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Keith Hurst and colleagues describe how they devised a method for calculating the number of nurses needed to care for different patients with different levels of dependency
NURSES CAN USE a bewildering array of tools to assess staffing requirements by calculating patient numbers and the amounts of care that patients need.
Healthcare practitioners have criticised these tools for being too time-consuming to use, however, and have relied instead on their professional judgement, justifying requests for extra staff on the grounds that wards are 'heavy' or that staffing levels seem unsafe.
This article describes a major nurse staffing study, recently completed in the UK, which aimed to overcome weaknesses in patient classification and nursing workload assessment, by developing an easy-touse method.
It describes why and how this method was developed, with reference to two workload assessment instruments, and how it can be used to calculate the number of nurses needed to care for different, specific numbers of patients with different levels of dependency.
The result is an efficient and effective way of creating a simple nurse staffing assessment system that has been received enthusiastically by health service staff, and saved several thousand pounds in unnecessary research and development.
Development of multipliers
A project group was set up to build on the Association of UK University Hospitals (AUKUH) ward staffing 'multipliers', which are workload-based, nurse-topatient ratios. Because these multipliers are calculated using professional judgement, it was decided that they needed strengthening empirically and validating independently.
Without such development, there was a risk that they could not be used to classify patients according to their demand for nursing care, which would lead to inappropriate ward staffing recommendations.
It was also hard to tell if the original multipliers generated good or poor care, which is an important issue because there is evidence of a relationship between high nursing workload, inadequate staffing and poor outcomes (Hurst 2005, Needleman et al 2002).
In short, the project group aimed to provide nurses with a simple staffing formula using data drawn from 'best practice' wards. This formula was launched as part of the AUKUH's Patient Care Portfolio last November at the annual conference of the chief nursing officer for England (Waters 2007).
Nurse staffing assessment methods
In a forerunner of the Department...