Donna Thomson

Beyond Demographic Change in Human Resources Planning: An Extended Framework and Application to Nursing

Objectives: To introduce health care production functions into human resources planning and to apply the approach to analysing the need for registered nurses in Ontario during a period of major reduction in inpatient capacity. Methods: Measurement of changes in services delivered by acute care hospitals in Ontario between 1994/95 and 1998/99, and comparison with changes in the mix of human resources, non-human resources and patient needs. Results: Inpatient episodes per nurse fell by almost 2%. At the same time the number of beds was cut by over 20%. As a result, the number of patients per bed increased by 12%. Allowing for severity, there was a 20% reduction in beds per episode and a 3.7% reduction in nurses per episode. Conclusions: The demands on nurses in acute care hospitals have increased as an increasing number of severity-adjusted episodes are served using fewer beds by a reduced number of nurses. Human resources planning traditionally only considers the effects of demographic change on the need for and supply of health care. Failure to recognize the variable and endogenous nature of other health care inputs leads to false impressions about the adequacy of existing supplies of human resources. Consideration of human resources in the context of the production function for health services provides a meaningful way of improving the effectiveness and efficiency of human resources planning.

Nurse absenteeism, stress and workplace injury: what are the contributing factors and what can/should be done about it?

States Canadian governments have, after a decade of health care downsizing, started to focus on issues of health human resources. Posits that nurses in particular experience higher rates of absenteeism and injury than other types of Canadian workers. Advocates that this study’s findings offers numerous ideas to managers of the system, unions, nurses, government and other parties on how to manage the system better for all involved and the improvement of the health care system.

Decision making for nurse staffing: Canadian perspectives.

The effectiveness of methods for determining nurse staffing is unknown. Despite a great deal of interest in Canada, efforts conducted to date indicate that there is a lack of consensus on nurse staffing decision-making processes. This study explored nurse staffing decision-making processes, supports in place for nurses, nursing workload being experienced, and perceptions of nursing care and outcomes in Canada. Substantial information was provided from participants about the nurse staffing decision-making methods currently employed in Canada including frameworks for nurse staffing, nurse-to-patient ratios, workload measurement systems, and “gut” instinct. A number of key themes emerged from the study that can form the basis for policy and practice changes related to determining appropriate workload for nursing in Canada. These include the use of (a) staffing principles and frameworks, (b) nursing workload measurement systems, (c) nurse-to-patient ratios, and (d) the need for uptake of evidence related to nurse staffing.

Evaluation of a Patient Care Delivery Model: Patient Outcomes in Acute Cardiac Care

PURPOSE To evaluate the influence of nurse staffing and work environment variables on patient outcomes by testing a conceptual model. DESIGN A prospective, correlational design with cross-sectional and longitudinal components was conducted in Canadian cardiac and cardiovascular care inpatient units. METHODS Data were collected from multiple sources. Hierarchical linear modeling was used to examine relationships among variables. CONCLUSIONS The findings indicate that patient outcomes are influenced not only by patient and nurse characteristics, but also by organizational staffing practices. Organizations that manage the complexity of work conditions and target staffing utilization levels between 80% and 88% at the unit level can optimize patient outcomes. CLINICAL RELEVANCE Empirical validation of the model provides evidence to inform management decisions about hospital nurse staffing.