Nurse Staff Allocation by Nurse Patient Ratio vs. a Computerized Nurse Dependency Management System: A Comparative Cost Analysis of Australian and New Zealand Hospitals

Article excerpt


* Coding, costing, and accounting for nursing care requirements in Australian public and private hospitals lacks systematic research.

* Nurse costing for two nurse staffing allocation methods - nurse patient ratios and a computerized nurse dependency management system - were compared.

* Retrospective nursing workload management data were obtained from hospital information systems in 21 acute care public and private hospitals in Australia and New Zealand.

* Descriptive statistics, cost analysis, and cost modeling were conducted for 103,269 shifts of nursing care.

* Descriptive statistics, cost analysis, and cost modeling were conducted for 103,269 shifts of nursing care.

* The provision of nursing care using the computerized nurse dependency management system was, overall, lower in cost than for nurse-patient ratios.

DIFFERENT METHODS ARE USED to allocate nurses to staffhospital wards in Australia and New Zealand. Most methods are either unpublished or have been published in non-commercial form. Methods described in the literature may be underpinned by hours per patient day or organizational models for the delivery of nursing care such as primary nursing, patient allocation, task assignment, and team nursing (Twigg, Duffield, Bremner, Rapley, & Finn, 2011; Duffield, Roche, Diers, Catling-Paull, & Blay, 2010). For the purposes of this article, we refer to two nurse staffallocation methods used in various forms in some hospitals in Australia and New Zealand: nurse patient ratios (NPRs) and computerized nurse dependency workload systems. Generally, computerized nurse dependency workload systems incorporate the dimension of patient acuity. The terms patient acuity, nurse depen - dency, and patient dependency refer to similar phenomenon where patient needs for nursing care are described and/or measured. In some Australian health services, NPRs are part of a formalized system. In other health services, nurse-patient ratios have been adapted by hospital managers internally as a model for setting safe stafflevels external to formalized structures.

NPRs are known as occupancy- based nurse patient allocation. They generally ensure the number of nurses matches the number of patients requiring care and that nurses in similar settings care for the same number of patients. In the state of Victoria, Australia, NPRs were mandated in 2000 for the public sectors. They are based on a workload complexity model that incorporates the type of shiftof care, such as morning or eve - ning, and the level of the hospital, such as major or minor metropolitan and rural. In the United States, they were mandated in California in 2004.

Differences exist between rules of NPRs for Victoria and California (Gerdtz & Nelson, 2007). In comparison to Victoria, California has been the site for many studies concerning NPRs (Aiken et al., 2010; Chan, Killeen, Vilke, Marshall, & Castillo, 2010; Chapman et al., 2009; Donaldson et al., 2005; Sochalski, Konetzka, Zhu, & Volpp, 2008). A literature synthesis on the impact of Californianmandated acute care hospital nurse staffing ratios found they reduced the number of patients per licensed nurses and increased the number of nursing hours per patient day in hospitals (Donaldson & Shapiro, 2010). A U.S. national survey of registered nurse perceptions of NPRs showed 62% wanted minimum nurse staffratios mandated; however, RNs employ - ed in California, where ratios are mandated, were significantly more likely to agree (Buerhaus, DesRoches, Donelan, & Hess, 2009).

Computerized nurse dependency workload systems consider patient dependency requirements for nurses by quantifying variables of direct nursing care. Since 1984, when the Australian Council for Health Care Standards introduced the requirement for hospitals to show evidence of a staffing pattern for nurses according to patient need, computerized nurse dependency systems were developed as a solution. …