Nurses' work environment is associated with both quality of care and organizational
outcomes. There is a clear relationship between nurse staffing and both patient outcomes
and nurses' perception of work environment. The severity of patients' illness is not
sufficient for making nurse assignment decisions. One benchmark of staffing is valid
measurement of patient acuity (patients' nursing care needs). Patient acuity measures
offer a potential for real-time matching of patient demand for nursing care. It is
defined as a measure of the severity of illness and the nursing care needs, complexity,
and workload required to provide care to a patient or group of patients.
There is a limited amount of research that examine the process of making direct nurse
staffing deicions in relation to patient acuity. By examining staffing levels and nurses'
perception of work environment in relation to measured patient acuity, we hope to
contribute to this field.
The overall aim of this research project is to examine patient-acuity measures as a part
of daily management, as being introduced to five wards within the somatic in-patient care
in Gävleborg County, Sweden in autumn 2023. The studies will focus on staffing levels in
relation to the patient acuity scores and on nurses' perception of work environment, both
before, during and after the start of the new work procedures, but also on a weekly
basis, related to the acuity scores of the actual work shift.
Data will be collected before, 6 months, and12 months after the implementation of patient
acuity measures, using a web-based survey that reaches all the nursing staff at the
wards. Data will be analysed with descriptive and inference statistics to explore if the
novel work process has brought differences of different asopects related to the nurses'
work environment such as their well-being and perception of stress. As a reference, the
same procedures will be carried out at two wards that haven't implemented patient acuity
measures.
Patient-acuity measures will be collected two times a day (morning and evening shifts)
from each of the five wards. Once a week, all nurses working at a particular shift will
be asked to make a short estimation (through a paper-based form) of their perception of
the work environment during that particular shift. These estimations with single
item-measures will be compared with the patient acuity and actual staffing during the
shift. An index will be used to compare staffing and patient acuity in the five wards.
Furthermore, semi-structured interviews with four nurses' and the manager from each ward
will be conducted with the same time intervals as the web-based surveys. Results will be
analysed with content analysis.