Nursing Workloads and Lower Urinary Tract Symptoms Among Chinese Female Nurses: The Mediating Role of Delayed Voiding Behaviors.

PURPOSE: Lower urinary tract symptoms (LUTS) are a challenge to the healthy nursing workforce. Nurses confront various objective and subjective nursing workloads which contribute to their LUTS, but less is known about how nursing workloads influence their LUTS. This study is designed to test hypotheses that delayed voiding behaviors mediate the relationships between nursing workloads and LUTS in female nurses. MATERIALS AND METHODS: This study analyzed the baseline data collected from an ongoing cohort study named Nurse Urinary Related Health Study in China. LUTS of nurses in 20 tertiary hospitals were assessed with the International Consultation on Incontinence Questionnaire‒Female Lower Urinary Tract Symptoms. Objective nursing workloads including working environment, working hours, and working schedule were collected, and perceived stress, the proxy of the subjective nursing workload, was assessed with the Perceived Stress Scale. Delayed voiding behaviors were assessed with 3 questions adapted from the Taiwan Nurse Bladder Survey. Structural equation modeling was used to run the mediation model. RESULTS: More than half (51%) of 13,191 female nurses had LUTS. Median age was 31 years (IQR 27-37). When delayed voiding behaviors served as a mediator, the direct effects of subjective nursing workload rather than objective nursing workloads on LUTS were significant. CONCLUSIONS: Nursing workloads influence nurses' LUTS via delayed voiding behaviors. Strategies tailored to delayed voiding behaviors should be developed, and these may work with stress-reducing strategies as the gatekeepers for nurses' bladder health.

A Delphi consensus study to determine the workload components and activity standards of dietitians in South Africa's central and tertiary public hospitals.

BACKGROUND: The global Human Resources for Health (HRH) strategy emphasizes the need to invest in HRH to meet population needs and improve the provision of quality health care services. In South Africa, dietitians are recognized as registered professionals who provide nutrition services. In this paper, we used 2 key steps (3 and 4) of the eight step World Health Organization (WHO) Workload Indicators of Staffing Need (WISN) methodology to determine the workload components and activity standards for dietitians at South African central and tertiary public hospitals. METHODS: All (9) provincial nutrition managers (phase one) and 21 out of a total 22 head dietitians at central and tertiary public hospitals (phase two) participated in an online survey. In phase one, the provincial managers provided the job descriptions (JDs) of dietitians in their provinces, and the JDs were analyzed to determine the baseline workload components. In phase two, dietitians participated in a multi-stage Delphi process to reach consensus on workload components and activity standards. Consensus was deemed to be agreement of 70% or more, while the median of participants' responses was used to obtain consensus on the activity standards. RESULTS: The JDs of dietitians were a useful baseline for the consensus exercise as there were no other suitable source documents. The response rate was 100% for all three rounds of the Delphi survey. Dietitians reached agreement (consensus ≥ 70%) on 92% of proposed workload components and activity standards. Following the removal of duplicate and certain administrative activities, a total of 15 health, 15 support and 15 additional service activities with aligned activity standards resulted from the consensus exercise. CONCLUSION: The Delphi technique was a suitable method for reaching agreement on workload components and activity standards for dietitians at South African central and tertiary public hospitals. The findings from this study can now be used to compile a standardized list of workload components and activity standards and ultimately to determine dietetic staffing needs for the central and tertiary public hospital level of care.

Work-family conflict among primary health workers during the COVID-19 pandemic: Its mediating role in the relationship between workload and job burnout.

