Cent Eur J Nurs Midw 2016, 7(2):420-427 | DOI: 10.15452/CEJNM.2016.07.0010

Nursing workload and staff allocation in an Italian hospital: a quality improvement initiative based on nursing care score

Santa Giammona^1,*, Giuseppe Arena¹, Michelangelo Calò¹, Maria Angela Barone², Davide Scelsa³, Andrea Lepre¹, Maria Rosaria Tarantino¹, Elizabeth A. Schlenk⁴

¹ Department of Nursing Services, IRCCS-ISMETT, Palermo, Italy

² Quality Services, IRCCS-ISMETT, Palermo, Italy

³ Department of MD Services, IRCCS-ISMETT, Palermo, Italy

⁴ School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania

Aim: To develop, implement, and evaluate a Nursing Care Score (NCS) system, built into the electronic health record, to optimize nursing workload and staff allocation.

Design: A quality improvement (QI) initiative with a pre- and post-implementation design was conducted by an interprofessional team in the 33-bed cardio-thoracic unit of a 72-bed hospital in Palermo, Italy.

Methods: A seven-phase process was used to develop, implement, and evaluate the NCS, which lists 53 nursing work tasks, each assigned a score from 1.5 to 5.0. The nurse-to-patient ratio on all shifts was determined by the NCS. Nurse satisfaction with both the existing system and the NCS workload system was assessed. Descriptive statistics and McNemar's test were used to analyze the data.

Results: At pre-implementation, 92.5% of nurses reported that the existing system was not effective, 87.5% reported it did not enable them to provide adequate nursing care, and 20.0% believed that workload was fairly distributed. At post-implementation, 75.0% of nurses reported that the NCS system was effective (p = 0.0348), 85.0% reported that the NCS system enabled them to provide adequate care, and 85.0% believed that workload was fairly distributed. An NCS score of 65 ± 5 was found to distribute workload most fairly.

Conclusion: An automatic electronic operating system to generate a daily workload report based on the NCS was successfully implemented and evaluated. The NCS provided relevant information to guide nurse managers in defining nurse-to-patient ratio and determining staff allocation. Nurses were satisfied with the NCS system. The steps used to develop, implement, and evaluate the NCS system may be transferable to other units and other hospitals.

Keywords: nursing care, nursing workload, nursing care score, staff allocation, patient outcomes

Received: June 30, 2015; Accepted: December 7, 2015; Published: September 30, 2016  Show citation