Measuring nurse workload in ambulatory care

nursing time required to care for patients. However, time is not the only factor to consider when measuring nursing workload, a prerequisite for developing ambulatory care nurse staffing models. For this reason , when nurses, managers, and administrators ask about the method for determining the levels and numbers of nursing staff appropriate for delivering quality care in the ambulatory setting, there is no magic solution. Many variables must be considered, and measured , when designing optimal ambulatory nurse staffing models. This is the first of two articles which will provide an overview of definitions and instruments for measuring nursing workload in ambulatory care. In the second article (to be published in an upcoming issue of Nursing Economic$), the use of these instruments for developing ambulatory nurse staffing models and their link with providing quality patient care will be discussed. Patient classification systems originated for utilization review purposes to analyze physician practice patterns and resource consumption of hospitalized patients (Arbitman, 1986). Selected patient classification systems are listed in Table 1. For nursing, patient classification and workload measurement developed to quantify and qualify the variable nature of the demand for nursing care. Nursing workload measurement systems grew out of a necessity to forecast the number of nurses required for care in hospitals on a daily basis. Systems typically include one or more instruments for measuring the time required for direct and indirect nursing care, selected ongoing infrastructure functions of the nursing organization, and the personal activities of the nurse (Edwardson & Giovannetti, 1994). Several comprehensive reviews of the literature relevant to acute care nursing workload measurement systems have been completed (Edwardson & Giovannetti, 1994). Terms used in nursing workload measurement include workload measurement system, nursing workload, patient classification systems, patient classification instruments, activity classification systems , and timed activity classification systems (see Table 2). Review of nursing workload measurement and comparability of instruments in the ambulatory care setting has received limited attention in the literature over the past 25 years.O VER THE PAST 30 YEARS, there has been rapid development of measurement systems for health services resource allocation in the United States, not always matched by using the same definition of concepts, not consistently based on any assessment of reliability or validity and/or thorough understanding of the phenomenon being measured. An example is the development of nursing workload measurement systems for ambulatory care. Although substantial differences exist among the measurement approaches, at …