AIMS AND OBJECTIVES: This study explores the situation of workload, work-family conflict and job burnout among primary health workers in China in the context of COVID-19 and identifies the mediating effect of work-family conflict between workload and job burnout. BACKGROUND: Since the breakout of the COVID-19 pandemic, primary health workers have been working on the frontline of the epidemic and may experience increasing workload, work-family conflict and job burnout. It is important to focus on the issue of how to alleviate job burnout of primary health workers. DESIGN: A cross-sectional study (STROBE) was used. METHODS: Data were collected from 785 primary health workers in China. Multiple regression analysis was used to examine the mediating effect of work-family conflict between workload and job burnout. RESULTS: 18.7%, 10.4% and 39.5% of respondents had high job burnout in the dimensions of emotional exhaustion, depersonalization and personal accomplishment, respectively. 34.6% of the respondents had high or very high workload, and 12.8% of the respondents had high or very high work-family conflict. Results of multiple regression analysis indicated that work-family conflict mediated the relationship between workload and job burnout. Workload (ß = .163, CI = .207-.549) and work-family conflict (ß = .211, CI = .311-.640) positively influenced job burnout, and workload (ß = .428, CI = .375-.508) positively influenced work-family conflict. CONCLUSION: The study indicated that primary health workers experienced a high level of job burnout, especially in the personal accomplishment dimension. Furthermore, this study verified the mediating effect of work-family conflict between workload and job burnout. RELEVANCE TO CLINICAL PRACTICE: Some interventions for alleviating workload, work-family conflict and job burnout should be taken, including workplace assistance programmes, family-friendly policies and a well-integrated healthcare system. NO PATIENT OR PUBLIC CONTRIBUTION: This study does not involve patient or public contribution in any part. IMPACT STATEMENT: Nurses and other primary health workers are health gatekeepers of residents and play a vital role in the healthcare system. Due to the breakout of COVID-19, they have taken more work and are more vulnerable to work overload, work-family conflict and the consequent job burnout. Some interventions should be taken to effectively alleviate their job burnout and improve their health and performance.

Relationship between job demands, work engagement, emotional workload and job performance among nurses: A moderated mediation model.

AIM: To explore the mediating effect of work engagement and the moderated mediating effect of emotional workload on the relationship between job demands and job performance among nurses. BACKGROUND: Nurses work in a high-demand situation that could affect their job performance. However, previous studies have reported an inconsistent relationship between job demands and job performance. The underlying mechanism of how job demands influence job performance remains unclear. METHODS: An online cross-sectional survey was conducted with a convenience sample of 893 nurses from 14 cities in Sichuan Province between November and December 2021. Data were collected using the Job Demands Scale, Job Performance Scale, Utrecht Work Engagement Scale, and emotional workload subscale of the Questionnaire on the Experience and Evaluation of Work. Bootstrap and simple slope methods were used to test a moderated mediation model using Hayes' PROCESS macro. The STROBE reporting guidelines were utilized. RESULTS: Job demands had a positive effect on job performance, and this effect was mediated by work engagement. Emotional workload moderated the indirect relationship between job demands and job performance. Specifically, the positive effect of job demands on job performance via work engagement was attenuated in nurses with a high emotional workload. CONCLUSION: This study sheds light on the complex relationship between job demands and job performance. Work engagement and emotional workload deserve more attention to improve nurses' performance. IMPLICATIONS FOR NURSING AND NURSING POLICY: Policymakers and nurse managers should make efforts to develop and implement strategies to foster nurses' work engagement, reduce their emotional workload, and further help nurses efficiently deal with job demands.

The first wave of COVID-19 and mental distress of physician residents in Brazil: a comparison between two cohorts.

INTRODUCTION: The reorganization of healthcare systems to face the COVID-19 pandemic has led to concerns regarding psychological distress of healthcare workers, and training requirements of physician residents. OBJECTIVE: To assess the influence of COVID-19 pandemic on depression, anxiety, burnout and training schedules of residents. METHODS: Two independent cross-sectional studies (the first in November 2019 [control], the second in June 2020, during the first wave of COVID-19 pandemic) enrolling physician residents from Brazil, using online surveys. In each of them, we collected demographic and training program data, and assessed depression, anxiety and burnout through PHQ-2, GAD-2 and MBI (2-item version) scales, respectively. We controlled confounding variables with logistic regression analysis. RESULTS: The COVID-19 cohort (n = 524) presented a briefer workload and had at least 1 day off per week more frequently, in relation to the control cohort (n = 1 419). The majority of residents (464/524, 89.5%) had a reduction in their duty hours, and believed they would need an extra training period after the end of the pandemic (399/524, 76.2%). The frequency of depression increased (46.0% vs. 58.8%, aOR = 1.64, 95% CI = 1.32-2.05), anxiety did not change (56.5% vs. 56.5%, aOR = 1.24, 95% CI = 0.99-1.55) and burnout decreased (37.0% vs. 26.1%, aOR = 0.77, 95% CI = 0.60-0.99). Sensitivity analysis did not change these results. CONCLUSION: Mental distress is frequent among residents and associated with both training program and social environments. The consequences of the COVID-19 pandemic on training requirements should be specifically addressed by supervisors and policymakers, in a case-by-case basis. Psychological support must be provided to healthcare workers.

