Advancing Healthcare: balancing workload of nurses to enhance quality of care, nurses’ health and operational excellence

Hospitals are being challenged to deliver high quality of care while demands are increasing and budgets are shrinking. Nurses are pivotal in delivering high quality of care and have a significant influence on patient experiences and outcomes. There is an increasing shortage of nurses, that can lead to high levels of workload, which in turn increase the risk of deteriorating quality of care, nurses’ health and work satisfaction. This thesis describes a new method to determine workload of nurses, based on objective measures. The method combines results of a Delphi study on patient characteristics and a time study on nurses’ activities. Linear mixed effects models were used to analyze the correlation between fifteen relevant patient characteristics and care time. Nine were significant: ‘partial assistance bathing, mobilization’, ‘full assistance bathing, mobilization, care for incontinent patient’, ‘full assistance meals, drip feed, TPN, ‘psychosocial support’, ‘extensive wound care, fistula, VAC bandages’, ‘new stoma’, ‘isolation measures’ or ‘one-on-one care’. Most characteristics required on average an additional 18 to 35 minutes of care time, with the exception of ‘two or more IV/drip/drain’ (8 minutes) and ‘one on-one care’ (156 minutes). The mean daily care time for patients with a profile where none of the characteristics apply (the baseline care time) was found to be between 44 and 57 minutes. Mean daily care time for patients with an average patient profile (of the patient characteristics in our study) was between 75 and 88 minutes. Explained variation of the model was 36% between patients. Results also show that it is important to incorporate nurse proficiency in the workload calculations. There is a clear correlation between our calculated workload and the workload that nurses perceive. The workload management method gives an indication of current and expected workload levels, in order to better manage workload, between departments and over time. In addition, the effect of four job demands (proportion of time spent on direct patient care, proportion of time spent on registration, work interruptions, equal work distribution), 3 job resources (support of management, support of colleagues, proportion of registered nurses) and two personal resources (self-efficacy, proficiency) on the relation between the modelled and perceived workload measures was studied. We found that when nurses feel supported by their colleagues, they perceive a lower amount of work and a lower work pace, and to a lesser extent also a lower mental, emotional and physical workload. Registered nurses experience a higher emotional workload than student nurses. Also, there is a positive correlation between the time nurses spent on direct patient care and perceived amount of work and work pace. On the other hand, there is a negative correlation between time spent on registration and the perceived amount of work. We did not find any evidence to prove that support of management, work interruptions, equal work distribution, self-efficacy or proficiency affect perceived workload. In times when workload is high, nurse leadership should consider interventions regarding team building and balancing time spent on direct patient care and time spent on registration