The qualitative dimension of Nursing workload: a measurement proposal

Cucolo, Danielle Fabiana; Perroca, Marcia Galan

doi:10.1590/1518-8345.3274.3238

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 27 • 2019 • https://doi.org/10.1590/1518-8345.3274.3238 copy

The qualitative dimension of Nursing workload: a measurement proposal^* * Paper extracted from doctoral dissertation “Carga de trabalho e sua influência sobre os resultados do processo de cuidar”, presented to Faculdade de Medicina de São José do Rio Preto (FAMERP), Pós-Graduação em Ciências da Saúde, São José do Rio Preto, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

construct and test a proposal to measure the qualitative dimension of nursing workload; identify the workload cut-off point and its indicator as predictors of the good and optimal nursing care product score.

Method:

this is a descriptive study conducted in four inpatient units and four intensive care units of a Brazilian teaching hospital, considering 308 evaluations performed by 19 nurses. Four measurement instruments were used: three to assess the care demand in relation to nursing and the other to classify the care product delivered at the end of the shift. The workload was calculated and its indicator was constructed.

Results:

a weak and inverse correlation was found between the care product score, workload and the workload indicator and the workload indicator in the units and moderate and inverse between Nursing care planning and Care needs assistance with the number of hospitalized patients.

Conclusion:

it is possible to associate workload and its indicator with the care product. Nursing workload ≤ 173 hours (24 hours) and indicator ≤ 12.3 hours / professional were associated with a higher probability of obtaining a “good” and “optimal” score in the care product in the inpatient units.

Descriptors:
Workload; Hospital Nursing Staff; Nursing Assessment; Hospital Administration; Health Management; Assessment on Outcome and Process (Health Care)

Units	Poor	Regular	Good	Optimal	Total
Units	N(%)	N(%)	N(%)	N(%)	N(%)
IU^* * IU = Inpatient Unit; (n=150)
Medical-Surgical 1	0(0.0)	5(11.9)	36(85.7)^† † Fischer’s exact test (p≤0.01);	1(2.4)	42(28.0)
Medical-Surgical 2	1(1.8)	12(22.2)	39(72.2)^† † Fischer’s exact test (p≤0.01);	2(3.7)	54(36.0)
Surgical	0(0.0)	13(46.4)^† † Fischer’s exact test (p≤0.01);	14(50.0)	1(3.6)	28(18.7)
Pediatrics	0(0.0)	3(11.5)	12(46.1)	11(42.3)^† † Fischer’s exact test (p≤0.01);	26(17.3)
Total	1(0.7)	33(22.0)	101(67.3)	15(10.0)	150(100)
ICU^‡ ‡ ICU = Intensive Care Unit (n=158)
ICU^‡ ‡ ICU = Intensive Care Unit Coronary	1(3.0)	5(15.1)	20(60.6)	7(21.2)^† † Fischer’s exact test (p≤0.01);	33(20.9)
ICU^‡ ‡ ICU = Intensive Care Unit Pediatric	0(0.0)	8(15.7)	35(68.6)^† † Fischer’s exact test (p≤0.01);	8(15.7)	51(32.3)
ICU^‡ ‡ ICU = Intensive Care Unit General	2(3.7)	11(20.3)^† † Fischer’s exact test (p≤0.01);	41(75.9)^† † Fischer’s exact test (p≤0.01);	0(0.0)	54(34.2)
ICU^‡ ‡ ICU = Intensive Care Unit Neonatal	0(0.0)	1(5.0)	13(65.0)	6(30.0)	20(12.6)
Total	3(1.9)	25(15.8)	109(69.0)	21(13.3)	158(100)

