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What’s New in the
Patient Safety World
September 2024
More on Measuring
Nursing Workload
We’ve done many columns showing the importance of adequate nursing staffing from a patient safety perspective. But one of our consistent themes has been that simple nurse:patient ratios fail to take into account the more important factor – nursing workload. But we’ve also lamented that the ideal way to measure nursing workload has been elusive.
Wallet et al. recently looked at how nurses’ perception of nursing workload matched up against a standardized measure of nursing workload in ICU’s (Wallet 2024). They note that several nursing workload scores have been developed and validated based on the classification of medical or nursing interventions, nursing activities and dependency, patient acuity, and nurse-to-patient ratios. These include the Therapeutic Intervention Scoring System (TISS), the Nursing Activities Score (NAS), the Nurse Operation Workload Score, and the Nine Equivalents of Nursing Manpower Use Score (NEMS) derived from TISS. But they acknowledge that those scores do not include individual nurse’s perception of workload. They also note that use of many of those scoring systems is time-consuming and results are not available in real-time.
The perceived nurse’s workload (PNW) was measured using an 11-point Likert scale (0 = lowest perceived workload and 10 = highest perceived workload) based on the unidimensional Overall Workload Scale. This was scored by a nurse at the end of each shift. For the objective measurement of workload, they used the Nine Equivalents of Nursing Manpower Use Score (NEMS) tool. That tool includes nursing tasks, the use of intravenous medications, the management of artificial or mechanical ventilation or spontaneous ventilation, the use of vasoactive drugs, extracorporeal support, and specific nursing tasks conducted in and outside the ICU (the latter including things like intrahospital transport). The NEMS score was calculated both manually (mNEMS) and electronically in the EMR (eNEMS).
They found that the correlation between the perceived nurse’s workload (PNW) and the NEMS, though significant, was weak. Moreover, a constantly weak correlation was found between the perceived workload and all individual NEMS items both in manual and electronic calculations.
Perhaps the most important finding of this study was that the time needed for eNEMS calculation was less than 10 seconds per patient! When discrepancies were noted between the mNEMS and eNEMS, over 80% of the errors were attributed to the manually input score.
We really like the idea of having an automated tool that can assess nursing workload objectively in real-time. That could certainly help with planning for nursing staffing. However, we strongly suspect that nurses’ perceptions of workload are a much more important factor leading to job dissatisfaction and burnout. Hopefully, someone will figure out how to include that perception into a score with those more objective measures.
Some of our other columns on nursing workload and missed
nursing care/care left undone:
November 26, 2013 “Missed Care: New Opportunities?”
May 9, 2017 “Missed Nursing Care and Mortality Risk”
March 6, 2018 “Nurse
Workload and Mortality”
May 29, 2018 “More
on Nursing Workload and Patient Safety”
October 2018 “Nurse
Staffing Legislative Efforts”
February 2019 “Nurse
Staffing, Workload, Missed Care, Mortality”
July 2019 “HAI’s and Nurse Staffing”
September 1, 2020 “NY State and Nurse Staffing Issues”
February 9, 2021 “Nursing Burnout”
August 2021 “The New NY State Law on Nursing Staffing”
January 2022 “Another Striking Nurse Staffing Study”
June 2024 “More on Missed Nursing Care”
June 2024 “AACN Standards for Critical Care Staffing”
References:
Wallet F, Bonnet A, Thiriaud V, et al. Weak Correlation Between Perceived and Measured Intensive Care Unit Nursing Workload: An Observational Study. Journal of Nursing Care Quality 2024; 39(3): E39-E45, July/September 2024
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