Ana Cristina Rossetti

Nursing workload in the emergency department: a methodological proposal

OBJECTIVE This study aimed to propose a methodology for identifying the nursing workload in the Emergency Department (ED). METHODS this is methodological research, undertaken in a public general hospital in the municipality of São Paulo, Brazil, in the areas: triage, shock room, emergency room, suturing room, and medication/procedures for adult and pediatric patients rooms, using different strategies and instruments. Due to the characteristics of the data collection, distinct samples were obtained in each of the areas. RESULTS The average daily workload, in hours, corresponded to: triage 48; shock room 30.9; emergency 170.6; observation of adult patients 293.6; observation of pediatric patients 108.7; medication/procedures in adult patients 175.5; medication/procedures in pediatric patients 60.4; and suturing 7.9. CONCLUSION The instruments used for data collection were shown to be appropriate and made it possible to construct a methodological proposal for identification of workload of nursing professionals in E.D. in a general public hospital.OBJETIVO: neste estudo o objetivo foi propor metodologia para identificar a carga de trabalho de enfermagem em pronto-socorro (PS). METODOS: trata-se de pesquisa metodologica, realizada em PS de hospital geral publico, no municipio de Sao Paulo, nas areas: triagem de risco, salas de choque, emergencia, sutura, medicacao/procedimentos de pacientes adultos e pediatricos e observacao de pacientes adultos e pediatricos, utilizando-se diferentes estrategias e instrumentos. Pela caracteristica da coleta de dados, obtiveram-se amostras distintas em cada uma das areas. RESULTADOS: a carga media diaria de trabalho, em horas, correspondeu a triagem de classificacao de risco 48, choque 30,9, emergencia 170,6,observacao de pacientes adultos 293,6, observacao de pacientes pediatricos 108,7, medicacao/procedimentos de pacientes adultos 175,5, medicacao/procedimentos de pacientes pediatricos 60,4 e sutura 7,9. CONCLUSAO: os instrumentos utilizados para coleta de dados mostraram-se adequados, possibilitando a construcao de proposta metodologica para identificacao de carga de trabalho dos profissionais de enfermagem em PS de hospital geral publico.

Nursing care time in the Intensive Care Unit: evaluation of the parameters proposed in COFEN Resolution Nº 293/04

This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in Sao Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in São Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.

Estimating the nursing staff required in a new hospital

Opening a new hospital poses a complex and consequential set of challenges. One of these challenges is to estimate the nursing staff. The aim of this article is to report the entire process adopted to estimate the required nursing staff for a new Hospital in Brazil. The nursing staff was projected according to the Brazilian Federal Nursing Council (Cofen). We applied an equation to estimate nursing staff and compared the results with two other existing hospitals. A significant difference (p<0.05) was observed when comparing the Nurse-License Practice Nurse ratio recommended by Cofen between the new Hospital and other hospitals. This statistical difference is mostly due to reduced nurse staff in intensive care units. Almost one year after the hospital opened its doors, it is necessary to review nursing staff hours with the real information to reinforce the expenditure on these personnel and to evaluate the decisions made so far.Abrir un nuevo hospital es un asunto complejo y sujeto a consecuencias. Uno de los desafios es estimar el personal de enfermeria. El objetivo de este trabajo es describir el proceso adoptado para estimar el personal de enfermeria en un hospital nuevo en Brasil. El numero de enfermeras del nuevo Hospital fue calculado de acuerdo con el metodo recomendado por el Consejo Federal de Enfermeria de Brasil (Cofen). Los resultados se compararon con dos hospitales similares, ya en funcionamiento. Se encontro una diferencia significativa (p <0,05) con respecto a la relacion entre enfermeras y auxiliares de enfermeria recomendado por Cofen en los tres hospitales. Esta diferencia estadistica se debe principalmente al menor numero de enfermeras en las unidades de cuidados intensivos. Casi dos anos despues de su apertura es necesario revisar el numero de enfermeras teniendo en cuenta la informacion real para justificar el coste de personal y evaluar las decisiones adoptadas hasta el momento.Abrir um novo hospital e desafio complexo e passivel de consequencias. Um desses desafios e estimar o quadro de pessoal de enfermagem. O objetivo deste artigo foi relatar o processo adotado para estimar o quadro de pessoal de enfermagem em um novo hospital, no Brasil. O quadro de enfermagem desse hospital foi projetado segundo o metodo recomendado pelo Conselho Federal de Enfermagem (COFEN). Os resultados foram comparados com o dimensionamento de dois hospitais semelhantes, ja em funcionamento. Houve diferenca significativa (p<0,05) quando se comparou a relacao enfermeiro/tecnico/auxiliar de enfermagem, recomendada pelo COFEN, nos tres hospitais. Essa diferenca, estatisticamente significante, foi decorrente do reduzido quadro de enfermeiros, nas unidades de terapia intensiva. Apos um ano de sua inauguracao, foi necessario rever o quadro de enfermagem projetado, considerando as informacoes reais para justificar o custo do pessoal de enfermagem e avaliar as decisoes tomadas ate o momento.