Levels and influencing factors of mental workload among intensive care unit nurses: A systematic review and meta-analysis.

AIM: The purpose of this systematic review was to determine the levels and influencing factors of mental workload in intensive care unit nurses. BACKGROUND: Intensive care unit nurses have a high mental workload level. To our knowledge, no meta-analytic research investigating the levels of mental workload in intensive care unit nurses and related factors has yet been performed. DESIGN: This article is a systematic review and meta-analysis. METHODS: Eleven electronic databases were searched from the database setup dates until 31 December 2022. The research team independently conducted study selection, quality assessments, data extractions and analysis of all included studies. The PRISMA guideline was used to guide reportage of the systematic review and meta-analysis. RESULTS: Seventeen studies were included. In these studies, the pooled mean score of mental workload was 68.07 (95%CI:64.39-71.75). Furthermore, subgroup analyses indicated that intensive care unit nurses' mental workload differed significantly by countries, sample size and publication year. The mental workload influential factors considered were demographic, work-related and psychological factors. CONCLUSION: Hospital administrators should develop interventions to reduce mental workload to enhance the mental health of intensive care unit nurses and nursing care quality. Hospital managers should pay attention to the mental health of nurses and guide them to correctly relieve occupational stress and reduce mental workload.

The cancer nursing workforce in Australia: a national survey exploring determinants of job satisfaction.

BACKGROUND: To maintain and improve the quality of the cancer nursing workforce, it is crucial to understand the factors that influence retention and job satisfaction. We aimed to investigate the characteristics of cancer nurses in Australia and identify predictors of job satisfaction. METHODS: We analysed data from an anonymous cross-sectional survey distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The survey was compared to national nursing registration data. Data were analysed with non-parametric tests, and a stepwise, linear regression model was developed to best predict job satisfaction. RESULTS: Responses were received from 930 cancer nurses. Most respondents (85%) described themselves as experienced nurses, and more than half had post-graduate qualifications. We identified individual, organizational, and systemic factors that contribute to job satisfaction and can impact in workforce shortages. The findings include strategies to address and prioritize workforce challenges. There were 89 different titles for advanced practice nursing roles. Managing high workload was a reported challenge by 88%. Intention to stay less than 10 years was reported by nearly 60%; this was significantly correlated with job satisfaction and age. Significantly higher scores for job satisfaction were associated with those who had career progression opportunities, career development opportunities, adequate peer support and a clearly defined scope of role. Conversely, job satisfaction scores decreased the more people agreed there was a lack of leadership and they had insufficient resources to provide quality care. CONCLUSION: Cancer nurses are critical to the delivery of cancer care however, the workforce faces multiple challenges. This study provides an understanding of the Australian cancer nursing workforce characteristics, their roles and activities, and highlights important considerations for retaining nurses in the profession.

The association between workload and quality of work life of nurses taking care of patients with COVID-19.

