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.

Workforce planning for urgent care services.

Due to major changes in how emergency care is delivered across different communities, one emergency department is no longer like another. Some have separate minor injury provision, some are general departments that cater for all types of patient, while others are designated major trauma centres. These differences in patient profile affect the required numbers and skill mix of nursing establishments so that the nursing workforce in each cannot be predicated on patient numbers alone. This article describes the development by the RCN Emergency Care Association of an evidence-based staffing tool and how it can be used in practice.

Measuring patient dependency in the emergency department.

The Jones Dependency Tool can be used in emergency departments to improve patient care and identify the required staffing and skill mix. Using the tool, the nurse can accurately identify a patient's specific nursing needs. The dependency tool is used to evaluate patients' needs in six areas: communication; airway, breathing and circulation; mobility; eating, drinking, elimination and personal care; environmental safety, health and social needs; and triage. Appropriate nursing care can be tailored to the dependency level, depending on whether the dependency level is low, moderate, high or total dependency.