Tempo de assistência de enfermagem em Unidade de Terapia Intensiva: avaliação dos parâmetros propostos pela Resolução COFEN nº293/04

This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in Sao Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in São Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.

Estimativa do quadro de pessoal de enfermagem em um novo hospital

Opening a new hospital poses a complex and consequential set of challenges. One of these challenges is to estimate the nursing staff. The aim of this article is to report the entire process adopted to estimate the required nursing staff for a new Hospital in Brazil. The nursing staff was projected according to the Brazilian Federal Nursing Council (Cofen). We applied an equation to estimate nursing staff and compared the results with two other existing hospitals. A significant difference (p<0.05) was observed when comparing the Nurse-License Practice Nurse ratio recommended by Cofen between the new Hospital and other hospitals. This statistical difference is mostly due to reduced nurse staff in intensive care units. Almost one year after the hospital opened its doors, it is necessary to review nursing staff hours with the real information to reinforce the expenditure on these personnel and to evaluate the decisions made so far.Abrir un nuevo hospital es un asunto complejo y sujeto a consecuencias. Uno de los desafios es estimar el personal de enfermeria. El objetivo de este trabajo es describir el proceso adoptado para estimar el personal de enfermeria en un hospital nuevo en Brasil. El numero de enfermeras del nuevo Hospital fue calculado de acuerdo con el metodo recomendado por el Consejo Federal de Enfermeria de Brasil (Cofen). Los resultados se compararon con dos hospitales similares, ya en funcionamiento. Se encontro una diferencia significativa (p <0,05) con respecto a la relacion entre enfermeras y auxiliares de enfermeria recomendado por Cofen en los tres hospitales. Esta diferencia estadistica se debe principalmente al menor numero de enfermeras en las unidades de cuidados intensivos. Casi dos anos despues de su apertura es necesario revisar el numero de enfermeras teniendo en cuenta la informacion real para justificar el coste de personal y evaluar las decisiones adoptadas hasta el momento.Abrir um novo hospital e desafio complexo e passivel de consequencias. Um desses desafios e estimar o quadro de pessoal de enfermagem. O objetivo deste artigo foi relatar o processo adotado para estimar o quadro de pessoal de enfermagem em um novo hospital, no Brasil. O quadro de enfermagem desse hospital foi projetado segundo o metodo recomendado pelo Conselho Federal de Enfermagem (COFEN). Os resultados foram comparados com o dimensionamento de dois hospitais semelhantes, ja em funcionamento. Houve diferenca significativa (p<0,05) quando se comparou a relacao enfermeiro/tecnico/auxiliar de enfermagem, recomendada pelo COFEN, nos tres hospitais. Essa diferenca, estatisticamente significante, foi decorrente do reduzido quadro de enfermeiros, nas unidades de terapia intensiva. Apos um ano de sua inauguracao, foi necessario rever o quadro de enfermagem projetado, considerando as informacoes reais para justificar o custo do pessoal de enfermagem e avaliar as decisoes tomadas ate o momento.

Implantação de sistema informatizado para planejamento, gerenciamento e otimização das escalas de enfermagem

OBJETIVO: Relatar el desarrollo e implantacion de un sistema informatizado para auxiliar en la planificacion, administracion y optimizacion en la elaboracion de los turnos de enfermeria en las unidades de internamiento del Hospital Israelita Albert Einstein. METODOS: Fue desarrollado el Sistema de administracion y Optimizacion de Recursos en la plataforma tecnologica dot.Net de Microsoft®. RESULTADOS: Fue implantado inicialmente en el area de enfermeria con visualizacion on-line de los turnos de las unidades y respectivas demandas de pacientes. Facilita y permite la elaboracion y administracion de los turnos mensuales de trabajo, reduciendo el tiempo utilizado en la confeccion, garantizando de este modo seguridad en la informacion y agilidad en la obtencion de datos. CONCLUSION: Despues de la implantacion es posible observar ganancias y oportunidades de mejoria tanto en el sistema como en el proceso de planificacion y administracion de los turnos de enfermeria.

Determining workload and size of nursing team in the pediatric emergency department

ABSTRACT Objective: To identify indicators of required nursing workload for pediatric patients care in an emergency department. Methods: This cross-sectional quantitative study was carried out in a pediatric short-stay unit at a public hospital in São Paulo (SP), Brazil. The patient classification system and activity times of nursing care proposed by the Brazilian Federal Nurse Council were applied to all patients admitted over a 1-month period. The instruments were applied by two nurses in populations of 500 and 453 patients, respectively. Nursing workload was calculated in terms of hours and by nurse/patient ratio. Data were analyzed by descriptive statistics, and inter- and intraobserver reliability was assessed by using Kappa coefficient. Confidence intervals were measured to verify differences in numbers of patient among work shifts. Results: The average daily workload was 108.7 hours and the average amount of time spent on nursing care per patient was 7.9 hours. The nurse-patient ratio was 1:2.6. Conclusion: The application of the standardized classification instrument was adequate. It enabled the classification of pediatric patients and the measurement of amount of time needed for nursing care. The average number of nursing work hours per patient met the average time for semi-intensive care established by the Brazilian Federal Nurse Council.