BACKGROUND: The COVID-19 epidemic has brought significant changes and complexities to nurses' working conditions. Given the crucial role of health workers, particularly nurses, in providing healthcare services, it is essential to determine the nurses' workload, and its association with the quality of work life (QWL) during COVID-19 epidemic, and to explain the factors predicting their QWL. METHODS: A total of 250 nurses, who provided care for patients with COVID-19 in Imam Hossein Hospital of Shahrud, and met the inclusion criteria, were considered the samples in the present cross-sectional study in 2021-2022. Data were collected using the demographic questionnaire, NASA Task Load Index (TLX), and Walton's QWL questionnaire, which were analyzed using SPSS26 and based on descriptive and inferential statistical tests. A p-value less than 0.05 was considered significant for all cases. RESULTS: The nurses' mean scores of workload and QWL were 71.43 ± 14.15 and 88.26 ± 19.5, respectively. Pearson's correlation test indicated a significant inverse relationship between workload and QWL (r=-0.308, p < 0.001). The subscales with the highest perceived workload scores were physical demand and mental demand (14.82 ± 8.27; 14.36 ± 7.43), respectively, and the subscale with the lowest workload was overall performance (6.63 ± 6.31). The subscales with the highest scores for QWL were safety and health in working conditions and opportunity to use and develop human capabilities (15.46 ± 4.11; 14.52 ± 3.84), respectively. The subscales with the lowest scores were adequate and fair compensation, work and total living space (7.46 ± 2.38; 6.52 ± 2.47), respectively. The number of children (ß = 4.61, p = 0.004), work experience (ß= -0.54, p = 0.019), effort (ß = 0.37, p = 0.033) and total workload (ß= -0.44, p = 0.000) explained 13% of the variance of nurses' QWL. CONCLUSIONS: The study's findings showed that a higher workload score is associated with nurses' lower perception of QWL. In order to improve the QWL of nurses, reducing the physical and mental demands of their workload and strengthening overall performance is necessary. Additionally, when promoting QWL, adequate and fair compensation and the work and living space should be considered. The researchers suggest that hospital managers should make more significant efforts to develop and promote the QWL of nurses. To achieve this goal, organizations can pay attention to other influential factors, primarily by increasing organizational support.

The mediating effect of personality on mental workload and perceived professional benefits of nurses in East China.

BACKGROUND: Nursing work is a work with high-stress load, and nurses with different personality may have different subjective feelings about their workload. Therefore, it is particularly necessary to comprehend the perceived professional benefits of nurses engaged in nursing work under high-pressure background, especially during the epidemic period. This study explored the relationship between mental workload, personality, and perceived professional benefits of nurses, and offer advices for the intervention of nurses with different personality to improve their perceived professional benefits. MATERIALS AND METHODS: In this study, we used a cross-sectional study with a convenient sampling. 473 in-service nurses in Class A tertiary hospitals of Zhejiang Province were recruited by using the NASA Mission Load Index scale of nurses, the brief version of China's Big Five Personality Questionnaire, and the Nurses' perceived professional benefits questionnaire from July 2020 to March 2021. Sample size is 54.91%, and the response rate is 100%. Cronbach's alpha method was used to evaluate the reliability of the instruments. Descriptive statistical analysis was used to describe the socio-demographic data of the subject, and scores for research variables. The Mann-Whitney U-test, and Kruskal-Wallis H rank-sum test were used to compare the scores of perceived professional benefits with different demographic characteristics. Correlation analysis results were presented as the Spearman correlation coefficient. The plug-in v2.16.3 provided by SPSS software was used for linear regression analysis, and the deviation-corrected percentile Bootstrap method was used to examine the mediating role of personality (neuroticism, conscientiousness, agreeableness, openness and extroversion). RESULTS: Age, length of service in nursing, and record of formal schooling can affect nurses' perceived professional benefits. Mental workload, and perceived professional benefits were all above the median value. The mental workload was negatively correlated with perceived professional benefits (r= -0.129, P < 0.01), positively correlated with neuroticism (r = 0.242, P < 0.01), negatively correlated with agreeableness, openness, extroversion (r=-0.229~-0.221, P < 0.01), and negatively correlated with conscientiousness, but the differences were not significant. Nurses' perceived professional benefits were negatively correlated neuroticism (r=-0.109, P < 0.05), but positively associated with conscientiousness, agreeableness, openness, and extroversion (r = 0.098 ~ 0.326, P < 0.05). The mental workload can directly affect the perceived professional benefits in the direct effects, and can also affect the it through the mediating effect of agreeableness, extroversion, neuroticism, and openness. CONCLUSIONS: Age, length of service in nursing, and record of formal schooling could affect nurses' perceived professional benefits, and personality played a partial mediating role in the influence of mental workload on the perceived professional benefits. The results of this study can provide strategies for nurses' human resource management. According to different demographic factors, and personality, various measures should be taken to guide nurses to evaluate the mental workload correctly, reduce their emotional pressure, increase job resources, and improve their perceived professional benefits.

