Determining Nurse Staffing By Classifying Patients Based on their Nursing Care Needs

Sung-Hyun Cho; Ji-Yun Lee; Kyung Jin Hong; Hyo-Jeong Yoon; Won-Hee Sim; Moon-Sook Kim; Iksoo Huh

doi:10.11111/jkana.2020.26.1.42

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Cho, Lee, Hong, Yoon, Sim, Kim, and Huh: Determining Nurse Staffing By Classifying Patients Based on their Nursing Care Needs

Original Article

Journal of Korean Academy of Nursing Administration 2020; 26(1): 42-54.

Published online: 31 January 2020

DOI: https://doi.org/10.11111/jkana.2020.26.1.42

Determining Nurse Staffing By Classifying Patients Based on their Nursing Care Needs

Sung-Hyun Cho¹

, Ji-Yun Lee², Kyung Jin Hong³, Hyo-Jeong Yoon⁴, Won-Hee Sim⁵, Moon-Sook Kim⁶, Iksoo Huh⁷

¹Professor, College of Nursing · Research Institute of Nursing Science, Seoul National University, Korea.

²Professor, College of Nursing, Kangwon National University, Korea.

³Assistant Professor, Department of Nursing, Semyung University, Korea.

⁴Researcher, Research Institute of Nursing Science, Seoul National University, Korea.

⁵Director of Outpatient Nursing Department, Seoul National University Hospital, Korea.

⁶Director of Medical Nursing Department, Seoul National University Hospital, Korea.

⁷Assistant Professor, College of Nursing · Research Institute of Nursing Science, Seoul National University, Korea.

Corresponding author: Cho, Sung-Hyun. College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8821, Fax: +82-2-765-4103, sunghcho@snu.ac.kr

Received 12 September 2019 Revised 22 October 2019 Accepted 22 October 2019

Korean Academy of Nursing Administration

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine nurse staffing by classifying patients based on their nursing care needs and to benchmark current staffing against the Safer Nursing Care Tool (SNCT) staffing requirements.

Methods

Cross-sectional data were collected from four general wards at a tertiary hospital. Nursing activities conducted by 86 registered nurses were observed at 10-minute intervals. The nursing care needs of 780 inpatients were measured with two dimensions: acuity (10 nursing activities) and dependency (four activities of daily living).

Results

Nurses worked for 9.3 hours per shift on average, reflecting overtime work of 1.3 hours per nurse. Nurses spent 37% of their time on direct care, 54% on indirect care, and 9% on associated work. Nursing hours per patient day increased as nursing care needs became higher. Patients were classified into four groups based on their level of nursing care needs. The staffing ratio of groups 1-4 was 1:9.8, 1:8.0, 1:7.0, and 1:4.6, respectively. The current staffing (i.e., nursing hours) was as low as 53% of the SNCT benchmark, resulting in informal caregiving by patients' family or their privately hired attendants.

Conclusion

Appropriate and safe staffing is required to meet patients' nursing care needs and to improve the quality of nursing care.

Keywords: Hospitals, Nurses, Nursing care needs, Safer Nursing Care Tool, Staffing

Figures and Tables

Figure 1

(A) A decision tree result from recursive partitioning approach for classifying patients based on their nursing care needs; (B) corresponding visualization on two dimensional plane of the result.

Table 1

Nursing Activities and Hours Provided by Registered Nurses and Nursing Aides Empty Cells Indicate No Cases

Empty cells indicate no cases.

Table 2

Table 2. Relationships between the Items of the Nursing Care Needs and Nursing Hours per Patient and Shift Provided by Registered Nurses (N=780)

Table 3

Distribution of Patients and Nursing Hours per Patient Provided by Patient Group

NHPPD=Nursing hours per patient day.

Table 4

Comparison of the Current Staffing and the Safer Nursing Care Tool (SNCT) Staffing Benchmark

NHPPD=Nursing hours per patient day; RN=Registered nurse; NA=Nursing aide.

Acknowledgements

We thank Dr. Keith Hurst for providing support with the research methodology in data collection and analysis. We also acknowledge the Clinical Staff (Shelford Group chief nurses) as the source of the Safer Nursing Care Tool materials.

Notes

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT). (No. 2017R1A2B4009241)

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ORCID iDs: Sung-Hyun Cho
https://orcid.org/0000-0002-1365-1879
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