Obciążenie pracą podczas ostatniego  dyżuru w opiniach pielęgniarek pracujących w szpitalach objętych projektem RN4CAST

Maria Cisek,

Lucyna Przewoźniak,

Maria Kózka,

Tomasz Brzostek,

Piotr Brzyski,

Maria Ogarek,

Teresa Gabryś,

Krzysztof Gajda,

Anna Ksykiewicz-Dorota

Abstrakt

Workload during the last shift in the opinion of hospital nurses involved in RN4CAST project

Background
The issue of workload is one of the most important ones as far as the nurses’ profession is concerned.

Numerous analyses prove the relationship between excessive workload and job dissatisfaction, which may lead to low morale, absenteeism, high rotation and low work efficiency and, consequently, result in deterioration of the care provided to the patient and even put the patient’s safety at risk. RN4CAST project is aimed at the evaluation of the workload which the nurses are exposed to during their shifts. Such a survey focuses on all structural determinants of hospital workload depending on: type of the ward, professional role, number of patients and their health condition as well as work conditions and organization: the number of working hours and shift staffing.

Aim of the survey
The survey is aimed at determining the factors responsible for the workload which the nurses are exposed to during their shifts in hospitals involved in RN4CAST project.

Material and Methods
The study included 2605 nurses working in 30 acute hospitals in Poland. The respondents were mainly women. Men made up only 0.4% of the population examined. The average age was 40.3 (SD = 7.8 years old). 23.5% of the respondents had the Bachelor’s degree in nursing. The average seniority was 18.6 years (SD = 8,6), and the seniority in the hospital involved in the survey – 15.6 years (SD = 9,2).
The material was collected by means of a survey and a structurised questionnaire completed by the nurses on their own. A correlational model was used to evaluate the workload determinants.

Results
During their last shift 84% of the nurses worked, on average, 11.3 hours (SD = 2.4). The number of patients on the ward was 31.1, on average (SD = 12.6) it varied significantly (p = 0.000) depending on the ward type. The nursing care was provided by 3.4 qualified nurses on average (SD = 2.2). One nurse was responsible for 20.4 patients on average (SD = 11.1), [median = 18, first quartile (Q1) = 12, third quartile (Q3) = 29)].
It was proved that the increase in the total number of the patients on the ward was accompanied by the increase in the number of patients who required assistance with everyday routines (tau-b = 0.17; p = 0.000) and in the number of patients who required monitoring or hourly (or even more frequent) treatment (tau-b=0.37; p=0.000).
Close examination of the variables responsible for individual workload showed that there is a little but noticeable correlation between the increase of the total number of patients on the ward (tau-b = 0.28; p = 0.000) and the increase in the number of patients each nurses was directly responsible for on her shift.
There was a positive correlation (tau-b = 0.40; p = 0.000) between the total number of patients and the total number of qualified nurses providing direct care to these patients during their shifts.
Also a slight negative correlation was observed (tau-b = –0.061; p = 0.000) between the total number of nurses and the number of patients each nurse was directly responsible for.
There was also a slight positive correlation (tau-b = 0.18; p = 0.000) between the number of nurses and the number of helping staff who provided direct care to the patients during their shifts. And also a slight correlation was observed (tau-b = 0.061; p = 0.000) between the number of patients and the number of helping staff during the shifts.
The analysis of the findings from both wards leads to the conclusion that the seven most frequent and common routines, which did not require nursing qualifications constituted a significant workload for nurses on all shifts (p = 0,000) and that the nurses who solely provided care to the patients were significantly more often responsible for routines which did not require any professional skills.
The nurses examined, evaluated their hospital working conditions as poor – 28.9%; satisfactory – 46.8%; good – 23.2%; excellent – 1.1%.
Majority of nurses (59.3%) claim that the number of hospital staff is definitely too low to work efficiently; 64.5% pointed out the lack of qualified nurses and 31.7% the lack of technical and helping staff. Vast majority of nurses (64%) claim that they can rely on the hospital management support only in some situations. Most nurses (77%) complained that their relations with the doctors were not always good, whereas 13.6% complained about lack of good professional relations between nurses and doctors.