A first census of skin cancer specialist nurses across UK secondary care trusts.

BACKGROUND: Skin cancer specialist nurses (SCSNs) support patients and work alongside healthcare professionals throughout the care pathway. Skin cancer management is rapidly evolving, with increasing and more complex treatment options now available, so the need for patient support is growing. While SCSNs are a major source of that support, the provision of SCSN resource across the UK has never previously been assessed. We therefore undertook a first SCSN census on 1st June 2021. METHODS: An electronic survey was disseminated to UK hospital trusts and registered skin cancer healthcare professionals. Responses were identifiable only by the respective trust name. RESULTS: 112 responses from 87 different secondary care trusts were received; 92% of trusts reporting having at least 1 established SCSN post. Average SCSN staffing per trust was 2.4 (range 0-7) whole time equivalents, managing an average caseload of 83 (range 6-400) patients per week. SCSN workload had increased in 82% hospitals in the previous year and 30% of trusts reported being under-resourced. Most SCSN time was spent managing melanoma (as opposed to non-melanoma skin cancer) patients linked to surgical services. Regional variations existed, particularly associated with provision of lymphoedema services, nurse prescribing skills and patient access to clinical trials. The COVID-19 pandemic was associated with a marked increase in SCSN-led telemedicine clinics, but loss of training and education opportunities. CONCLUSIONS: SCSNs based in secondary care hospitals play a major role supporting both clinicians and patients throughout the care pathway. This first UK census confirmed that SCSN workload is increasing and in one third of hospital trusts, the work was reported to outstrip the staffing available to manage the volume of work. Regional variations in SCSN resource, workload and job role, as well as availability of certain skin cancer services were identified, providing valuable information to healthcare commissioners concerned with service improvement.

Workflow interruption and nurses' mental workload in electronic health record tasks: An observational study.

BACKGROUND: Workflow interruptions are common in modern work systems. Electronic health record (EHR) tasks are typical tasks involving human-machine interactions in nursing care, but few studies have examined interruptions and nurses' mental workload in the tasks. Therefore, this study aims to investigate how frequent interruptions and multilevel factors affect nurses' mental workload and performance in EHR tasks. METHODS: A prospective observational study was conducted in a tertiary hospital providing specialist and sub-specialist care from June 1st to October 31st, 2021. An observer documented nurses' EHR task interruptions, reactions and performance (errors and near errors) during one-shift observation sessions. Questionnaires were administered at the end of the electronic health record task observation to measure nurses' mental workload for the electronic health record tasks, task difficulty, system usability, professional experience, professional competency, and self-efficacy. Path analysis was used to test a hypothetical model. RESULTS: In 145 shift observations, 2871 interruptions occurred, and the mean task duration was 84.69 (SD 56.68) minutes per shift. The incidence of error or near error was 158, while 68.35% of errors were self-corrected. The total mean mental workload level was 44.57 (SD 14.08). A path analysis model with adequate fit indices is presented. There was a relationship among concurrent multitasking, task switching and task time. Task time, task difficulty and system usability had direct effects on mental workload. Task performance was influenced by mental workload and professional title. Negative affect mediated the path from task performance to mental workload. CONCLUSIONS: Nursing interruptions occur frequently in EHR tasks, come from different sources and may lead to elevated mental workload and negative outcomes. By exploring the variables related to mental workload and performance, we offer a new perspective on quality improvement strategies. Reducing harmful interruptions to decrease task time can avoid negative outcomes. Training nurses to cope with interruptions and improve competency in EHR implementation and task operation has the potential to decrease nurses' mental workload and improve task performance. Moreover, improving system usability is beneficial to nurses to mitigate mental workload.

Characteristics of faculty mentoring in the Robert Wood Johnson Foundation Future of Nursing Scholars Program.

