Bishwajit Mazumder

Nursing Instructor
Dhaka Nursing College, Dhaka
E. mail: mbishwa@rocketmail.com

Workload of nursing staff and the role of nurse manager

1. Introduction:

The provision of quality and safety of health care is seen by the most countries
as a high priority and the delivery of quality patient care is depended on adequate
nurse staffing. The increasing costs of treatment in hospital and the need to use
resources with efficiency are reasons to define the adequacy between nursing staff and
nursing workload. As nursing costs of hospital based on location(out door, general
ward, icu, ccu), its use has to be adjusted to the patients nursing care requirements
(Miranda et al., 1998). Therefore, indicators of nursing workload have become
increasingly necessary in order to assure patient safety, to improve quality of care and
to balance cost-effectiveness of hospital. Evaluation of the nursing workload and
consequently of the patient care needs, is a prerequisite for the adequate allocation of
staff in hospital. This can be explained by the fact that an oversized team becomes
more expensive, whereas reduced staff may imply a decrease in care efficacy/ quality,
prolonging hospitalization and increasing the cost of patient treatment (Aiken et al.,
2002; Guccione et al., 2004; Miranda, 1999). Thus, considering that the assessment of
nursing workload is relevant for planning nursing care and adapting human resources
to the patients requirements

2. Background

Workload management is the process of management that tries to ensure that

service users and potential service users are given timely, appropriate and good
quality services. To achieve this there needs to be a sufficient number of competent
workers, who have case loads that are manageable. Workload management therefore
is a process for managing work flow. Requests for assessment and the provision or
arrangement of services is provided by social workers or other professionals. These
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professionals need to have the time to undertake the assessments and arrange or
provide appropriate support. Value for money is an important factor, which includes
the effective deployment of professional time.
Organizations need to ensure that they have sufficient staff, with sufficient
knowledge and skills to undertake the work. Workload management and workforce
planning need to inform each other to try and ensure sufficient staff are available both
in the short term and the longer term. An essential aspect of workload management is
the determination of priorities. Workload management almost always involves a
significant element of calculating the degree of urgency, risk of inaction or priority
when services are potentially required. The heavy workload of hospital nurses is a
major problem for the health care system. Nurses are experiencing higher workloads
than ever before due to four main reasons: (1) increased demand for nurses, (2)
inadequate supply of nurses, (3) reduced staffing and increased overtime, and (4)
reduction in patient length of stay.
First, the demand for nurses is increasing as a result of population aging.
Second, the supply of nurses is not adequate to meet the current demand, and the
shortage is projected to grow more severe as future demand increases and nursing
schools are not able to keep up with the increasing educational demand. When a
nursing shortage occurs, the workload increases for those who remain on the job.
Third, in response to increasing health care costs since the 1990s, hospitals reduced
their nursing staffs and implemented mandatory overtime policies to meet
unexpectedly high demands, which significantly increased nursing workloads. Fourth,
increasing cost pressure forced health care organizations to reduce patient length of
stay. As a result, hospital nurses today take care of patients who are sicker than in the
past; therefore, their work is more intensive.

3. Concept of workload:

Workload is a complicated form from various conceptual elements and multi

facet structure . The scope of nursing work from simple to complex, include
comprehensively physical, emotional, and intellectual labor. More than in necessary
workload occurs, when an employee become aware that he/she has to many task to do
in a period of time. Carayon and Gurses( 2005) conceptualized Workload into two
ways: 1) perceived workload and 2) nursing requirements
3.1.

Perceived workload:

According to this conceptualization, workload is a subject experience or cost

incurred by an individual accomplishing direct and indirect activities of care that
reflect in the combined effects of demand imposed by various obstacles and
facilitators in the work environment.
3.2.

Nursing requirements:
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This conceptualizations think carefully about workload as the total time a

nurse need to entire all the required nursing activities. Time needed in assumed to
depended on patient characteristics and need.

