1. Nursing & Midwifery Workload and Workforce Planning
Approaches to Workload Measurement

2. Workload Measurement a complex area of professional activity
time and effort invested in developing and refining methods of estimating the ‘right’ number of nurses
methods will calculate number of nursing hours required expressed as whole time equivalent (WTE)
no single ‘right’ way - need to use more than one method
workload tools valuable aid to decision making about staffing

3. Determining what data to collect
managers at different levels require data at different levels of detail
at ward level require detailed data to inform staff deployment, e.g. number of nurses required to cover the workload by W.T.E. and skill mix
NHS organisations require aggregate data to compare:
nursing workload across specialties
in the same specialties between hospitals
for the same case mix type between hospitals
community workload in different localities

4. Uses for Workload Data historical workload data can be used for:
short-term planning, e.g. rostering
long-term planning, e.g. establishment setting and skill mix
retrospective analysis and audit purposes
practical and operational decisions about patient care, e.g:
how many staff do I need?
what skills are needed to provide effective nursing care?
what staff should be doing what?
how do I ensure workload is equitably distributed?

5. Nursing Activity
direct workload - that which is directly associated with a specific patient;
indirect workload - where it may be patient related but either not specifically to a named patient, or not directly involving the patient; and
associated work - where workload is not patient related at all.

6. Consider the following:
Nurses spend 31-44% of their time in direct patient care activities
Nurses experience an average 8.4 interruptions to or failure of work system per 8 hour shift
medications, orders, supplies, staffing, equipment
Nurses spend 42 minutes of each shift resolving operational failures ( Tucker and Spear 2006)
Think about your own, or someone else’s area of practice and the activities identified in learning activities 2 and 3: (You may also want to consider any Releasing Time to Care information you have)
What activities are carried out that do not add value to patient care?
Consider ways to shift the balance of work so that more time is spent on direct patient care, without employing more staff
Think about staff you have and how you might deploy them in a different or better way

7. Workload Measurement Systems
‘Top-down’ approaches
norms and formulae
using expert opinion
‘Bottom-up’ approaches
professional judgement (Telford) approach
nurses per occupied bed
dependency-activity-quality (Acuity-quality)
timed-task/activity approaches
regression-based systems
population benchmarking database

8. Workload Measurement Approach used in NHSScotland
The NHSScotland triangulated approach means that you have three sets of indicators on which to base your judgements.
These are obtained form three sources:
outcome of two workload measurement tools (professional judgement and specific for your area – e.g. adult acute)
present funded establishment data (agreed staffing establishment and skill mix, available from your line manager)
clinical quality indicator evidence – SCN review

9. Workload Measurement Approach used in NHSScotland
Specific tool
Professional judgement
Funded and actual establishment
Local context
Quality
Local context includes:
integrated workforce planning
skills base
speciality mix
model of care