BACKGROUND: To address the need for faculty scientists, Robert Wood Johnson Foundation (RWJF) provided support for an accelerated PhD program: Future of Nursing Scholars (FNS). PURPOSE: To describe the experience of faculty mentoring PhD students in the RWJF FNS program pursuing a 3-year accelerated PhD degree, including faculty members' support activities for students, time commitment, student productivity in manuscript dissemination, and challenges and opportunities for supporting students. METHODS: Surveys were sent to faculty mentors of FNS to understand mentoring activities, strategies used, and mentee productivity. FINDINGS: Of 93 faculty mentors, they reported most FNS students (n = 61, 65.6%) completed a manuscript format dissertation. FNS students required academic/dissertation mentoring, with frequent emotional support and positive reinforcement. DISCUSSION AND CONCLUSION: Mentors reported providing more frequent mentoring and spent more time mentoring FNS students than with other PhD students. Alignment of the student's research to that of the faculty mentor was identified as valuable.

[Physician working hours and effects on health, satisfaction and healthcare]. / Arbeitszeit bei Ärzt:innen und Auswirkungen auf Gesundheit, Zufriedenheit und Gesundheitsversorgung.

Changes in the working environment with respect to innovative working time models are also increasingly affecting patient care. The number of physicians working part-time, for example, is continuously rising. At the same time, a general increase in chronic diseases and multimorbid conditions as well as the growing shortage of medical staff, leads to more workload and dissatisfaction among this profession. This short overview summarizes the current study situation and associated consequences regarding working hours of physicians and gives a first explorative overview of possible solutions.

Application of the workload indicators of staffing need method to calculate the size of the medical staff at a maternity hospital in the state of Bahia, Brazil.

BACKGROUND: Functioning health systems require a health workforce (HWF) that is qualified, available, equitably distributed, and accessible to the entire population as the basis for guaranteeing access to health. There is a global HWF crisis, manifested in Brazil by unequal distribution of healthcare personnel, particularly in rural areas, urban peripheries, and other hard-to-reach communities, posing a major obstacle to guaranteeing access to health systems and services. Based on the above, calculating the size and analyzing the workloads of the medical staff in the Obstetrics Department (OD) and Urgent Care Center (UCC) in a state maternity hospital is relevant for designing improvements in the work processes and future strategies for recruiting, selecting, and retaining these workers at the hospital, in turn favoring improvement in the quality of care for women and children at the state level. This scenario motivated the study's design, in which the overall objective was to analyze the workload of staff physicians working in the Obstetrics Department and Urgent Care Center of a public maternity hospital in the state of Bahia, based on the WISN method. METHODS: This was an exploratory-descriptive intervention study with a quantitative approach and qualitative elements, using the methodological stages recommended by the WISN to calculate and analyze the workload of obstetricians working in the OD and UCC in the maternity hospital. RESULTS: The study found a deficit of 14 shift obstetricians at the hospital with a workload of 0.81. The study also found that the insufficient number of obstetricians at the hospital resulted from precarious hiring formats, idle medical positions, and poorly structured work processes and a shortage in the multidisciplinary staff. CONCLUSION: The research sought to contribute to the reduction of the gap in models and methodologies for the staffing of gynecologists and obstetricians in Bahia Maternity Hospitals, without covering the whole subject, but to demonstrate that the findings of the workload analysis and its validation could be useful in promoting and directing the design and implementation of interventions to improve the quality of the workload.

Application of workload indicators to assess the allocation of orthopedists in a national referral hospital in Brazil.

BACKGROUND: The study analyzes the allocation of specialized doctors' orthopedists in a high-complex hospital, using the WHO's Workload Indicators of Staffing Need (WISN) methodology and approach, which measures the workload pressure on the healthcare team (positive, negative, or well-adjusted). METHODS: In the first phase, the hospital's operations and activities were analyzed using the information system. The duration of the tasks performed by the specialist physicians was observed and directly measured in the second phase. Finally, the indicators were analyzed, and the workload was calculated using the WISN application. The measurement was made using the available work time per year divided by the time unit over the previous 12 months. RESULTS: The hand surgery care unit was WISN 1.0 and the ratios for the spine surgery care unit was 1.22, indicating enough physicians and no work overload among the groups surveyed. The ratio in the knee unit was 1.69, indicating that there was an excess of staffing for the workload. CONCLUSION: The workload findings and staffing calculations were useful in supporting and orienting the design and implementation of measures to increase the efficiency and effectiveness of health services.