4. Definition of Workload
Workload is commonly defined as the degree of processing capacity that is
expended during task performance, and it reflects a relationship between resource
supply and task demand. Aiken, Sochlski, and Anderson (1996) defined workload
the amount of the nurses time, mental and physical energy that is devoted to various
work related activities and more specifically to direct patient care . Workload refers to
nurses perception of amount of work they do(Zeytinoglu, Denton, Baumann, Blythe,
& Boos,2007)
Definition of Arthur and James(1994)provide a broadest perspective workload
as the volume and level of nursing work. Needham(1997) defined nursing workload
as the totality of the need of nursing time from all work that must be carried out over
a defied a period of time. Workload is sometimes defined operationally in terms of
factors such as the task requirements or the error that must be expanded to perform
the task.
The NASA-TLX, however, defines the workload experience in terms of the
sources of loading imposed by different tasks. Weinger and colleagues report three
principal methods for measuring workload: physiological, procedural, and perceptual
(subjective). Examples of physiological measures include recording of heart rate and
blood pressure as responses to stress such as that induced by physical activities. The
procedural method largely measures time spent on secondary tasks. Perceptual (or
subjective) workload measurement uses rating scales to evaluate participants
perceived workload. Although physiological and procedural measurements may
appear to be more accurate and objective,subjective measurement of workload has
been reported to be less invasive, easier and less expensive to obtain, more easily
reproduced, and of higher face validity. A pilot workload assessment study found
subjective measures to be sensitive enough to produce meaningfuldata. The focus of
this discussion, therefore, will be on perceptual (subjective) workload.

5. Sources of Nursing workload

Nursing overload arises from a variety of sources. Overcapacity of patients in
relation to available bed space is a common cause. Inadequate staff availability is
commonly reported, because of inadequate baseline staffing, or failure to replace staff
that are away ill or on vacation. Failure to replace staff may be due to lack of
available replacement staff, or may be a cost-cutting measure. Inadequate staffing also
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occurs when the system is unable to adjust its staffing to address the acuity of
patients, or to adjust to surges in capacity. Requiring nurses to work beyond their
scheduled hours has a significant impact on their quality of life and can result in
fatigued nurses giving unsafe care.
Inadequate staffing may also be the result of lack of availability of the right
kind of staff, including lack of the appropriate designation of nursing staff (RN, LPN)
required to care for the complexity of patients, the required advanced training (critical
care nursing, for example), or the appropriate supply of support staff whose absence
requires nurses to assume non-nursing tasks, such as pottering patients, making beds,
passing trays and searching for supplies. A review of published literature, data, and
interviews with nursing leaders noted the following most frequently cited causes of
the faculty shortage:

Lack of interest in nursing faculty careers

Long periods of clinical practice delay entry into faculty positions
Fluctuating enrollment in nursing programs
Low academic salaries
High educational costs associated with faculty training
Dissatisfaction with careers in nursing education
Inadequate institutional funding for additional faculty positions

6. Workload Management Overview:

Workload management is a general term that refers to staffing and scheduling

operations by an organizations manager. The three duties of workload management:
staffing, scheduling, and reallocation, are not mutually exclusive, as illustrated in also
shows the direct link among staffing, scheduling, and productivity variables. First of
all, let us define those three components of workload management
Staffing.procedures decide on the appropriate number of full-time employees (FTEs)
to be hired in each skill class (RN, LPN, aides). Staffing decisions are generally made
annually, although taking seasonal variations into account; thus staffing decisions are
tactical.
Scheduling establishes when each staff (nurse) will be on or off duty, and on
which shifts they will work. Weekends, work stretches, vacation requests, and
potential sick days are all important considerations in scheduling decisions, which are
generally considered to be operational. The third component is the reallocation of
human resources, which fine-tunes the previous two decisions. Reallocation is a daily,
if not a shift-by-shift decision. The number of float nurses needed on each unit is
determined daily according to unforeseen changes in need as classified by a patient
acuity system.
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Although staffing, scheduling, and reallocation are the core responsibilities of

workload management, other tasks, other dimensions too, are important. The
development of workload standards, for instance, is a prerequisite for effective
workload management. Both workload management and workload standards
development significantly affect productivity and productivity-related variables:
staffing costs, job-satisfaction levels, and staff utilization. The following sections
examine each of these aspects of workload management more closely.

