Nursing Workload Measurement Systems - A Discussion of the Issues
The work performed by nurses is essential to the well being of patients and clients accessing the healthcare system. Registered nurses provide the greatest hours of care and coordinate the care provided by other healthcare providers. They are the primary interface between the patient and the health care system. It is therefore essential that the work that nurses perform is understood. This requires the development of a means for identifying the specific contribution of nurses to patient outcomes as well as the resources required to affect this outcome.
At this time the majority of automated healthcare records do not include the interventions that nurses perform nor the outcome linked to these interventions. 2 The only information currently contained in provincial databases 3is the actual hours of nursing provided, including the skill mix and employment status of these nurses, and nursing workload. As data provided in provincial databases is limited, it is even more important to ensure that accurate data is captured locally to describe the work that nurses perform and the relationship between nursing workload and patient outcomes using sound methodology.
To date, workload measurement systems (WLMS) are the only mechanism whereby nursing interventions are captured to reflect the work involved in professional nursing. The purpose of this paper is to highlight some of the key issues in the measurement of nursing workload, the use of workload measurement data, and the implications for nurses, the system and patient care. The focus is on nurses in direct care in the hospital sector rather than those in advanced practice roles or other sectors.
While there is a lack of empirical evidence to support the identification of issues affecting the capture and use of workload measurement data, there is a plethora of anecdotal evidence which point to issues. This evidence indicates that issues face both front line nurses and those in administration. This paper will identify and address some of these issues in WLMS. Discussion and debate is critical in order for nurses to explain the work that they do, the contribution of this work to outcomes, and impact of workload on nurses. In this way nurses can begin to exercise control of their practice and advocate for a work environment that supports quality care and the critical role of the professional nurse in successful health delivery systems.