Workload during the last shift in the opinion of hospital nurses involved in RN4CAST project

Background
The issue of workload is one of the most important ones as far as the nurses’ profession is concerned.
Numerous analyses prove the relationship between excessive workload and job dissatisfaction, which may lead to low morale, absenteeism, high rotation and low work efficiency and, consequently, result in deterioration of the care provided to the patient and even put the patient’s safety at risk. RN4CAST project is aimed at the evaluation of the workload which the nurses are exposed to during their shifts. Such a survey focuses on all structural determinants of hospital workload depending on: type of the ward, professional role, number of patients and their health condition as well as work conditions and organization: the number of working hours and shift staffing.

Aim of the survey
The survey is aimed at determining the factors responsible for the workload which the nurses are exposed to during their shifts in hospitals involved in RN4CAST project.

Material and Methods
The study included 2605 nurses working in 30 acute hospitals in Poland. The respondents were mainly women. Men made up only 0.4% of the population examined. The average age was 40.3 (SD = 7.8 years old). 23.5% of the respondents had the Bachelor’s degree in nursing. The average seniority was 18.6 years (SD = 8,6), and the seniority in the hospital involved in the survey – 15.6 years (SD = 9,2).
The material was collected by means of a survey and a structurised questionnaire completed by the nurses on their own. A correlational model was used to evaluate the workload determinants.

Results
During their last shift 84% of the nurses worked, on average, 11.3 hours (SD = 2.4). The number of patients on the ward was 31.1, on average (SD = 12.6) it varied significantly (p = 0.000) depending on the ward type. The nursing care was provided by 3.4 qualified nurses on average (SD = 2.2). One nurse was responsible for 20.4 patients on average (SD = 11.1), [median = 18, first quartile (Q1) = 12, third quartile (Q3) = 29)].
It was proved that the increase in the total number of the patients on the ward was accompanied by the increase in the number of patients who required assistance with everyday routines (tau-b = 0.17; p = 0.000) and in the number of patients who required monitoring or hourly (or even more frequent) treatment (tau-b=0.37; p=0.000).
Close examination of the variables responsible for individual workload showed that there is a little but noticeable correlation between the increase of the total number of patients on the ward (tau-b = 0.28; p = 0.000) and the increase in the number of patients each nurses was directly responsible for on her shift.
There was a positive correlation (tau-b = 0.40; p = 0.000) between the total number of patients and the total number of qualified nurses providing direct care to these patients during their shifts.
Also a slight negative correlation was observed (tau-b = –0.061; p = 0.000) between the total number of nurses and the number of patients each nurse was directly responsible for.
There was also a slight positive correlation (tau-b = 0.18; p = 0.000) between the number of nurses and the number of helping staff who provided direct care to the patients during their shifts. And also a slight correlation was observed (tau-b = 0.061; p = 0.000) between the number of patients and the number of helping staff during the shifts.
The analysis of the findings from both wards leads to the conclusion that the seven most frequent and common routines, which did not require nursing qualifications constituted a significant workload for nurses on all shifts (p = 0,000) and that the nurses who solely provided care to the patients were significantly more often responsible for routines which did not require any professional skills.
The nurses examined, evaluated their hospital working conditions as poor – 28.9%; satisfactory – 46.8%; good – 23.2%; excellent – 1.1%.
Majority of nurses (59.3%) claim that the number of hospital staff is definitely too low to work efficiently; 64.5% pointed out the lack of qualified nurses and 31.7% the lack of technical and helping staff. Vast majority of nurses (64%) claim that they can rely on the hospital management support only in some situations. Most nurses (77%) complained that their relations with the doctors were not always good, whereas 13.6% complained about lack of good professional relations between nurses and doctors.

Conclusions
1. The analysis of the findings shows that structural factors (such as type of the ward, professional role, number and condition of patients) as well as organisational factors (such as number of shift hours, shift staffing and work environment) determined the nurses’ workload.
2. The shift survey as a device for evaluating nurses’ workload should be recommended to ward nurses and hospital management because of the simplicity with which particular elements can be observed. The observation can be carried out during a relatively short period of time (8–12-hour shift), which allows for a better and faster explanation of the reasons of excessive workload and consequently may lead to implementing solutions, which would eliminate this negative phenomenon.