7. Principles of workload management

Workload management is underpinned by the following principles:

Managing workloads and the change that occurs in workplaces on a daily basis
is the responsibility of managers and forms part of normal business and project
planning processes.
The maintenance of safe work environments and safe work practices, and
adherence to workplace health and safety legislation/policy are a priority
objective of workload management.
Workload management processes must comply with hospital legislation,
awards and agreements including hours of work and remuneration provisions.
Workload management and associated workload allocation supports the
pursuit of strategic priorities, and is to be linked to business, operational and
workforce planning processes in addition to individual performance
management processes.
Workload management decisions should take account of the work-life balance
of employees.
To ensure the various local and business area needs are met, agency flexibility
and discretion is to be maintained in applying workload management
processes.
Workloads are to be equitably distributed in an open and transparent manner
with both managers and employees having accountability for effective
workload management.
Employees and managers understand and accept that in each workplace there
can be natural peaks and troughs in terms of workload that is associated with
service delivery requirements.
Employees should not be required to undertake work that significantly and
regularly exceeds ordinary working hours unless exceptional circumstances
exist such as: an urgent or unexpected high volume of work of a short term

nature and/or for a specified period of time; or where there are critical
community service requirements e.g. emergency management services.
Workload allocation should take into account the training, skill, knowledge,
career and professional development of individual employees.
Workload management is to be informed by effective identification and
analysis of data/information and accurate and consistent performance
reporting within the context of the business function.
Workload management processes should coincide with and complement other
workforce management programs or processes e.g. flexible work
arrangements, worker health and wellbeing programs, organizational change,
workforce renewal programs, voluntary redundancy etc.
The processes undertaken and the information collected as part of workload
management must take into account the privacy of, and confidentiality of
issues raised by, individual employees

7. Measurement of Nursing Workload :

Nursing workload measures can be categorized into four levels: (1) unit level,
(2) job level, (3) patient level, and (4) situation level. These measures can be
organized into a hierarchy. The situation- and patient-level workloads are embedded
in the job-level workload, and the job-level.
8.1.

Workload at the Unit Level

The most commonly used unit-level workload measure is the nurse-patient

ratio. The nurse-patient ratio can be used to compare units and their patient outcomes
in relation to nursing staffing. Previous research provides strong evidence that high
nursing workloads at the unit level have a negative impact on patient outcomes.7, 12,
13 These studies suggestions regarding improving patient care are limited to
increasing the number of nurses in a unit or decreasing the number of patients
assigned to each nurse. However, it may not be possible to follow these suggestions
due to costs and the nursing shortage. The major weakness of this type of research is
that it conceptualizes nursing workload at a macro level, ignoring the contextual and
organizational characteristics of a particular health care setting (e.g., physical layout,
information technology available) that may significantly affect workload. Research
should examine the impact on nursing workload of work factors in the health care
microsystems.

8.2.

Workload at the Job Level

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According to this conceptualization, the level of workload depends on the type

of nursing job or specialty (ICU nurse versus operating room nurse). For instance,
Schaufeli and LeBlanc14 used a job-level measure of workload to investigate the
impact of workload on burnout and performance among ICU nurses. Previous
research linked job-level workload (a working condition) to various nursing
outcomes, such as stress15, 16 and job dissatisfaction.17 Workload measures at the
job level are appropriate to use when comparing workload levels of nurses with
different specialties or job titles (ICU nurses versus ward nurses).18 However,
workload is a complex, multidimensional construct, and there are several contextual
factors in a nursing work environment (e.g., performance obstacles and facilitators)
other than job title that may affect nursing workload.19 In other words, two medical
ICU nurses may experience different levels of workload due to the different
contextual factors that exist in each ICU. The workload at the job-level
conceptualization fails to explain the difference in the workloads of these two nurses.
8.3.

