A systems perspective on nursing productivity

Recent New Zealand reports have identified the nursing workforce for its potential to make a significant contribution to increased productivity in health services. The purpose of this paper is to review critically the recent and current labour approaches to improve nursing productivity in New Zealand, in a context of international research and experience.

An examination of government documents regarding productivity, and a review of New Zealand and international literature and research on nursing productivity and its measurement form the basis of the paper.

It is found that productivity improvement strategies are influenced by theories of labour economics and scientific management that conceptualise a nurse as a labour unit and a cost to the organisation. Nursing productivity rose significantly with the health reforms of the 1990s that reduced nursing input costs but impacts on patient safety and nurses were negative. Current approaches to increasing nursing productivity, including the "productive ward" and reconfiguration of nursing teams, also draw on manufacturing innovations. Emerging thinking considers productivity in the context of the work environment and changing professional roles, and proposes reconceptualising the nurse as an intellectual asset to knowledge-intensive health organisations.

Strategies that take a systems approach to nursing productivity, that view nursing as a capital asset, that focus on the interface between nurse and working environment and measure patient and nurse outcomes are advocated.

The paper shows that reframing nursing productivity brings into focus management strategies to raise productivity while protecting nursing and patient outcomes.