Nursing workload in UK tertiary neonatal units.

Area of Science:

• Neonatal intensive care nursing
• Healthcare workload assessment
• Nursing resource management

Background:

• Existing research on neonatal nurse staffing and infant care needs is over 10 years old.
• Significant changes in the preterm population and treatment practices necessitate updated assessments.
• Neonatal intensive care requires adequate numbers of trained neonatal nurses for safe and effective care.

Purpose of the Study:

• To validate the British Association of Perinatal Medicine (BAPM) dependency categories.
• To revalidate the Northern Region (NR) dependency categories.
• To assess contemporary nursing workload in neonatal intensive care units.

Main Methods:

• Direct observation of nursing activities around infants in three English tertiary neonatal intensive care services.
• Data collection occurred every 10 minutes by trained observers.
• Analysis related time spent on nursing activities to infant dependency category and nurse grade.

Main Results:

• Both BAPM and NR scales identified differences between dependency categories.
• Distinguishing nasal continuous positive airway pressure (nCPAP) from ventilation improved category discrimination when combined with BAPM2/NRA.
• The revised four-point scale showed varying nursing time requirements per hour: BAPM1/NRA (56 min), nCPAP/BAPM2/NRB (36 min), BAPM3/NRC (20-22 min), BAPM4/NRD (31-32 min).
• The NR scale was easier to apply and demonstrated higher interobserver agreement (98.5%) than the BAPM scale (93%).
• All dependency categories required more nursing time compared to 1993.

Conclusions:

• Both validated scales effectively predict average nursing workload.
• A revised categorization, separating nCPAP from ventilation, offers a more robust and practical approach.
• Overall nursing time required for all infant categories has increased since 1993.