Workload at the Patient Level

This conceptualization assumes that the main determinant of nursing workload

is the clinical condition of the patient. Several patient-level workload measures have
been developed based on the therapeutic variables related to the patients condition
(e.g., Therapeutic Intervention Scoring System)15, 20, 21 and have been extensively
discussed in the nursing literature. However, recent studies show that factors other
than the patients clinical condition (e.g., ineffective communication, supplies not
well-stocked) may significantly affect nursing workload. As with the previous two
workload measures, patient-level workload measures have not been designed to
measure the impact of these contextual factors on nursing workload.
8.4.

Situation-Level Workload

To remedy the shortcomings of the three levels of measures explained above

and complement them, we have suggested using another way to conceptualize and
measure nursing workload based on the existing literature on workload in human
factors engineering: situation-level workload.11 In addition to the number of patients
assigned to a nurse and the patients clinical condition, situation-level workload can
explain the workload experienced by a nurse due to the design of the health care
microsystem. In a previous study, we found that various characteristics of an ICU
microsystem (performance obstacles and facilitators)such as a poor physical work
environment, supplies not well stocked, many family needs, and ineffective
communication among multidisciplinary team memberssignificantly affect
situation-level workload.22 For example, sometimes several members of the same
family may call a nurse separately and ask very similar questions regarding the same
patients condition. Answering all these different calls and repeating the same
information about the patients status to different members of the family is a
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performance obstacle that significantly increases the (situation-level) workload of

nurse.
It is important to note that the impact of this performance obstacle on nursing
workload would not be apparent if we used a unit-level or patient-level workload
measure. Compared to workload at the job level, situation-level workload is
temporally bound: it explains the impact of a specific performance obstacle or
facilitator on nursing workload over a well-defined and relatively short period of time
(e.g., 12-hour shift), rather than using the overall experience of the nurse in a given
microsystem. Situation-level workload is multidimensional, that is, different types of
performance obstacles and facilitators affect different types of workload. Whereas the
distance between the patients rooms assigned to a nurse affects physical workload,
the condition of the work environment (noisy versus quiet, hectic versus calm) affects
the overall effort spent by the nurse to perform her job.23 No prior study investigated
the impact of the microsystem characteristics on situation-level nursing workload.19
In summary, by studying workload at the situation level, researchers can identify the
characteristics of a microsystem that affects workload. This information is vital for
reducing nursing workload by reduce.

9. Outcome of workload
Studies continue to reinforce the findings of the early studies by Aiken et al.
(2002) and Needleman et al. (2002) that nurse staffing impacts what happens
topatients. In a Californian study, increases in hospital nurse staffing were
associatedwith reductions in mortality (Harless& Mark, 2010).In a US study of
hospital administrative data, Needleman et al. (2011) looked at mortality in situations
where nurse staffing was frequently eight hours or more belowthe recommended
standard. An increased risk of death occurred in agencies that were frequently staffed
below standard. A risk of increased mortality also occurred on units with high patient
turnover. This may relate to the increased time demands on nurses for admission and
discharge assessments, interaction with patients and families, and the need for
immediate development of plans of care and discharge plans that arise when patients
are admitted, discharged and new patients admitted to units over the course of a shift
(Needleman, Buerhaus, Pankratz, Leibson& Stevens, 2011).
Increased nurse staffing was associated with lower hospital-related mortality
in intensive care, surgical and medical units in a summary of 28 international
studiesStudies in critical care units support the findings on non-critical care units. A
2010 systematic review of 26 research studies in critical care found decreased staffing
in intensive care units, associated with increased adverse events in virtually all studies
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(Penoyer, 2010).Studies have also addressed specific nursing outcomes, including

nosocomial (hospital-acquired) infection, readmission, falls, failure to rescue, length
of stay, medication errors, and patient satisfaction in relation to patient outcomes.
9.2.

