Comparison of nurse workload approaches.

Area of Science:

• Nursing
• Healthcare Management
• Hospital Operations

Background:

• The midnight census is the standard metric for hospital nursing workload and staffing decisions.
• Current methods, like hours per patient day (HPPD) based on midnight census, inadequately reflect 24-hour nursing needs and staffing variations.
• A discrepancy exists between nurse managers' real-time patient needs assessment and financial analysts' reliance on midnight data.

Purpose of the Study:

• To compare intra-day nursing workload variations with projections based solely on the midnight census.
• To evaluate the impact of including patient admissions and discharges on nursing workload calculations.

Main Methods:

• Collected patient census data at four time points: 06:00, 14:00, 22:00, and midnight.
• Calculated projected nursing hours based on intra-day census data.
• Incorporated patient admissions and discharges into nursing hour projections for 8-hour periods.

Main Results:

• Observed statistically significant increases in patient counts at 06:00 and decreases at 14:00 and 22:00 compared to the midnight census.
• No significant difference in daily nursing hour projections when comparing intra-day versus midnight census alone.
• Statistically significant increases in nursing hour projections across all shifts when accounting for the workload of patient admissions and discharges.

Conclusions:

• The midnight census is an imprecise measure for predicting nursing workload and costing nursing care.
• Accurate 24-hour nursing workload assessment requires incorporating the nursing activities associated with patient admissions and discharges.
• A new model is needed to accurately cost and potentially bill for direct nursing care, reflecting the true hospital nursing workload.