RN4CAST HEALTH-2007-3.2-4: Health care human resource planning in nursing Grant agreement no.: 223468

Workload during the last shift in the opinion of hospital nurses involved in RN4CAST project

Background
The issue of workload is one of the most important ones as far as the nurses’ profession is concerned.
Numerous analyses prove the relationship between excessive workload and job dissatisfaction, which may lead to low morale, absenteeism, high rotation and low work efficiency and, consequently, result in deterioration of the care provided to the patient and even put the patient’s safety at risk. RN4CAST project is aimed at the evaluation of the workload which the nurses are exposed to during their shifts. Such a survey focuses on all structural determinants of hospital workload depending on: type of the ward, professional role, number of patients and their health condition as well as work conditions and organization: the number of working hours and shift staffing.

Aim of the survey
The survey is aimed at determining the factors responsible for the workload which the nurses are exposed to during their shifts in hospitals involved in RN4CAST project.

Material and Methods
The study included 2605 nurses working in 30 acute hospitals in Poland. The respondents were mainly women. Men made up only 0.4% of the population examined. The average age was 40.3 (SD = 7.8 years old). 23.5% of the respondents had the Bachelor’s degree in nursing. The average seniority was 18.6 years (SD = 8,6), and the seniority in the hospital involved in the survey – 15.6 years (SD = 9,2).
The material was collected by means of a survey and a structurised questionnaire completed by the nurses on their own. A correlational model was used to evaluate the workload determinants.

Results
During their last shift 84% of the nurses worked, on average, 11.3 hours (SD = 2.4). The number of patients on the ward was 31.1, on average (SD = 12.6) it varied significantly (p = 0.000) depending on the ward type. The nursing care was provided by 3.4 qualified nurses on average (SD = 2.2). One nurse was responsible for 20.4 patients on average (SD = 11.1), [median = 18, first quartile (Q1) = 12, third quartile (Q3) = 29)].
It was proved that the increase in the total number of the patients on the ward was accompanied by the increase in the number of patients who required assistance with everyday routines (tau-b = 0.17; p = 0.000) and in the number of patients who required monitoring or hourly (or even more frequent) treatment (tau-b=0.37; p=0.000).
Close examination of the variables responsible for individual workload showed that there is a little but noticeable correlation between the increase of the total number of patients on the ward (tau-b = 0.28; p = 0.000) and the increase in the number of patients each nurses was directly responsible for on her shift.
There was a positive correlation (tau-b = 0.40; p = 0.000) between the total number of patients and the total number of qualified nurses providing direct care to these patients during their shifts.
Also a slight negative correlation was observed (tau-b = –0.061; p = 0.000) between the total number of nurses and the number of patients each nurse was directly responsible for.
There was also a slight positive correlation (tau-b = 0.18; p = 0.000) between the number of nurses and the number of helping staff who provided direct care to the patients during their shifts. And also a slight correlation was observed (tau-b = 0.061; p = 0.000) between the number of patients and the number of helping staff during the shifts.
The analysis of the findings from both wards leads to the conclusion that the seven most frequent and common routines, which did not require nursing qualifications constituted a significant workload for nurses on all shifts (p = 0,000) and that the nurses who solely provided care to the patients were significantly more often responsible for routines which did not require any professional skills.
The nurses examined, evaluated their hospital working conditions as poor – 28.9%; satisfactory – 46.8%; good – 23.2%; excellent – 1.1%.
Majority of nurses (59.3%) claim that the number of hospital staff is definitely too low to work efficiently; 64.5% pointed out the lack of qualified nurses and 31.7% the lack of technical and helping staff. Vast majority of nurses (64%) claim that they can rely on the hospital management support only in some situations. Most nurses (77%) complained that their relations with the doctors were not always good, whereas 13.6% complained about lack of good professional relations between nurses and doctors.

Conclusions
1. The analysis of the findings shows that structural factors (such as type of the ward, professional role, number and condition of patients) as well as organisational factors (such as number of shift hours, shift staffing and work environment) determined the nurses’ workload.
2. The shift survey as a device for evaluating nurses’ workload should be recommended to ward nurses and hospital management because of the simplicity with which particular elements can be observed. The observation can be carried out during a relatively short period of time (8–12-hour shift), which allows for a better and faster explanation of the reasons of excessive workload and consequently may lead to implementing solutions, which would eliminate this negative phenomenon.

RN4CAST HEALTH-2007-3.2-4: Health care human resource planning in nursing Grant agreement no.: 223468