Nosocomial infection

Nurse staffing impacts infection rates. A recent Canadian study found that
higher nursing staffing levels predicted fewer occurrences of methicillin-resistant
staphylococcusaureus (MRSA) infection (Manojlovich, Souraya,
Antonakos, 2011).
9.3.

ovell &

Readmission

Studies continue to show that improving nursing staffing reduces the incidence
of readmission. In a recent US study, researchers found an increase of 0.71 hours
in RN hours per patient day (RNHPPD) was associated with 45% lower odds of
an unplanned emergency room (ER) visit after discharge. In contrast, a 0.08-hour
increase in registered nurse overtime was associated with a 33% increase in the odds
of an unplanned patient ER visit (Bobay, Yakusheva& Weiss, 2011).
9.4.

Falls

In a 2011 study of patient falls in military hospitals in the United States, a

greaterproportion of RNs relative to unlicensed assistive personnel was associated
withfewer falls in medical-surgical and critical care units. Higher nursing care hours
perpatient per shift were significantly associated with a decreased likelihood of both
fallsand falls with injury. Increased falls were associated with increased acuity on
medical surgical units. A higher patient census was related to more falls in both stepdownand medical-surgical units (Patrician, Donaldson, Loan, Bingham, McCarthy,
Brosch&Fridman, 2011).
9.5.

Failure to rescue

Failure to rescue is a nursing care indicator of death of a patient, usually

believedto be related to a failure to observe, recognize or act on complications
(Shever, 2011). Studies show that the number of times a nurse observes and assesses a
patient in a day directly influences patient health outcomes. Researchers refer to these
assessments and observations as nurse surveillance, defined as intentional, ongoing
acquisition, interpretation, and synthesis of patient data for clinical decision making.
The amount of nurse surveillance possible is, of course, clearly contingent on the
level of nurse staffing. A recent US study indicated that when nursing surveillance
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was performed an average of 12 times a day or greater, there was a significant

decrease in the odds of experiencing failure to rescue (Shever, 2011).
9.6.

Length of stay

Proper nursing staffing can reduce patients length of stay. In a systematic

reviewof 17 studies addressing patient length of stay and hospital costs, all studies
thatlooked at the relationship between nurse staffing and length of stay found that
thehigher the number of nursing hours, the shorter the length of stay
(Thungjaroenku,Cummings &Embleton, 2007). A US study found that length of stay
was shortenedby 24% in ICUs and by 31% in surgical patients with an increase of one
RN per patientday over baseline staffing (Kane et al., 2007). Length of stay is a major
factor in thecost of hospitalization. The Canadian Institute for Health Information
estimated thatthe average hospital stay cost $6,983 in the baseline year 2004
(Canadian Institutefor Health Information, 2009).
9.7.

Medication errors

There is significant evidence indicating that improved nurse staffing and

hoursof work reduce medication errors. A 2009 US study found a higher likelihood
ofmedication errors when nurses experienced higher patient care demands (Holdenet
al., 2011). A 2010 US study found that nurses who worked more than 40 hours
perweek were 28% more likely to report that patients occasionally/frequently
receivedthe wrong medication or dose. For every additional hour of overtime worked
eachweek, the likelihood that a nurse reported occasional/frequent wrong medication
ordose administration increased by 2% (Olds & Clarke, 2010).
9.8.

Patient satisfaction/patient experience

Nurses are key players in the patient experience. A foundational study in

healthhuman resources in Canada in 2001 reported that nurses job satisfaction was
thestrongest predictor of patient satisfaction (Baumann et al., 2001).There is a clear
relationship between nursing workload, quality of nursing work life, and patient
satisfaction. In other words, many of the tools necessary to improve the patient
experience are already in our hands.The research findings with respect to nursing
workload and patient outcomes areconsistent and conclusive. But so too are the
findings with respect to the impact ofnursing workload on nurses themselves. The
negative impact of excessive workloadand poor quality workplaces has been known
for many years. The author of the 2002Canadian Nursing Advisory Committee
Report, Dr. Michael Decter, introduced thereport with this statement:
9.9.

