily computerized so that the method becomes
part of a nursing information system.
Commercial systems, such as GRASP, are readily
available.
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26. STRENGTHS
The base information is easily updated by
periodic reviews of nursing interventions.
Adopting the system in other care settings is
possible without destroying its integrity.
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27. DRAWBACKS
• This method is time hungry and time spent
on the preparation and maintenance of
detailed care plans may add considerably to
the overall nursing workload.
• The effort needed to maintain detailed care
plans for each patient in every shift adds
considerably to the ward ‘overhead’.
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28. DRAWBACKS
• Commercial systems are the most expensive of
all the methods described, but are largely capital
rather than recurrent costs.
• Systems are time consuming to set up and
implement.
• The system does not lend itself to application
across a variety of ward settings and does not
accommodate diversity within a ward well.
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29. DATA COLLECTION FOR ACTIVITY
ANALYSIS
• The frequently used tools in activity analysis
are observation flowcharts and checklists.
• emi-structured interview schedule and
focused group interviews are also used.
• One of the tools utilized to record nurse’s
activity was developed by Professor Keith
Hurst.
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30. ACTIVITY ANALYSIS ALGORITHM
Table 2. Activity Method Base Data
Variable Medical ward
No. of wards 83
occupancy 25
Dep 1 19%
Dep 2 42%
Dep 3 28%
Dep 4 11%
Daily minutes
Dep 1 46
Dep 2 106
Dep 3 197
Dep 4 336
Direct care 42%
Meal break 10%
Time out 22%
Grade mix
G/H/I 4%
F 11%
E 21%
D 33%
C 12%
Nursing assistant 19% 30
31. ACTIVITY ANALYSIS IN INDIA
Type of Activity Number of
Activities
Percentage of
Activities
1. basic patient care
2. Complex Patient Care
3. Administration
4. Education
5. Clerical
6. Housekeeping
7. Maintaining Supplies and Equipments
8. Non Productive
83
892
56
1
132
23
32
116
6.2
66.8
4.1
*
9.9
1.7
2.4
8.7
Total 1335 100
Table 3. Number and Percentage Distribution of Activities performed
by staff nurses in a medical ward
Note: * indicates < 0.5%
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33. COMMONLY EMPLOYED METHODS
• According to Royal College of Psychiatrist’s
report, three methods commonly employed
to determine nurse staffing levels within
acute mental health services are:
– Professional judgment
– Patient dependency; and
– Activity analysis
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34. ACTIVITY APPROACH IN MHN
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The list of procedures included:
PROCEDURE STANDARD TIME
Activities of daily living 60 min
Neurological assessment / intervention 60 min
Seating / wheelchair assessment 60 min
Sensory evaluation 60 min
Musculoskeletal assessment / intervention 60 min
Life skills 75 min
Education 45 min
Case conference 90 min
Supportive intervention 60 min
An activity approach adopted by Wright, Scott and Cockerill (1993) :
35. WORKLOAD INDICATORS OF STAFFING
NEED (WISN) METHOD – WHO
• In 1998 the World Health Organization (WHO)
published an approach to adjusting staffing levels to
effect a fair and optimal distribution of staff at health
facilities at all levels, from local to national.
• The WISN method is based on a health worker’s
workload, with activity (time) standards applied for
each workload component.
• The WISN method takes into account differences in
services provided and in complexity of care in
different facilities.
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36. WORKLOAD INDICATORS OF STAFFING
NEED (WISN) METHOD – WHO
Two types of results : differences and ratios are
provided by the WISN method.
– The difference between the actual and calculated
number of health workers shows the level of staff
shortage or surplus for the particular staff category.
– The ratio of the actual to the required number of
staff is a measure of the workload pressure with
which the staff is coping.
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37. WORKLOAD INDICATORS OF STAFFING
NEED (WISN) METHOD – WHO
The advantages of WISN method are:
• Simple to operate, using already collected, available
data
• Simple to use, applicable to staffing decisions at all
health service levels
• Technically acceptable to health service managers
• Comprehensible to non-medical managers
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38. WORKFORCE ESTIMATING SYSTEMS IN
VARIOUS COUNTRIES
COUNTRY WORKFORCE PLANNING SYSTEMS
USA Mandatory nurse to patient ratios
Australia Australia introduced nurse-patient ratios in
December 2000
Scotland Professional judgment is the method of workforce
planning in Scotland.
Belgium In 1987, legislation in Belgium fixed basic staffing
levels for hospital wards.
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39. WORKFORCE ESTIMATING SYSTEMS IN
VARIOUS COUNTRIES
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COUNTRY WORKFORCE PLANNING SYSTEMS
Ireland Patient dependency systems. The most prevalent
system - Criteria for Care.
England • ICU’s / HDU’s – Intensive Care Society’s
Standards 2013
• CCU’s - Safer Nursing Care Tool
• Pediatrics – Royal College of Nursing Skill Mix
• Maternity – Birthrate Plus 2007
40. ESTIMATION OF STAFFING IN INDIA
The Indian nursing council norms:
Chief Nursing Officer : 1 per 500 beds
Nursing Superintendent : 1 per 400 beds or above
D.N.S. : 1 per 300 beds and 1 additional
for every 200 beds
A.N.S. : 1 for 100-150 beds or 3-4 wards
Ward Sister : 1 for 25-30 beds or one ward.
30% leave reserve
Staff Nurse : 1 for 3 beds in Teaching Hospital
in general ward & 1 for 5 beds in
non-teaching Hospital +30% Leave
reserve
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41. ESTIMATION OF STAFFING IN INDIA
For OPD and Emergency : 1 staff nurse for 100 patients
(1:100) + 30% leave reserve
For Intensive Care unit : 1:1 or (1:3 for each shift)
+30% leave reserve.
It is suggested that for 250 bedded hospitals there should be One
Infection Control Nurse (ICN).
For specialised departments, such as Operation Theatre, Labour
Room, etc. 1:25 +30% leave reserve.
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42. 42
COMPARISON OF NORMS OF VARIOUS
COMMITTEES WITH NIMHANS
S.
NO
CATEGORIES BAJAJ
COMMITTEE
HIGH POWER
COMMITTEE
NIMHANS REMARKS
1. NS 1:200 beds 1:200 beds HoD -1 ADEQUATE
2. DNS 1:300 beds 1:300 beds Faculty – 5 ADEQUATE
3. ANS 7:1000 +
1/1000 beds
1:150 WS or
7:1000 beds
17 Nursing
tutors for 973
beds
SURPLUS
4. WARD
SUPERVISOR
8:200 beds +
30% leave
reserve
1:25 beds +
30% leave
reserve
45 ward
supervisors
for 973 beds
ADEQUATE
43. COMPARISON OF NORMS OF VARIOUS
COMMITTEES WITH NIMHANS
43
S.
NO
CATEGORIES BAJAJ
COMMITTEE
HIGH POWER
COMMITTEE
NIMHANS REMARKS
5. STAFF NURSES
FOR OPD
1:100 + 30%
leave reserve
1:100 + 30%
leave reserve
1 WS + 7 SN
(20 bedded)
ADEQUATE
6. STAFF NURSES
FOR ICU
1:1 (1:3 for
each shift) +
30% leave
reserve
1:1 (1:3 for
each shift) +
30% leave
reserve
2 WS + 15 SN
(14 bedded)
ADEQUATE
7. STAFF NURSES
FOR SPECIAL
WARDS
8:200 beds +
30% leave
reserve
1:25 beds +
30% leave
reserve
1 WS+ 12 SN
(60 bedded
closed wards)
ADEQUATE
