Model Of Nursing Human Resources Allocation In Ophthalmologic Units

Objectives This study was performed to develop a model of nursing human resources allocation in ophthalmologic units(1) Identify Nursing Interventions Classification (NIC) interventions performed by ophthalmologic nurses.(2) Identify and analyze the distribution of nurses’working hours at an ophthalmic unit.(3) Determine the workload of nursing each admitted, surgical, observed and discharged patient(4) Develop a model of nursing human resources allocation in ophthalmologic units based on the required nursing time of each admitted, surgical, observed and discharged patient.Methods Stage I:Identification of nurses’activities,17 nurses in their clinical work for the whole shift was followed to observe all their activities, including nursing activities and non-productive activities, a single list of activities was formed after it was verified by 2 head nurses and 2 registered nurse with 15-year-old working experience in the unit; Each nursing activity in the single list were compared with these definition and with the activities described in each NIC intervention. After this procedure, interventions were classified as direct and indirect care interventions according to the definitions in NIC. Finally a list of nursing interventions was formed. StageⅡ:A work sampling study was conducted during 2013 with the list of nursing interventions. A snapshot of nursing activity and the patient type of this activity was recorded at 10-minute intervals from 7:00 to 17:00 spread over 40 days.Results A total of 19,664 nursing activities were observed and recorded for 400 hours. According to the result in stage I, the activities listed comprised 238 nursing activities. From the 238 listed nursing activities, 211(88.66%) corresponded to the activities described in 56 NIC interventions, including direct care interventions and 18 indirect. According to the result in stage Ⅱ, percentage distribution of nurses’ working time was categorized as follows:24.67%direct care interventions, 32.05% indirect interventions,8.33% unit-related and 34.95% non-productive time. Productivity of nurses and nurse assistants was 70.05% and 63.54%. And the productivity in quantum 8:00 to 9:00 was 81.43% and ranked the first. While the productivity in quantum 12:00 to 13:00 was 53.23% and ranked the last. Nursing time of each admitted, surgical, observed and discharged patient and activities not belonging to the above four is 51.12min,32.21min,20.72min,10.09min and 1341.5min. Daily nursing time of ophthalmologic units equaled to the summation of nursing time for four kinds of patients multiplied by the number of different kinds of patients respectively adding the total time of activities not belonging to the above four. The allowance rate can be divided into four parts. Personal allowance rate was set to 5.00%; fatigue allowance rate was set to 19.00% determined by intensity of nursing work and working environment;delayed allowance rate includes looking for, searching, taking note and waiting and its value was 11.11%;policy allowance rate was 0.The total allowance rate in the current study was 35.11%.The model of nursing human resources allocation in Ophthalmologic units equals to the equation of the daily nursing staffing requirement: (51.12min*the number of admitted patients+32.21min*the number of surgical patients+20.72min*the number of observed patients+10.09min*the number of discharged patients+1341.50min)/8h*60min*(1-35.11%)Conclusion(1) These data shows nurses spent less proportion of time in direct nursing interventions. There is a need to transfer nursing personnel’s-indirect interventions and unit-related activities to nonprofessional personnel.(2)The productivity in study units was 65.06%. Compared with other results available in literature, this index is considered to be lower productivity index.(3)The productivity in study units fluctuates from hours to hours. Nursing staff can be adjusted according to nursing workload of each hour. Measurement should be taken to reduce unavoidable delay time to improve nursing productivity.(4) Results found in the present study reaffirm the need to consider unavoidable time in non-productive activities as well as associated activities inpersonnel allocation methods.(5) This model can predict daily actual nursing staff requirement in ophthalmologic units.