Burnout

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Nurse Alia Accad, an expert on nurse burnout, eloquently sums up the

issue. :In 40 years specializing in stress and burnout, one thing is clear to me
burnout isthe result of people working in conflict with their deepest values. Nurses
have thecapacity to work tirelessly and hard for years when they feel good about
themselvesand the value of their work. However, working for prolonged periods with
no personalsatisfaction from the effort is a situation ripe for burnout (Accad,
2009).With their current crippling work assignments, lack of input into how
thoseassignments are determined, and lack of autonomous decision making with
respectto their patients care, nurses are experiencing burnout at unprecedented levels.
They are simply not able to provide the care that they know their patients
need. They are unable to meet their professional, legal and ethical obligations to
patients and their families, and the angst that results takes its toll.Burnout is an
international phenomenon.In a study of 546 nurses from 42 Belgian hospitals,
significant associations werefound between unit-level nursing practice environments
and burnout, job satisfaction,intention to leave, and nurse-reported perceptions of
quality of care (Van Bogaert,Clarke, Roelant, Meulemans& Van de Heyning, 2010).
9.10. Turnover
High levels of nurse turnover pose a significant problem for the health
system.A recent Canadian study on turnover found that the mean turnover rate in
the41 hospitals surveyed was 19.9%. Higher turnover was associated with lower
jobsatisfaction. High levels of role ambiguity and role conflict were associated
withmental health deterioration in the nurses in these agencies. Higher turnover rates
and higher role ambiguity were associated with increased risk of error.
Recent studies report varying but consistently high costs for turnover: an
average of $25,000 per nurse (OBrien-Pallas et al., 2010), or ranging between
$21,514 to as high as $67,100 per nurse (Tschannen, Kalisch& Lee, 2010), or even
1.3 times the salary of the departing nurse (Jones & Gates, 2007). Costs of nurse
turnover include recruitment, advertising, replacement costs during vacancy
(including overtime, bed closure, diversion to other institutions, etc.), hiring,
orientation, decreased productivity, potential patient errors, poor work environment,
loss of organizational knowledge, and additional turnover (Jones & Gates, 2007).
9.11. Fatigue
Nursing fatigue seriously affects the ability of nurses to care effectively for
theirpatients. In a major study on nurse fatigue and patient safety, conducted in
2010,the Canadian Nurses Association (CNA) and the Registered Nurses Association
ofOntario (RNAO) found that nurses reported significant levels of fatigue, defined
asa subjective feeling of tiredness that is physically and mentally penetrative. It
ranges from tiredness to exhaustion, creating an unrelenting overall condition that
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interferes with individuals physical and cognitive ability to function to their normal
capacity. It is multidimensional in both its causes and manifestations; it is influenced
by many factors: physiological (e.g., circadian rhythms), psychological (e.g., stress,
alertness, sleepiness),behavioral (e.g., pattern of work, sleep habits) and
environmental (e.g., work demand). Its experience involves some combination of
features: physical (e.g., sleepiness) and psychological (e.g., compassion fatigue,
emotional exhaustion).
Nurses reported the causes of their fatigue as workload,shift work, including
12-hour shifts and working more than 12 hours in one shift,patient acuity, little time
for professional development and mentoring, a decline inorganizational leadership
and decision-making processes, and inadequate recoverytime during and following
work shifts (Canadian Nurses Association and RegisteredNurses Association of
Ontario, 2010). Clearly, nurses feel a moral obligation to theirpatients, which prevents
them from taking action to address their fatigue levels.
9.12. Absenteeism
The stress in nurses working lives affects their ability to come to work.
Ananalysis of Statistics Canada Labour Force data found that in 2010, an average of
19,200 Canadian nurses were absent from work every week due to illness or
disability. Nine percent of public-sector health care nurses who usually work at least
30 hours per week were absent due to illness or disability every week. This is nearly
twice the rate of all other occupations, and remains higher than all other health care
occupations. The annual cost of Canadian nurse absenteeism due to own illness or
disability was $711 million in 2010 (Canadian Federation of Nurses Unions, 2011).
Issues of excessive workload and poor quality work environments are not only found
in acute care settings.
In a recent Canadian study, 675 RNs, LPNs and other staff from 26 long-term
care facilities were surveyed about their work environment and related factors, as well
as their job satisfaction and turnover intentions. Among the findings, higher job
satisfaction was associated with lower emotional exhaustion, higher empowerment,
better organizational support and stronger work group cohesion. Higher turnover
intention was associated with lower job satisfaction, higher emotional exhaustion and
weaker work-group cohesion (Tourangeau, Cranley,Laschinger&Pachis, 2010).
10. Roll of Nursing manager:
Responsible for development of WMSN(work management system nursing)
education commensurate with the levels of expertise and responsibilities of the
nursing staff.
10.1. Chief, Department of Nursing:
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1. Monitors accuracy & appropriateness of uses of WMSN information.

