Nursing Workload, Nurse Staffing Methodologies and Tools: a systematic scoping review and discussion
Griffiths, P; Saville, C; Ball, J; et al.Jones, J; Patterson, N; Monks, T
Date: 29 November 2019
Journal
International Journal of Nursing Studies
Publisher
Elsevier
Publisher DOI
Abstract
Background
The importance of nurse staffing levels in acute hospital wards is widely recognised
but evidence for tools to determine staffing requirements although extensive, has
been reported to be weak. Building on a review of reviews undertaken in 2014, we
set out to give an overview of the major approaches to assessing nurse ...
Background
The importance of nurse staffing levels in acute hospital wards is widely recognised
but evidence for tools to determine staffing requirements although extensive, has
been reported to be weak. Building on a review of reviews undertaken in 2014, we
set out to give an overview of the major approaches to assessing nurse staffing
requirements and identify recent evidence in order to address unanswered questions
including the accuracy and effectiveness of tools.
Methods
We undertook a systematic scoping review. Searches of Medline, the Cochrane
Library and CINAHL were used to identify recent primary research, which was
reviewed in the context of conclusions from existing reviews.
Results
The published literature is extensive and describes a variety of uses for tools
including establishment setting, daily deployment and retrospective review. There
are a variety of approaches including professional judgement, simple volume-based
methods (such as patient-to-nurse ratios), patient prototype / classification and
timed-task approaches. Tools generally attempt to match staffing to a mean average
demand or time requirement despite evidence of skewed demand distributions. The
largest group of recent studies reported the evaluation of (mainly new) tools and
systems, but provide little evidence of impacts on patient care and none on costs.
Benefits of staffing levels set using the tools appear to be linked to increased staffing
with no evidence of tools providing a more efficient or effective use of a given staff
resource. Although there is evidence that staffing assessments made using tools
may correlate with other assessments, different systems lead to dramatically
different estimates of staffing requirements. While it is evident that there are many
sources of variation in demand, the extent to which systems can deliver staffing
levels to meet such demand is unclear. The assumption that staffing to meet
average need is the optimal response to varying demand is untested and may be
incorrect.
Conclusions
Despite the importance of the question and the large volume of publication evidence
about nurse staffing methods remains highly limited. There is no evidence to support
the choice of any particular tool. Future research should focus on learning more
about the use of existing tools rather than simply developing new ones. Priority
research questions include how best to use tools to identify the required staffing level
to meet varying patient need and the costs and consequences of using tools.
Tweetable abstract: Decades of research on tools to determine nurse staffing
requirements is largely uninformative. Little is known about the costs or
consequences of widely used tools.
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Except where otherwise noted, this item's licence is described as © 2019. This version is made available under the CC-BY-NC-ND 4.0 license: https://creativecommons.org/licenses/by-nc-nd/4.0/