Research On The Calculation Of Nursing Manpower Cost In The Nursing Home Based On The Workload Of Nursing

[Objective]To measure nursing workload based on the RBRVS,and to form a nursing workload evaluation index system for long-term care projects in conjunction with the actual supply of long-term care projects in elderly care institutions,and to further establish a method for accounting for nursing manpower costs in elderly care institutions,so as to provide a reference basis for the rational allocation of nursing human resources,the allocation of nursing performance and the setting of reimbursement standards for long-term care projects.[Methods]1.Using convenience sampling,a whole group of four elderly care institutions in Jiangsu Province were selected to measure the working hours of long-term care items through an on-site survey method,to screen out the items to be accounted for in terms of nursing manpower costs and to calculate the average working hours.2.Using the RBRVS as a guide,a framework of nursing workload evaluation indicators for long-term care programs was developed through literature review and focus group discussions,and this was used as a tool for expert correspondence to construct a nursing workload evaluation indicator system for long-term care programs.3.Using a convenience sample of eight elderly institutions in Jiangsu and Zhejiang provinces,a questionnaire survey was conducted on elderly nurses in the institutions to analyze the nursing workload of long-term care programs in four dimensions:time consumption,skill consumption,labor consumption and risk taking,and the stability of the assessment model was tested by regression models,while the relative value ratio was calculated based on the workload assessment results.[Result]1.The results of measuring the working hours of long-term care items:①General information of nursing staff in elderly institutions:a total of 340 nurses and caregivers on duty in four elderly institutions in Jiangsu Province were surveyed;the nurses were generally younger and had lower titles;the caregivers were generally older and less educated,and the proportion of unlicensed workers was high;②General information on elderly people in elderly institutions:989 cases of elderly people were assessed,and a total of 938 valid questionnaires and corresponding elderly people’s working hours measurement data were eventually collected;③ Ability assessment of elderly people in elderly institutions:93.6%of the 938 elderly people in four elderly institutions were mildly disabled or above;④Distribution of direct care working hours of elderly people with different ability levels:the average working hours of direct care items for elderly people with intact ability,mildly disabled,moderately disabled and The average working hours of direct care items for the elderly with severe disability were(8.17±14.55)mins,(18.29±18.10)mins,(53.44±27.32)mins,(87.57±27.32)mins respectively;comparative analysis of direct care working hours:the different ability levels of the elderly were related to excretion,diet,cleaning,assistance with activities,medication administration,nursing assessment and monitoring.,medication administration,nursing assessment and monitoring,risk protection,airway management and sleep were statistically different from each other in terms of total direct nursing work hours for each of the nine major categories;⑤Screened long-term care items and average working hours:a total of 36 long-term care items were finally screened,of which 20 daily living care services,14 specialist care services and 2 health management services,with the average working hours of all long-term care items ranging from 0.57 to 9.37 minutes.2.The results of the long-term care project nursing workload evaluation index system:a total of 15 experts were consulted in two rounds,and the return rate of the questionnaires in each round was 100%,the authority coefficients of experts were 0.87 and 0.90 respectively,the Kendall’s consistency coefficients were 0.230 and 0.252 respectively,and the coefficients of variation of the indicators in the two rounds were between 0.10-0.28 and 0.07-0.17 respectively.The final result is a nursing workload evaluation index system consisting of four primary indicators of time consumption,technology consumption,labour consumption and risk taking and nine secondary indicators of long-term care projects.3.Results of the nursing manpower costing methodology for long-term care projects:①General information on nurses in nursing institutions:154 nurses on duty in 8 nursing institutions in Jiangsu and Zhejiang provinces were surveyed,with a valid return rate of 94.8%and 146 questionnaires finally included;② The total Cronbach’s alpha coefficient of the questionnaire was 0.837,the item-level The content validity(item-level CVI,I-CVI)ranged from 0.833 to 1,and the scale-level CVI(S-CVI)was 0.875;the total nursing workload and time consumption(r=0.606,p<0.01),skill consumption(r=0.858,p<0.01),labour consumption(r=0.866,P<0.01),and risk-taking(r=0.7709,P<0.01);regression analysis showed that the four dimensions of time consumption,skill consumption,labour consumption and risk-taking selected for this study explained 91.4%of the total nursing workload,passing the F-test(F=93.530,P=0.000<0.05).③"Toileting assistance",which had a low coefficient of variation and a medium cumulative value,was included as a reference item,and the relative value ratio of nursing workload for the 36 long-term care items ranged from 0.24 to 5.20,which was substituted into the nursing manpower costing formula.[Conclusion]1.This study measured the working hours of long-term care programmes in elderly care institutions.The items included in this study were selected on the basis of the research conducted by the research team in the field and the pilot projects recommended by the National Health Care Commission.The average working hours of long-term care projects are based on information technology data collection methods,measuring a large multi-centre sample of data obtained from a number of elderly care institutions of different nature,and the data results are authentic,reliable,scientifically accurate,and have good representativeness and generalizability.2.The index system for evaluating the nursing workload of long-term care projects constructed in this study is based on the RBRVS concept,combining the indicators of the original system at home and abroad,and improving and streamlining the update according to the actual operation within the elderly institutions,including multi-dimensional resource input of labour time and labour intensity,which is more applicable and scientific.3.The manpower costing formula for long-term care projects developed in this study is easy to calculate by substitution and can be adjusted flexibly according to the actual care cost budget and total workload of each institution and region.The manpower cost obtained based on the multi-dimensional care workload measurement helps to solve the misalignment of cross-subsidies between high-and low-difficulty care projects and to price the projects in a reasonable and fair manner.