2. Distributes and redistributes nursing personnel on a short- and long-term basis to
offset nursing care hours (NCHs) deficits.
3. Monitors monthly comparisons of WMSN requirements to the requirements,
authorization, and assigned numbers documented in the TDA, unit IRR scores, and
unit acuity for major changes and trends within the facility.
4. Educates the Commander, Deputy Chief for Clinical Services, deputy chief of
administration, and others involved in hospital administration about the managerial
and manpower implications of the WMSN.
5. Reports WMSN manpower and workload statistics to the command group.
6. Facilitates the development of regulations, policies, and procedures in collaboration
with individuals affected by the system to promote the use of the data to balance
workload and manpower.
10.2. Facility Nurse Methods Analyst:
1. Liaison between the resource management staff and the C, DON.
2. Monitors changes in workload & staffing.
3. Provides trend analysis and identifies factors contributing to fluctuations in
workload for Resource Management Staff and C, DON.
10.3. Executive Level of Nursing:
1. Report nursing manpower and workload statistics to the Command group, and other
key personnel as needed.
2. Provide an overview of staffing trends and patterns.
3. Initiate and expand a nursing pool.
4. Make initial nursing personnel assignments.
6. Justify combining units permanently or temporarily such as during a holiday
period.
7. Justify exclusion from a hiring freeze.
8. Reduce the number of attempts by non-nursing areas to acquire nursing
authorizations.
9. Use with risk management and quality improvement programs.
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10. Budget planning (includes personnel, equipment, supplies etc.)

11. Support and substantiate nursing request for additional assets, i.e., through the
Program Budget Advisory Committee process.
12. Project capability for new missions.
13. Evaluate nursing productivity.
14. Include as part of the performance plan for each nurse.
15. Justify the removal of unit personnel from additional duty rosters due to
shortages.
16. Teach "staff", the management of personnel resources.
10.4. Operations level of Nursing:
1. Improve nursing documentation.
2. Determine areas for cross training.
3. Include as part of the performance plan for each nurse.
4. Recommend changes to the surgery schedule for more efficient utilization of staff.
5. Evaluate nursing productivity.
6. Use as an educational tool for staff management development.
7. Proactive to staff shortages based on the 24 hour staff projection.
8. Adjust staffing on all shifts to improve the utilization of personnel across all shifts.
9. Identify staffing patterns and workload trends.
10. Assist in determining which units have the capability to support additional
workload or temporary missions or projects.
11. Justify the need to cap admissions, redirect admissions, or transfer patients areas
of lesser workload.
12. Justify needs for additional resources or overtime.
13. Improve accountability for personnel.
14. Encourage loaning of staff between units without resentment.
15. Encourage peer review.
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16. Provide objective data when discussing unusual occurrences.

10.5. Current Role
In exploring and describing the current context of the nurse manager role within the
clinical ward/unit this document provides a narrative around the findings.
The following areas of responsibility are broadly summarized as follows:
1.Nurse Managers will be responsible for providing advice and support to
employee(nurses) relating to the implications of workload issues and processes.
2. It is the responsibility of managers and supervisors to work with nurses to review,
plan for, implement, address issues and report on workload management in an open,
consultative, fair and reasonable manner. In addition, managers/supervisors have an
obligation to ensure safe work practices are undertaken and adhered to and
consequently safe work environments are maintained.
3. It is the responsibility of nurses to assist managers/supervisors and contribute to
reviewing, planning for, implementing, addressing issues and reporting on workload
management within their work team, unit or business function. In addition,nurses
have an obligation to apply safe work practices as a means of maintaining safe work
environments
Leadership of Clinical area
Patient flow
Standard of care
Driver of model of care
Patient and family advocate
Discharge planning
General management of
Human resource and staff
Budgeting
Unit equipment and maintenance
Communicating with others
Clinical governance

