Dynamic Allocation Of The Nursing Human Resources In A Tertiary Hospital In Shanghai

ObjectiveAccording to the requirements of national health regulatory and nursing humanresource allocation situation in our country, the paper aims to1) explore the index frameof nursing workload suit for the nursing service mode to provide scientific and effectivetool for measuring accurate nursing workload.2) study the main factors of the nursingworkload based on patients’ needs, being as patient classification index to provide amethod for scientifically forecasting nursing hours and human resources needs.3)preliminary design the framework structure of the software of nursing dynamic allocation,and lay a solid foundation for the realization of the scientific, rational, dynamic andconvenient nursing human allocation.MethodsAfter literature study and expert consultation to set up the item pool for the indexframe of nursing workload, this paper forms the nursing workload index frame to15experts by Delphi methods twice. This study selected4wards by random sampling andpurpose sampling, and measured the nursing time for28days. In the result, nursing grade,ADL grade (Activities of Daily Living, ADL), the disease severity, and surgery type aredescribed as the percentage. Daily direct nursing times of different kinds of patients areused as the x±s, median. The Kruskal-Wallis and Nemenyi test are used to compare thedirect nursing time between patients characterized by different nursing grade, ADL grade,the disease severity and the surgery type in the same ward. Multiple regression analysisfor influencing factors of daily direct nursing time and get the main factors for patientclassification. The daily total direct nursing time of different kind of patients and thedaily total indirect time are developed as the time module of the software to be designedout.Then, analyzing the nursing manpower productivity (NMP) between the total nursingtime needed by the patients and actual time offered by the nurse every day, and dividingthe warning intervals of the staff excessive and insufficient situation to provide the basisfor nurse dynamic allocation. ASP.NET was applied for the design and development ofthe software of nursing dynamic allocation.Results1. Setting up the index system of nursing human resources allocation and nursing workload linkage through Delphi methods twice. It includes5domains of direct nursingworkload: nursing evaluation, basic nursing, therapeutic nursing, health education, andspecialty nursing, which is96direct items totally; and5domains of indirect nursingworkload: nursing documents ward management, disinfection and isolation, nursingteaching, and preparation for treatment, which is19indirect items totally.2. Measuring the nursing time for4988patients in4wards based on the item from theindex frame of nursing workload. It reaches the conclusion that the nursing grade, ADLgrade, disease severity and surgery type, may be the influencing factors on the directnursing time; after multiple regression analysis, the nursing grade, ADL grade, diseaseseverity are the main factors for the patients in department of Neurology and digestiveinternal medicine, as well as preoperative patients in neurosurgical and general surgicaldepartment; however, only the ADL grade and disease severity for postoperative patients inneurosurgery and general surgery department,but surgery type is excluded in the regressionequation, it is not as the main factors of the patients daily direct nursing time.3. Classifying the patients in accordance to the main factors of nursing workload indifferent wards, and establishing time sheets of direct nursing time for every type ofpatients and the total indirect nursing time in every ward. Thus, put forward the NMPbased the ratio of the nursing time needed by the patients and offered by the nurses. WhenNMP<0.95, the warning is green, which prompts that human resource has a surplus, andthe head nurse can withdraw some personnel scheduling.When0.95<NMP<1.05, thesituation is almost balanced, there is no need to adjust.When1.05≤NMP≤1.1, the bluewarning prompts that the lack of nurse isin the minor level, and the head nurse can adjustwithin the ward. When1.1<NMP≤1.2, the yellow warning prompts that the lack is in themiddle level, and the chief head nurse adjust it where she is responsible for all wards.When NMP>1.2, the red warning prompts the lack is in the severe level, and it should beadjusted from the whole hospital level by nursing department.4. According to the establishment of nursing time sheets and warning interval,preliminary design the software framework of nursing human resource dynamic allocation,including making the dynamic allocation process, developing the plan of softwaretechnology program, envisaging the composition of software modules, to provide anapproach for the dynamic allocation of nursing human resources.Conclusion1. The index frame of nursing workload with based on Delphi methods, which is of the science, comprehensiveness and practicality, can be used as an effective tool for nursingworkload measurement.2. The nursing grade, ADL grade, and disease severity are the main influencing factorson the patients classification, which can reflect the needs of different kinds of patients, andpredict nursing manpower scientifically.3. The NMP prompts the saturated conditions of nursing human allocation, and dividesdifferent warning intervals, which provide the scientific basis for reasonable arrangementsfor nursing human resources.4. The development of nursing human resource allocation software can realize thedynamic allocation of the nursing human resources in science, rationality, dynamic andconvenience, provide the management efficiency and the job satisfaction of nurses.