Variables	Inpatient Units (n=150)		Intensive Care Units (n=158)		p^‡ ‡ p = Mann-Whitney test;
Variables	M(SD)^* * M(SD) = Mean and Standard Deviation;	Md(Q1-Q3)^† † M (Q1-Q3) = Median and Quartiles;	M(Dp)^* * M(SD) = Mean and Standard Deviation;	Md(Q1-Q3)^† † M (Q1-Q3) = Median and Quartiles;	p^‡ ‡ p = Mann-Whitney test;
Nursing
Nurses	3(0.7)	3(3-3)	5.2(2.4)	4(3-7)	≤0.01
Technitians/Auxiliaries	13.4(1.6)	13(12-14)	24.7(11.1)	19(16-36)	≤0.01
Total	16.4(1.9)	16(15-17)	29.9(13.4)	23(19-44)	≤0.01
Patients	22.1(4.2)	22(18-26)	11.5(4.8)	10(8-15)	≤0.01
Beds	27.4(2.5)	29(24-30)	17.2(8.2)	12(10-30)	≤0.01
Occupation(%)	80.7(12.8)	83(73-90)	71.3(19.4)	70(56-90)	≤0.01
Classif patients^§ § Classif patients = Classification of patients;
Minimum	1.8(2.0)	1(0-3)	-	-
Intermediary	14.6(5.2)	15(11-20)	-	-
High dependence	1.3(3.0)	0(0-0)	-	-
Semi-intensive	3.4(2.5)	3(1-5)	-	-
Intensive	1.0(1.1)	1(0-1)	-	-
NAS (hours)^ǁ ǁ NAS = Nursing Activities Score;	-	-	244(115)	196(155-347)
NWL (hours)^¶ ¶ NWL= Nursing Workload;	157(27)	156(138-176)	244(115)	196(155-347)	≤0.01
NWLi (hours/prof)^ NWLi = Indicator Nursing Workload (hours / professional);	9.8(1.6)	9.8(8.7-10.7)	8.3(2.3)	7.8(6.8-9.8)	≤0.01
APROCENF^†† †† APROCENF = Nursing Care Product Evaluation
Planning	2.9(0.7)	3(3-3)	3.2(0.9)	3(3-4)	≤0.01
Resources	3.0(0.7)	3(3-3)	2.9(0.9)	3(3-3)
Sizing	2.9(0.8)	3(3-3)	3.2(0.9)	3(3-4)	≤0.01
Education	3.0(0.7)	3(3-4)	2.9(0.9)	3(2-4)
Monitoring	2.8(0.7)	3(2-3)	3.2(0.8)	3(3-4)	≤0.01
Interaction	2.5(0.8)	2(2-3)	2.4(0.9)	2(2-3)
Atention	2.9(0.6)	3(3-3)	3.0(0.8)	3(3-4)
Necessities	3.2(0.6)	3(3-4)	3.1(0.8)	3(3-4)
Total Score	23.2(3.8)	24(21-26)	24(4.1)	24(22-27)	≤0.05