Conclusions
1. The analysis of the findings shows that structural factors (such as type of the ward, professional role, number and condition of patients) as well as organisational factors (such as number of shift hours, shift staffing and work environment) determined the nurses’ workload.
2. The shift survey as a device for evaluating nurses’ workload should be recommended to ward nurses and hospital management because of the simplicity with which particular elements can be observed. The observation can be carried out during a relatively short period of time (8–12-hour shift), which allows for a better and faster explanation of the reasons of excessive workload and consequently may lead to implementing solutions, which would eliminate this negative phenomenon.

 

RN4CAST HEALTH-2007-3.2-4: Health care human resource planning in nursing Grant agreement no.: 223468

Słowa kluczowe: obciążenie pracą, pielęgniarki, szpital, praca zmianowa
References

Seremus S., RN4CAST Nurse Forecasting: Human Resources Planning in Nursing; http://www.rn4cast.eu; dostęp: 21.08.2013.

Seremus S. et al., Nurse forecasting In Europe (RN4CAST); Rationale, design and methodology;„BMC Nursing”, http://www.biomedcentral.com/1472-6955/10/6; dostęp: 21.11.2012.

Hospital Nurse Staffing and Quality of Care, www.ahrq.gov; dostęp: 17.10.2011.

Kuriata E., Felińczak A., Grzebieluch J., Szachniewicz M., Specyfika pracy pielęgniarskiej w szpitalu – warunki pracy i aktualne wyzwania. Część I, „Piel. Zdr. Publ.” 2011; 1, 2: 163–167.

KułagowskaE., KosińskaM.,Obciążenie pracą personelu pielęgniarskiego, Annales Universitatis Mariae Curie-Skłodowska, Lublin – Polonia 2003; LVIII, suppl. XIII, 145 Sectio D. 

Kuriata E., Felińczak A., Grzebieluch J., Szachniewicz M., Czynniki szkodliwe oraz obciążenie pracą pielęgniarek zatrudnionych w szpitalu. Część II, „Piel. Zdr. Publ.” 2011; 1, 3: 269–273; http://www.pzp.am.wroc.pl/pdf/2011/22.pdf; dostęp: 30.04.2013.

Ustawa z 15 lipca 2011 r. o zawodach pielęgniarki i położnej (Dz.U. Nr 174, poz.1039 z późn. zm.).

Ustawa z dnia 1 lipca 2011 r. o samorządzie pielęgniarek i położnych (Dz.U. Nr 174, poz. 1038 z późn. zm.).

Wstępna ocena zasobów kadrowych pielęgniarek i położnych w Polsce do roku 2020, Naczelna Rada Pielęgniarek i Położnych, Warszawa czerwiec 2010; http://www.nipip.pl/attachments/article/1782/Wstepna.ocena.zasobow.kadrowych.pdf; dostęp: 21.08.2013.

Rozporządzenie Ministra Zdrowiaz dnia 21 grudnia 1999 r. w sprawie sposobu ustalania minimalnych norm zatrudnienia pielęgniarek i położnych w zakładach opieki zdrowotnej (Dz.U. Nr 111, poz. 1314).

Stanowisko Polskiego Towarzystwa Pielęgniarskiego w sprawie Rozporządzenia Ministra Zdrowia z dn. 28.12.2012 r. w sprawie sposobu ustalania minimalnych norm zatrudnienia pielęgniarek i położnych w podmiotach leczniczych niebędących przedsiębiorcami; http://www.ptp.na1.pl/pliki/PTP_Stanowiska/30_Opinia_PTP_w_sprawie_Projektu_Rozporzadzenia_-_obsady_pielegniarskie_23_11_2012.pdf; dostęp: 21.08.2013.

Wiskow Ch., Pomiar obciążenia pracą w określaniu potrzeb kadrowych. Przegląd piśmiennictwa. Opracowanie dla Międzynarodowej Rady Pielęgniarek, 2006; http://www.ptp.na1.pl/pliki/ICN/ICN_pomiar_obciazenia_praca_03_11_2009.pdf; dostęp: 30.04.2013.

Wiskow Ch., Tit A., de Carlo P., How to create an attractive and supportive working environment for health professionals. Health systems and policy analysis; http://www.euro.who.int/_data/assets/pdf_file/0018/124416/e94293.pdf; dostęp: 30.04.2013.

