Measuring Nursing Productivity Based on a Review of the Literature: A Pilot Study

One of the performance indicators of nurses is measuring their productivity. This is despite the fact that there is a serious weakness regarding the criteria to measure nursing productivity. Therefore, this study aimed to define the productivity indicators and to conduct a pilot test using the productivity measures in a hospital.

This multi-phase study is conducted in three parts. In the first phase, a review is conducted to extract nurses' productivity measures. In the second phase, the measures are prioritized and evaluated using experts' opinions. Finally, a pilot study based on the list of productivity measures is implemented. For this reason, we conducted a time-motion study to analyze work efficiency in a pilot hospital.

In the systematic review phase, 11 articles were included in the study. They reported several measures like actual working hours, expected working hours, nurses' salaries and benefits, the number of patients under care, and relative value units (RVU) as indicators to measure nurses' productivity. Experts rated output/input, standard hours/actual hours, productive hours in patient day, and actual hours as more feasible, valid, and important indicators to measure productivity for nurses. Finally, in the third phase of this study, in order to measure actual working hours, nursing activities were extracted. Thirty-six nurses were observed and evaluated in three internal, surgical, and special care units. The mean monthly clinical time was highest in the Internal Medicine unit (116.17 h), followed by the Surgical unit (109.93 h), and the Intensive Care unit (106.83 h). The ICU had the highest standard, recorded (Timex-based), and paid hours. Finally, productivity was calculated by dividing clinical work hours by attendance hours in units. Performance ratio (productivity) was about 77%, 75%, and 68% in the internal medicine, surgical, and intensive care units, respectively.

The productivity status of nurses was at a desirable level. The average productivity of nurses in the internal unit was higher than others. The productivity index can be the criterion of action in the field of performance-based payment.