This chapter is about the major policy issue of nursing resource allocation for hospitals. Health service executives have different views about whether systems based on ratios or those based on patient dependency are more accurate. This chapter reports on a statistical analysis of almost 2 million hours of nursing data provided by 22 acute care public and private hospitals in Australia, New Zealand, and Thailand. The TrendCare informatics system was selected because it has the capacity to simultaneously measure nurse patient ratios and nursing workloads by a dependency method of nursing hours per patient day. The results showed that TrendCare predicts actual direct nursing care requirements with greater accuracy than ratios for all hospital and patient types, facilitating better allocation of nursing resources and demonstrating that the cost of nursing care would be less for hospitals using that system than for ratios. This is an important outcome for nursing informatics.
Insights Into An Information Deficit
The objective of this chapter is to illustrate the influence nurses can have on policy development and refinement in a climate of contrasting views and practices, using data and trends analysis from an Australian patient level workload informatics system. A study was designed to inform the debate about future policy directions in workforce planning. It is expected to be of interest to all stakeholders and notably to funding agencies that have established nursing policy using either of these two systems to measure and allocate nursing workloads. Examples of these policies include the introduction of mandated nurse patient ratios in Victoria (Australia’s second most populated state) by the Department of Human Services (DHS), the Safe Staffing Law governing hospitals and nurse patient ratios in California, USA and a staffing by TrendCare agreement incorporated in the Enterprise Bargaining Agreements of some regional Victorian public hospitals (Plummer, 2005)..
This study was set in the policy arena of the Victorian public hospital experience where a staffing ratio law had been passed that trumped acuity based staffing. It was conducted from the perspective of an observer, attempting to understand the political and clinical landscape of mandated nurse patient ratios and was designed to shed light on a situation where policy has been established in the absence of data and the alternative was never tested. The study was grounded in nursing resource allocation and costs frameworks and is in effect a simulation of two different policy approaches. This was a correlational study of a retrospective cohort of nursing workload reports for the same patients and staff, during the same cross-sectional period of time. It was a study that will inform policy decisions on workloads.