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 Occupational health and safety

Quality projects, research
Audits
Complaints and incident investigation
Incident management and monitoring
Risk and hazard identification
Accreditation
Leadership
Role modelingbehavior
Review findings
Leading the team
Professional development
Change management
Other (mainly rural and remote but not limited to these facilities)
Travel, accommodation arrangements for staff/patients
Escorting patients via ambulance
Overseeing vehicle maintenance and control
Counseling of staff
On-call
Public relations

10.Barriers
1. Barriers are described as things which inhibit the ability of the individual
nurse manager to perform the job to the level of their own satisfaction. These
include but are not limited to:
2. Lack of understanding and expectation of the role by:
Self

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3.
4.

5.
6.
7.

Organization (includes nursing staff, medical, allied health and executive

management team)
Inconsistencies in the role across QH
Lack of staff:
Recruitment processes are long and time consuming
Shortage of and temporary positions.
Skill mix limiting opportunity for succession planning/requiring constant
presence in clinical unit of Clinical Nurses and NUM.
Nurse managers counted into clinical hours.
Lack of resources and ability to influence budget.
QH processes for fostering, payroll, financial management, reporting.
Professional development within role:
Limited to ad-hoc courses/workshops.
Tertiary study within own time

11.Conclusion:

The relationship between nursing workload and patient safety is based on the
systemic, organizational impact of nursing workload: a heavy workload experienced
by a nurse not only affects this nurse, but can also affect other nurses and health care
providers in the nurses work system. Understaffing may reduce time nurses have to
help other nurses. Nursing workload is affected by staffing levels and the patients
conditions, but also by the design of the nurses work system. Therefore, indicators of
nursing workload have become increasingly necessary in order to assure patient
safety, to improve quality of care and to balance cost-effectiveness of hospital.
Evaluation of the nursing workload and consequently of the patient care needs, is a
prerequisite for the adequate allocation of staff in hospital. This can be explained by
the fact that an oversized team becomes more expensive, whereas reduced staff may
imply a decrease in care efficacy/ quality, prolonging hospitalization and increasing
the cost of patient treatment (Aiken et al., 2002; Guccione et al., 2004; Miranda,
1999). Thus, considering that the assessment of nursing workload is relevant for
planning nursing care and adapting human resources to the patients requirements.
11. Reference:

1. Berry L. PhD & Curry P. (2012), Nursing workload and patient care.(p29-39,47,48,75-77)
2. Neill D. Nursing workload and changing healthcare environment: A review
literature

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3. Mugisha F.J.&Namaganda G Using the work load indicator of staffing

needs(WISN) methodology to asses work pressure among the nursing staff
of Lacor hospital, Faculty of health science, Uganda Martyrs University.
4. Carayon P. &Gurses P.A. Nursing workload and patient safety- A human
factors engeneeringperspection.
5. Twigg D. & Duffield C.(August,2008) A review of workload measures: A
context for a new staffing methodology in western Austrilia.
6. Gerolama G.A. & Roemer F.G.(April,2011)workload and the nurse
faculty shortage: Implication for policy and research.
7. CarayonP.,Alvarado J.C. &Hundt S.A. (2003) Reducing workload and
increasing patient safety through work and workspace design.

Assignment
on

Workload of nursing staff and the role of nurse manager

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Subject: 111541 Human Resource Management in

Nursing Organization
Date: 11/12/2012

Submitted toAssist. Prof. Dr. AreerutKhumyu

Nursing Faculty, BUU.
Submitted byBishwajit Mazumder
ID No- 55910278
Nursing Faculty, BUU

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