Variables	Nur^* * Nur = Nurse;	T/A^† † T / A = Nursing Technician and Assistant;	Prof^‡ ‡ Prof = Total Nursing Professionals;	Ptes^§ § Pctes = Patients; CupOcup = Occupancy Rate;	Beds	Occupǁ	CTE¶	iCTE^ NWLi = Indicator Nursing Workload (hours / professional);
IU^†† †† IU = Inpatient unit; (n=150)
Planning	0.14	-0.17^‡‡ ‡‡ p≤0.05;	-0.20^‡‡ ‡‡ p≤0.05;	-0.40^§§ §§ P≤0,01;	-0.20^‡‡ ‡‡ p≤0.05;	-0.45^§§ §§ P≤0,01;	-0.38^§§ §§ P≤0,01;	-0.21^‡‡ ‡‡ p≤0.05;
Resources	-0.12	-0.32^§§ §§ P≤0,01;	-0.31^§§ §§ P≤0,01;	-0.26^‡‡ ‡‡ p≤0.05;	-0.28^‡‡ ‡‡ p≤0.05;	-0.17^‡‡ ‡‡ p≤0.05;	-0.22^‡‡ ‡‡ p≤0.05;	0.04
Sizing	-0.03	0.19^‡‡ ‡‡ p≤0.05;	0.15	0.01	0.05	-0.07	-0.04	-0.12
Education	-0.09	0.14^‡‡ ‡‡ p≤0.05;	0.08	-0.03	0.09	-0.12	-0.12	-0.17
Monitor	-0.13	-0.03	-0.06	-0.15	0.01	-0.23^§§ §§ P≤0,01;	-0.19^‡‡ ‡‡ p≤0.05;	-0.16
Interaction	-0.10	0.23^§§ §§ P≤0,01;	0.17^‡‡ ‡‡ p≤0.05;	-0.07	0.37^§§ §§ P≤0,01;	-0.30^§§ §§ P≤0,01;	-0.08	- 0.23^§§ §§ P≤0,01;
Atention	-0.13	-0.06	-0.09	-0.24^§§ §§ P≤0,01;	0.00	-0.34^§§ §§ P≤0,01;	-0.28^§§ §§ P≤0,01;	- 0.21^§§ §§ P≤0,01;
Necessities	-0.04	-0.18^‡‡ ‡‡ p≤0.05;	-0.17^‡‡ ‡‡ p≤0.05;	-0.22^§§ §§ P≤0,01;	-0.14	-0.20^‡‡ ‡‡ p≤0.05;	-0.25^§§ §§ P≤0,01;	-0.10
Total Sc^ǁǁ ǁǁ Total SC = Total Score;	-0.13	-0.01	-0.05	-0.19^‡‡ ‡‡ p≤0.05;	0.01	-0.28^§§ §§ P≤0,01;	-0.25^§§ §§ P≤0,01;	-0.19^‡‡ ‡‡ p≤0.05;
CMS Sc^¶¶ ¶¶ CMS Sc = Clinical medical-surgical score; 1	0.15	-0.31^‡‡ ‡‡ p≤0.05;	-0.20	0.23	-	0.23	0.05	0.15
CMS Sc^¶¶ ¶¶ CMS Sc = Clinical medical-surgical score; 2	-0.04	0.49^§§ §§ P≤0,01;	0.38^§§ §§ P≤0,01;	-0.06	-	-0.06	-0.41^§§ §§ P≤0,01;	-0.43^§§ §§ P≤0,01;
SurC Sc^* ***** SurC sc = Surgical Clinical Score;	-0.27	-0.17	-0.24	-0.25	-	-0.25	-0.39^‡‡ ‡‡ p≤0.05;	-0.14
Ped Sc^††† ††† Ped Sc = Pediatric Score;	0.09	0.19	0.23	0.24	-	0.24	0.29	0.08
ICU^‡‡‡ ‡‡‡ ICU = Intensive Care Unit; (n=158)
Planning	0.19^‡‡ ‡‡ p≤0.05;	0.22^§§ §§ P≤0,01;	0.21^§§ §§ P≤0,01;	0.01	0.19^‡‡ ‡‡ p≤0.05;	-0.34^§§ §§ P≤0,01;	0.14	-0.13
Resources	0.01	0.02	0.03	-0.10	0.03	-0.16^‡‡ ‡‡ p≤0.05;	-0.12	-0.26^§§ §§ P≤0,01;
Sizing	-0.25^§§ §§ P≤0,01;	-0.29^§§ §§ P≤0,01;	-0.28^§§ §§ P≤0,01;	-0.21^‡‡ ‡‡ p≤0.05;	-0.32^§§ §§ P≤0,01;	0.18^‡‡ ‡‡ p≤0.05;	-0.29^§§ §§ P≤0,01;	-0.10
Education	-0.25^§§ §§ P≤0,01;	-0.33^§§ §§ P≤0,01;	-0.32^§§ §§ P≤0,01;	-0.34^§§ §§ P≤0,01;	-0.39^§§ §§ P≤0,01;	0.04	-0.30^§§ §§ P≤0,01;	-0.10
Monitor	-0.27^§§ §§ P≤0,01;	0.33^§§ §§ P≤0,01;	0.32^§§ §§ P≤0,01;	0.15	0.32^§§ §§ P≤0,01;	-0.32^§§ §§ P≤0,01;	0.21^§§ §§ P≤0,01;	-0.12
Interaction	-0.10	-0.11	-0.10	-0.15	-0.08	-0.10	-0.06	-0.03
Atention	-0.12	-0.16^‡‡ ‡‡ p≤0.05;	-0.16^‡‡ ‡‡ p≤0.05;	-0.23^§§ §§ P≤0,01;	-0.17^‡‡ ‡‡ p≤0.05;	0.01	-0.09	0.06
Necessities	-0.32^§§ §§ P≤0,01;	-0.34^§§ §§ P≤0,01;	-0.34^§§ §§ P≤0,01;	-0.41^§§ §§ P≤0,01;	-0.37^§§ §§ P≤0,01;	0.02	-0.27^§§ §§ P≤0,01;	0.04
Total Sc^ǁǁ ǁǁ Total SC = Total Score;	-0.13	-0.13	-0.13	-0.24^* * Nur = Nurse;	-0.15	-0.11	- 0.18^‡‡ ‡‡ p≤0.05;	- 0.18^‡‡ ‡‡ p≤0.05;
COU Sc^§§§ §§§ COU Sc = Coronary Unit Score; PICU Sc = Pediatric Intensive Care Unit Score;	-0.24	0.06	0.02	0.17	-	0.02	-0.01	-0.02
PICU Scǁǁǁ	-0.22	-0.14	-0.19	-0.33^‡‡ ‡‡ p≤0.05;	-	-0.32^‡‡ ‡‡ p≤0.05;	-0.34^‡‡ ‡‡ p≤0.05;	-0.31^‡‡ ‡‡ p≤0.05;
GICU Sc^¶¶¶ ¶¶¶ GICU Sc = General Intensive Care Unit Score;	0.08	0.19	0.18	0.10	-	0.09	0.05	-0.04
NICU Sc^** ****** NICU Sc = Neonatal Intensive Care Unit Score	0.55^§§ §§ P≤0,01;	-0.36	-0.09	-0.39	-	-0.39	-0.44	-0.40