Gajda K., Kózka M., Brzyski P., Gabryś T., Przewoźniak L., Cisek M., Ogarek M., Ksykiewicz-Dorota A., Brzostek T., Wpływ struktury zatrudnienia personelu i wybranych czynników organizacyjnych szpitala na wskaźnik zgonów pacjentów hospitalizowanych w szpitalach polskich uczestniczących w projekcie RN4CAST, „Zeszyty Naukowe Ochrony Zdrowia. Zdrowie Publiczne i Zarządzanie” 2012; 10(4): 49–57.

Aiken L.J., Clarke S.P., Sloane D.M. et al., Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. „JAMA” 2002; 288(16): 1987–1993.

Leiter M.P., Maslach C., Areas of worklife: A structured approach to organizational predictors of job burnout, w: Perrewe P.L., Ganster D.C. (red.), Research in occupational stress and well-being (t. 3, 91–134), Elsevier, Oxford 2004.

Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States; http://www.bmj.com/content/344/bmj.e1717; dostęp: 17.05.2012.

Aiken L., Sochalski J., Anderson G., Downsizing the hospital nursing workforce, „Health Aff.” 1996; 15: 88–92.

Oates R.K., Oates P., Stress and mental health in neonatal intensive care units, „Arch. Dis. Child” 1995; 72: F107–10.

Maslach C., Leiter M.P., The Truth About Burnout: How organizations cause personal stress and what to do about it, Jossey-Bass, San Francisco, CA 1997.

Griffith C.H., Wilson J.F., Desai N.S., et al., Housestaff workload and procedure frequency in the neonatal intensive care unit. „Crit. Care Med.” 1999; 27: 815–820.

Tourangeau A., Doran D., McGillis Hall L., O’Brien Pallas L., Pringle D., Cranley L., Tu J., Impact of hospital nursing care on 30-day mortality for acute medical patients, „Journal of Advanced Nursing” 2006; 57(1): 32–44.

Darvas J.A., Hawkins L.G., What makes a good intensive care unit: a nursing perspective, „Aust. Crit Care” 2002; 15(2): 77–82.

Cavanagh S.J., Job satisfaction of nursing staff working in hospitals, „J. Adv. Nurs.” 1992; 17: 704–711.

Carayon P., Gurses A.P., Nursing Workload and Patient Safety – A Human Factors Engineering Perspective. Chapter 30, w: Hughes R.G. (red.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Agency for Healthcare Research and Quality (US); Rockville (MD) 2008; http://www.ncbi.nlm.nih.gov/books/NBK2657; dostęp: 21.08.2013.

Baumann A., Giovannetti P., O’Brien-Pallas L. et al., Healthcare restructuring: the impact of job change, „Can. J. Nurs. Leadersh.” 2001; 14: 14–20.

Nursing Workload and Patient Care; https://nursesunions.ca/.../cfnu_workload_paper_pdf; dostęp: 19.08.2013.

Nursing workload and staffing: impact on patients and Staff;http://trove.nla.gov.au/work/28897523; dostęp: 30.08.2013.

Zarządzanie w pielęgniarstwie. Podręcznik dla studentów studiów magisterskich Wydziałów Pielęgniarstwa oraz Wydziałów Nauk o Zdrowiu, Ksykiewicz-Dorota A. (red.), Wydawnictwo Lekarskie PZWK, Lublin 2013.

Ball J.E., Murrells T., Rafferty A.M., Morrow E., ­Griffiths P., Care left undone’ during nursing shifts: associations with workload and perceived quality of care, „BMJ Qual. Saf.” doi:10.1136/bmjqs-2012-001767;http://qualitysafety.bmj.com/content/early/2013/07/08/bmjqs-2012-001767.full; dostęp: 10.08.2013.

Przewoźniak L., Kózka M., Cisek M., Gajda K., Brzyski P., Ogarek M., Gabryś T., Brzostek T., Organizacja i zakres badań RN4CAST (Registered Nurse Forecasting) dotyczących planowania zatrudnienia w pielęgniarstwie w Polsce, „Zeszyty Naukowe Ochrony Zdrowia. Zdrowie Publiczne i Zarządzanie” 2012; 10(4): 19–29.

