Development and validation of an assessment tool for nursing workload in emergency departments.

AIMS: To develop the Workload Assessment of Nurses on Emergency (WANE) tool and to test its validity and reliability to measure nursing workload in the emergency departments. BACKGROUND: Ensuring safe nursing staffing in emergency departments is a worldwide concern. There is no valid tool to measure emergency nursing workload in order to determine the needed nurse staffing in the emergency departments. DESIGN: A two-year, cross-sectional, multicenter study. METHODS: Workload was operationalised as the time nurses spent with nursing activities, classified into direct and indirect care. A board of experts provided content validity. Construct validity was evaluated by examining the WANE's correlations and group-discriminations patterns within the network of variables known to determine nursing workload. Reliability was assessed by the tool's ability to yield consistent results across repeated measurements. Reporting of this research adheres to STROBE guidelines. RESULTS: Seven emergency departments, including 3,024 patients, were involved in the first year and 18 emergency departments and 7,442 patients in the second year. Direct care time correlated positively and significantly with patient dependency on nursing care, age and length of emergency department stay and discriminated between the categories of dependency on nursing care, age and hospitalisation. Both direct and indirect care time discriminated between the emergency departments according to different patient care profiles and unit characteristics. WANE showed consistent results across measurements. CONCLUSIONS: Results support the WANE's reliability and validity to measure emergency nursing workload. This tool could be used to determine, on patient and unit, a baseline nurse staffing and the nursing skill mix in the emergency departments. WANE is also an evidence-based management tool for benchmarking purposes. RELEVANCE TO CLINICAL PRACTICE: The use of an evidence-based workload tool in making staffing decisions in emergency departments is crucial to ensure safe patient care and prevent work overload in nursing staff.

Studying the Variability in Patient Inflow and Staffing Trends on Sundays versus Other Days in the Academic Emergency Department.

BACKGROUND: Resource limitation, staff deficiency, and variability in patient inflow contribute to emergency department (ED) overcrowding, associated with delayed care, poor care, and poor patient outcomes. This study seeks to describe and analyze patient inflow variability and staffing trends on Sundays versus other days in a tertiary academic ED from South India. METHODS: Patient inflow and staffing data for 2 years were collected from hospital records, cross-checked, and statistically analyzed using Epi Info 7.0. RESULTS: Significant increase in patient inflow (45.6%) was noted on Sundays compared to other days (155.9 [95% confidence interval (CI): 152.75-159.05] vs. 107.1 [95% CI: 105.98-108.22]; P < 0.001), with higher inflow in the morning shifts (67.4 [95% CI: 65.41-69.45] vs. 32.1 [95% CI: 31.45-32.70]; P < 0.001). All categories of ED staff were deficient across all shifts (2.1 [95% CI: 2.05-2.15] tier-2 physicians, 4.9 [95% CI: 4.86-4.94] nurses, and 1.9 [95% CI: 1.88-1.92] nurse assistants on an average), especially tier-1 physicians (0.3 [95% CI: 0.24-0.36] on Sundays and 0.5 [95% CI: 0.48-0.52] on other days; P < 0.001). Patient-per-hour (PPH)-per-provider based on patient arrival rate was generally high. PPH per tier-1 physician was the highest, being 10.6 (95% CI: 9.95-11.14) versus 5.4 (95% CI: 5.26-5.59; P < 0.001) in the morning and 7.2 (95% CI: 6.95-7.45) versus 6.6 (95% CI: 6.43-6.74; P = 0.08) in the evening shifts on Sundays and other days, respectively. CONCLUSIONS: There were deficiencies in all categories of ED staff on all days, and this was pronounced on Sundays due to significantly higher patient inflow. Inadequate ED staffing, especially due to a significant dearth of tier-1 physicians is a pointer toward quality compromise in developing EDs. Authors recommend adequate staff deployment in developing EDs for optimum quality care. This should be implemented such that staffing is based on expected patient inflow so that a PPH-per-provider goal of 2.5 is targeted across all shifts.