Measuring nursing workload: a cautionary tale

The need to develop methods of measuring nursing workload is not new, but the search for accurate measures to calculate the demand for nursing has assumed greater significance in recent years owing to the advent of resource management and the necessity to manage efficiently the most costly resource in the NHS; that of nursing. Currently there are 23 Nurse Management Systems available to choose from and of these, some are ward nurse tracking systems/nurse deployment or rostering systems, some are designed to provide workload requirements, and others, which tend to be those introduced most recently, serve a care-planning function. This paper examines the methodologies and instruments used for measuring nursing workload and describes the rationale for selecting four Nursing Workload Management Systems (NWMs) for review. Integral to every NWM calculation is a series of parameters or assumptions. These parameters are derived, in most cases, from the results of activity analysis undertaken at the site where the chosen NWM is being implemented. The choice of basic parameters appropriate to individual wards/units is a crucial factor in the derivation of workload estimates and the financial consequences of these choices can range from £28,000 to £64,000 per annum per ward. There is general agreement that efficient nursing utilisation is becoming increasingly urgent in the “new” NHS. Whilst the reliability of all NWM systems is being questioned in the USA, criticism of NWM systems in the UK tends to be confined to certain aspects of a particular system or approach rather than to workload measurement as a whole. This UK perspective must be widened by the recognition of the fundamental weaknesses of reliability and consistency of NWM systems.