Predictors	Sensi^† † Sensi = Sensitivity; (%)	Spec^‡ ‡ Spec = Specificity; (%)	Cut-off (hours)	PPV^§ § PPV = Positive Predictive Value; (%)	NPV^ǁ ǁ NPV = Negative Predictive Value; (%)	Accuracy (%)
NWL^¶ ¶ NWL = Nursing Workload;
IUs^ IU = Inpatient Units; (n=150)^†† †† p≤0.01;	75.0	55.9	≤ 173.0	85.3	39.6	70.7
ICUs^‡‡ ‡‡ ICUs = Intensive Care Units; (n=158)	63.8	50.0	≤ 260.0	85.6	22.9	61.4
Total (N=308)	71.9	38.7	≤ 195.4	82.3	25.8	65.3
NWLi^§§ §§ NWLi = Indicator Nursing Workload; ≤p≤0.05
IUs^ IU = Inpatient Units; (n=150)^ǁ ǁ NPV = Negative Predictive Value;	96.6	26.5	≤ 12.3	81.7	69.2	80.7
ICUs^‡‡ ‡‡ ICUs = Intensive Care Units; (n=158)	38.5	82.1	≤ 7.2	90.9	22.3	46.2
Total (N=308)	73.6	40.3	≤ 10.2	83.0	27.8	66.9

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[1] Corresponding author: Danielle Fabiana Cucolo. E-mail: danielle.fabiana.cucolo@gmail.com