Workload assessment of medical doctors at primary health care centers in the Duhok governorate.

BACKGROUND: A shortage in human resources, particularly physicians, has become a challenge confronting health authorities in the Duhok governorate, as these resources are the key input for delivering health care. It has become necessary to identify the most appropriate scientifically sound method for having adequate staffing levels. This study aimed to forecast the required number of physicians to cope with the current workload at the main primary health care centers in the Duhok governorate. METHODS: A cross-sectional study was adopted to collect data for 1 full year. Data collection included both primary and secondary data sources. A semi-structured questionnaire was developed to obtain information every month from health centers on activities related to training and leaves. Data analysis was performed using Workload Indicators of Staffing Need software. RESULTS: Sixty-one primary health care centers met the final criteria for analysis. The study revealed physician shortages and inequity in the distribution of staffing. In these centers, 145 physicians lacked an adequate delivery of health services based on the workload imposed on them. The 'workload indicators of staffing need' ratio was 0.33, indicating high work pressure on medical doctors. Some centers offered more health care than others, but had fewer doctors based on the current staffing practices. CONCLUSIONS: This study pointed out the importance for the public health sector and academic medical institutions to use Workload Indicators of Staffing Needs software in health policy administration to restructure their efforts to address the physician shortages and distribution imbalances at primary health care facilities.

Adopting workload-based staffing norms at public sector health facilities in Bangladesh: evidence from two districts.

BACKGROUND: Bangladesh's Health system is characterized by severe shortage and unequitable distribution of the formally trained health workforce. In this context, government of Bangladesh uses fixed staffing norms for its health facilities. These norms do not always reflect the actual requirement in reality. This study was conducted in public sector health facilities in two selected districts to assess the existing staffing norms with the purpose of adopting better norms and a more efficient utilization of the existing workforce. METHODS: To carry out this assessment, WHO's Workload Indicators of Staffing Need (WISN) method was applied. Selection of the two districts out of 64 and a total of 24 health facilities were made in consultation with the formally established steering committee of the Ministry of Health. Health facilities, which were performing well in serving the patients during 2016-2017, were selected. This assessment examined staffing requirement of 20 staff categories. RESULTS: Based on the computer-generated WISN results, most of the staff categories were found to have a workload pressure of Very High (seven out of 20 staff categories), followed by Extremely High (five staff categories). Two staff categories had high, three had moderately high, two normal, and one low workload. Nurses were found to be predominantly occupied with support activities (50-60% of working time), instead of actual nursing care. Regarding vacancy, if all the vacant posts were filled, understandably, the workload would reduce, but not yet sufficient to meet the existing staff requirements such as consultants, general physicians and nurses at the district and sub-district/upazila-based hospitals. CONCLUSION: The existing staffing norms fall short of the WISN staffing requirement. The results provide evidence to prompt a revisit of the staffing policies and adopt workload-based norms. This can be supplemented by reviewing the scope of practice of the staff categories in their respective health facilities. In the short term, government might consider redistributing existing workforce as per workload. In the long term, revision of staffing norms is needed to provide quality health services for all.

How to make the best use of the workload indicators of staffing needs method in determining the proportion of time spent in each of the workload components and its implication in decision making: the experience of the Sultanate of Oman.

BACKGROUND: The Ministry of Health in the Sultanate of Oman decided to have better distribution of the health workforce among all health facilities through evidenced-based staffing norms. Four directorates worked together to develop the staffing norms through making use of the workload indicators of staffing needs (WISN) method. The aim of this study is to describe the process of applying the WISN method in Primary Health Care institutions and how to make the best use of method in determining the proportion of time spent in each of the workload components and its implication in decision making. METHODS: The WISN was applied for five priority categories, namely, doctors, nurses, pharmacists, laboratory technicians, and radiology technicians at PHC institutions. The WISN ratio has been translated into workload pressure as a percentage through applying the formula [workload pressure as % (in case of shortage) = (1 - WISN ratio) × 100%]. While the proportion of time spent in each of the workload components was calculated through making use of the category allowance standard, the individual allowance standard to determine the time spent in support and additional activities. The sum is subtracted from 100% to give the time spent in the health service activities. RESULTS: Determining the workload pressure as a percent and its interpretation is based on the fact that one cadre or as a group can bear up to 10% of extra workload. Thus, managers can undertake sensible short-term arrangements or decisions in redistributing the cadres among the health facilities on expectation of deploying more staff. DISCUSSION: Careful and detailed analysis of the proportion of time spent in each of the workload components will allow to have better understanding of the context and dynamics of work. CONCLUSION: Decision makers and planners can undertake rational short-term decisions in redistributing the cadres among the health facilities based on the workload pressure. In addition, they can as well as easily decide on the optimal proportions of time for each staff category, and hence choose what activities and tasks to be shifted or delegated to other staff category.

