Improving the effectiveness of the nursing workforce

The objective of this paper is to set out the key findings and implications from an analysis of the activity and workload of nurses of different grades. This is with a view to identifying nursing skill mixes and working practices that may reduce workforce demand for more highly skilled nursing staff. The research utilises a large data set collected across some 30 hospitals as part of a nursing workload classification system (NISCM – Nursing Information System for Change Management). ‘Activity’ refers to the amount of time in a shift spent on different types of tasks by nurses and ‘workload’ refers to the number of patients on wards by ‘demand’ group. The classification of patients to demand groups, which is an integral part of NISCM, is based on the observation in each ward of the number of minutes required for patients with differing dependency/demand levels. The ‘activity’ evidence presented in this report is based on data from 5,208 staff recording their activity in 535 shift blocks ( a ‘block’ is the same shift over 7 days) in 19 hospitals; whilst the ‘workload’ evidence is based on data from 38,585 shifts in 90 wards in 17 hospitals. It should be emphasised that most of the data is ‘timeless’ – in the sense that nursing interventions and general skill profiles changes very little over the 1990s and, as we shall show, little variation in the patterns of activity or in the skill mix on the wards, can be attributed to the year in which the data were collected. The original questions posed at the beginning of this exercise are given in Annex I. The ultimate aim of this analysis is to develop appropriate and relevant strategies for changing skill mixes in terms of the balance of staff groups deployed.