Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Measuring the Workload of Community Mental Health Nurses: A Review of the Literature

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Measuring the Workload of Community Mental Health Nurses: A Review of the Literature

Article excerpt

INTRODUCTION

In the last decade of the twentieth century negotiations between labour and capital in Australia moved progressively from centralised awards towards localised union-based enterprise level (Enterprise Bargaining Agreements), or non-union individual agreements (Australian Workplace Agreements or AWA's).1 In the period 1996 to 2005 these agreements were covered by the Australian Workplace Relations Act 1996 (Commonwealth of Australia 1996) for all public sector nurses across all states. A key component of AWA's and Enterprise Bargaining Agreements is the tying of salary increases to a commitment to work towards productivity and efficiency gains. While research suggests that Enterprise Bargaining Agreements by themselves have had little impact on productivity, many nurses in the public sector reported an increase in work intensification over this period (Stanton 2000). As a result the Australian Nursing Federation (ANF), which has a federal office and state and territory branches, has attempted to use the three yearly Enterprise Bargaining negotiation periods to de-intensify the labour of their members despite the risk of breaching the requirement to increase productivity. Between 1996 and 2005 across all states and territories the ANF signed off on agreements that effectively de-intensified the working time of nurses. The strategy for achieving this was the inclusion of workload measuring tools into agreements. These tools have ranged from highly prescriptive time per task measures reminiscent of Taylorist principles to more autonomous case load or nurse-patient ratio models.While there are a range of workload measuring tools suitable for the acute sector, finding tools that measure workload in the community sector is more problematic.We undertook a review of the literature to identify issues around the development of workload measures for the community nursing and mental health context; to explore the nature of community mental health case management; to identify issues that would need to be considered in developing a workload measure for a community mental health context; to provide evidence for an appropriate caseload; and identify existing caseload measures for community mental health settings.

METHODS

A search was undertaken of CINAHL and Medline using the search terms 'workload', 'caseload', 'case management','community nurse', 'community health' and 'mental health' for the period 1995 to 2007. Forty-nine articles were identified in all. Of these, twenty-five articles reported studies either exploring the workload and role of community mental health nurses or the development of workload models for community settings. These articles were included within the review.The grey literature was also accessed. Reports on projects to develop nursing workload tools in other contexts and on nursing industrial issues were identified either through searching the internet using the above search terms or through consultation with researchers involved in similar projects. Eighteen reports were identified in all, with six reports of relevance to this project.

APPROACHES TO MEASURING WORKLOAD

Begley et al (2004) identify two approaches for assessing workload: activity and dependencybased models. Activity-based models measure the tasks performed retrospectively but do not consider the acuity level of the clients, complexity and quality of care given. Dependency-based workload measures in contrast, determine the amount of nursing care needed over a given period of time prospectively on the basis of existing formula. These authors identify two types of dependency measures, prototype and factor patient classification systems. Prototype patient classification systems determine nursing time on the basis of the average amount of care and resources a patient within a given category is viewed as requiring, while factor patient classification systems allocate resources on the basis of average time taken to complete a given task. …

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