Carga de trabalho de enfermagem em pronto-socorro geral: proposta metodológica

OBJECTIVE This study aimed to propose a methodology for identifying the nursing workload in the Emergency Department (ED). METHODS this is methodological research, undertaken in a public general hospital in the municipality of São Paulo, Brazil, in the areas: triage, shock room, emergency room, suturing room, and medication/procedures for adult and pediatric patients rooms, using different strategies and instruments. Due to the characteristics of the data collection, distinct samples were obtained in each of the areas. RESULTS The average daily workload, in hours, corresponded to: triage 48; shock room 30.9; emergency 170.6; observation of adult patients 293.6; observation of pediatric patients 108.7; medication/procedures in adult patients 175.5; medication/procedures in pediatric patients 60.4; and suturing 7.9. CONCLUSION The instruments used for data collection were shown to be appropriate and made it possible to construct a methodological proposal for identification of workload of nursing professionals in E.D. in a general public hospital.OBJETIVO: neste estudo o objetivo foi propor metodologia para identificar a carga de trabalho de enfermagem em pronto-socorro (PS). METODOS: trata-se de pesquisa metodologica, realizada em PS de hospital geral publico, no municipio de Sao Paulo, nas areas: triagem de risco, salas de choque, emergencia, sutura, medicacao/procedimentos de pacientes adultos e pediatricos e observacao de pacientes adultos e pediatricos, utilizando-se diferentes estrategias e instrumentos. Pela caracteristica da coleta de dados, obtiveram-se amostras distintas em cada uma das areas. RESULTADOS: a carga media diaria de trabalho, em horas, correspondeu a triagem de classificacao de risco 48, choque 30,9, emergencia 170,6,observacao de pacientes adultos 293,6, observacao de pacientes pediatricos 108,7, medicacao/procedimentos de pacientes adultos 175,5, medicacao/procedimentos de pacientes pediatricos 60,4 e sutura 7,9. CONCLUSAO: os instrumentos utilizados para coleta de dados mostraram-se adequados, possibilitando a construcao de proposta metodologica para identificacao de carga de trabalho dos profissionais de enfermagem em PS de hospital geral publico.

Carga de trabajo de enfermería en sala de emergencias general: enfoque metodológico

OBJECTIVE This study aimed to propose a methodology for identifying the nursing workload in the Emergency Department (ED). METHODS this is methodological research, undertaken in a public general hospital in the municipality of São Paulo, Brazil, in the areas: triage, shock room, emergency room, suturing room, and medication/procedures for adult and pediatric patients rooms, using different strategies and instruments. Due to the characteristics of the data collection, distinct samples were obtained in each of the areas. RESULTS The average daily workload, in hours, corresponded to: triage 48; shock room 30.9; emergency 170.6; observation of adult patients 293.6; observation of pediatric patients 108.7; medication/procedures in adult patients 175.5; medication/procedures in pediatric patients 60.4; and suturing 7.9. CONCLUSION The instruments used for data collection were shown to be appropriate and made it possible to construct a methodological proposal for identification of workload of nursing professionals in E.D. in a general public hospital.OBJETIVO: neste estudo o objetivo foi propor metodologia para identificar a carga de trabalho de enfermagem em pronto-socorro (PS). METODOS: trata-se de pesquisa metodologica, realizada em PS de hospital geral publico, no municipio de Sao Paulo, nas areas: triagem de risco, salas de choque, emergencia, sutura, medicacao/procedimentos de pacientes adultos e pediatricos e observacao de pacientes adultos e pediatricos, utilizando-se diferentes estrategias e instrumentos. Pela caracteristica da coleta de dados, obtiveram-se amostras distintas em cada uma das areas. RESULTADOS: a carga media diaria de trabalho, em horas, correspondeu a triagem de classificacao de risco 48, choque 30,9, emergencia 170,6,observacao de pacientes adultos 293,6, observacao de pacientes pediatricos 108,7, medicacao/procedimentos de pacientes adultos 175,5, medicacao/procedimentos de pacientes pediatricos 60,4 e sutura 7,9. CONCLUSAO: os instrumentos utilizados para coleta de dados mostraram-se adequados, possibilitando a construcao de proposta metodologica para identificacao de carga de trabalho dos profissionais de enfermagem em PS de hospital geral publico.

Tiempo de asistencia de enfermería en la Unidad de Cuidados Intensivos: evaluación de los parámetros propuestos por la Resolución COFEN nº 293/04

This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in Sao Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in São Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.