Kózka M., Gabryś T., Brzyski P., Ogarek M., Cisek M., Przewoźniak L., Ksykiewicz-Dorota A., Gajda K., Brzostek T., Wybrane czynniki determinujące ocenę jakości opieki pielęgniarskiej w szpitalach pełniących stały dyżur. Wyniki projektu RN4CAST, „Zeszyty Naukowe Ochrony Zdrowia. Zdrowie Publiczne i Zarządzanie” 2012; 10(4): 30–40.

Aiken L.H., Clarke S.P., Sloane D.M., Lake E.T., Cheney T., Effects of hospital environment on patient mortality and nurse outcomes, „Journal of Nursing Administration” 2008; 38(5): 223–229.

Warszawsky N.E., Sullivan H.D., Global Use of the Practice Environment Scale of the Nursing Work Index, „Nurs. Res.” 2011; 60(1): 17–31; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021172/#R1; dostęp: 10.11.2012.

Gaweł G., Obciążenie pracą pielęgniarek pracujących w systemie zmianowym 12-godzinnym a ich stan zdrowia, „Pielęgniarstwo XXI Wieku” 2003; 3: 77–82.

Ksykiewicz-Dorota A., Gerasim B., Zagórski J., Sadło A., Ocena obciążenia pracą fizyczną na stanowisku pielęgniarki odcinkowej w oddziale szpitalnym, „Zeszyty Naukowe Ochrony Zdrowia. Zdrowie Publiczne i Zarządzanie” 1992; 103,10: 511–518.

Kułagowska E., Kosińska M., Obciążenie fizyczne pielęgniarek – przyczyny i skutki, „Zeszyty Naukowe Ochrony Zdrowia. Zdrowie Publiczne i Zarządzanie” 2002; 112,Supl. 1: 109–112.

Gaweł G., Obciążenie pracą pielęgniarek pracujących w systemie zmianowym 12-godzinnym a ich stan zdrowia, „Pielęgniarstwo XXI Wieku” 2003; 3: 77–82.

Needleman J., Buerhaus P., Pankratz S. et al., Nurse staffing and inpatient hospital mortality, „N. Engl. J. Med.” 2011; 364: 1037–1045.

Baggs J.D., Schmitt M.H., Mushlin A.I. et al., Association between nurse-physician collaboration and patient outcomes in three intensive care units, „Crit Care Med.” 1999; 27: 1991–1998.

Estabrooks C.A., Midodzi W.K., Cummings G.G., Ricker K.L., Giovannetti P., The impact of hospital nursing characteristics on 30-day mortality, „Nurs. Res.” 2005; 54(2): 74–84.

Lake E., Development of the practice environment scale of the nursing work index, „Res. Nurs. Health” 2002; 25: 176–188.

Kazanijian A., Green L., Wong J., Reid R., Effect of the hospital nursing environment on patient mortality: a systematic review, „Journal of Health Services Research and Policy” 2005; 10(2): 111–117.

Lankshear A., Sheldon T., Maynard A., Nurse staffing and healthcare outcomes, „Adv. Nurs. Science” 2005; 28: 163–174.

Lucero R.J., Lake E.T., Aiken L.H., Nursing care quality and adverse events in US hospitals, „Journal Clinical Nursing” 2010; 19(15–16): 2185–2195.

Pai H., Lee S., Chang T., A confirmatory factor analysis of the clinical nursing practice environment scale with hospital registered nurses in Taiwan, „J. Clin. Nurs.” 2011; 20: 2344–2354.

Planowanie obsad pielęgniarskich w oddziałach zachowawczych i zabiegowych o różnym profilu, Małas Z. (oprac.), Naczelna Rada Pielęgniarek i Położnych, Warszawa 2011.

Kovner C., Cheryl J., Chunliu Z. et al., Nurse staffing and postsurgical adverse events: an analysis of administrative data from a sample of U.S. hospitals, 1990–1996, „Health Serv. Res.” 2002; 37(3): 611–629.

Rozporządzenie Ministra Zdrowia z dnia 28 grudnia 2012 r. w sprawie sposobu ustalania minimalnych norm zatrudnienia pielęgniarek i położnych w podmiotach leczniczych niebędących przedsiębiorcami (Dz.U.12.1545 z dnia 31 grudnia 2012 r.)

Czasopismo ukazuje się w sposób ciągły on-line.
Pierwotną wersją czasopisma jest wersja elektroniczna.