Multi-country case studies on planning RMNCH services using WISN methodology: Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea.

BACKGROUND: Globally, many countries are adopting evidence-based workforce planning that facilitates progress towards achieving sustainable development goals for reproductive, maternal newborn and child health. We reviewed case studies on workforce planning for reproductive maternal newborn child health services at primary care level facilities using workload indicators of staffing need in five countries. METHOD: Using available workload indicators for staffing need reports from Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea, we generated descriptive statistics to explore comparable workload components and activity standards, health service delivery models with an emphasis on the primary care levels and the specific health occupations offering interventions associated with reproductive maternal, newborn and child health services. RESULTS: The health services delivery models vary from one country to another. The results showed variability in the countries, in the workload components and activity standards of each regardless of facility level or occupational groups involved. All the countries have decentralized health services with emphasis on comprehensive primary care. Reproductive, maternal and new-born child health care services include antenatal, postnatal, immunization, family planning, baby wellness clinics, delivery and management of integrated minor childhood illnesses. Only Sultanate of Oman offers fertility services at primary care. Kenya has expanded interventions in the households and communities. CONCLUSION: Since the health care services models, health services delivery contexts and the health care worker teams vary from one country to another, the study therefore concludes that activity standards cannot be adopted or adapted from one country to another despite having similar workload components. Evidence based workforce planning must be context-specific, and therefore requires that each country develop its own workload components and activity standards aligned to their local contexts.

Use of the WISN method to assess the health workforce requirements for the high-volume clinical biochemical laboratories.

BACKGROUND: The clinical laboratory services, as an essential part of health care, require appropriate staff capacity to assure satisfaction and improve outcomes for both patients and clinical staff. This study aimed to apply the Workload Indicators of Staffing Need (WISN) method for estimating required laboratory staff requirements for the high-volume clinical biochemical laboratories. METHODS: In 2019, we applied the WISN method in all 13 laboratories within the Center for Medical Biochemistry of the University Clinical Centre of Serbia (CMB UCCS). A review of annual routinely collected statistics, laboratory processes observations, and structured interviews with lab staff helped identify their health service and additional activities and duration of these activities. The study outcomes were WISN-based staff requirements, WISN ratio and difference, and a recommendation on the new staffing standards for two priority laboratory workers (medical biochemists and medical laboratory technicians). RESULTS: Medical biochemists' and laboratory technicians' annual available working time in 2019 was 1508 and 1347 working hours, respectively, for the workload of 1,848,889 samples. In general, the staff has four health service, eight support, and 15 additional individual activities. Health service activities per sample can take from 1.2 to 12.6 min. Medical biochemists and medical laboratory technicians spend almost 70% and more than 80% of their available working time, undertaking health service activities. The WISN method revealed laboratory workforce shortages in the CMB (i.e. current 40 medical biochemists and 180 medical laboratory technicians as opposed to required 48 medical biochemists and 206 medical laboratory technicians). Workforce maldistribution regarding the laboratory workload contributes to a moderate-high workload pressure of medical biochemists in five and medical laboratory technicians in nine organizational units. CONCLUSIONS: The WISN method showed mainly a laboratory workforce shortages and workload pressure in the CMB UCCS. WISN is a simple, easy-to-use method that can help decision-makers and policymakers prioritize the recruitment and equitable allocation of laboratory workers, optimize their utilization, and develop normative guidelines in the field of clinical laboratory diagnostics. WISN estimates require periodic reviews.