Nursing Workload Associated with Hospital Patient Care

Background: Nursing costs are poorly estimated in economic studies conducted in hospitals because of a lack of data on nursing times for day-to-day activities relating to patient care. Objective: To determine standard time values for nursing activities for specific indications in a cohort of hospital patients. Study design: Patient care hours scores, calculated using the Grace Reynolds Application and Study of PETO (GRASP(R)) system, were extracted from patient records. A total of 483 patients with five different indications (acute myocardial infarction [MI]: n = 98; diabetes mellitus: n = 93; pneumonia: n = 98; schizophrenia: n = 94; and stroke: n = 100) who were hospitalized in March 2002 at the Sunnybrook Health Sciences Centre, Toronto, Canada were included. Main outcome: Patient care hour scores were converted into minutes, and the results were stratified by patient diagnosis and analyzed as to the frequency and duration of each nursing task. Results: Nurses reported that the greatest amount of time was spent providing care for patients with MI, (2.50_+-_2.31 hours of care per patient per hospital stay), followed by those with pneumonia (2.35_+-_2.02 hours), diabetes (1.96_+-_1.31 hours), schizophrenia (1.72_+-_1.95 hours), and stroke (1.70_+-_1.47 hours). The task most frequently undertaken in patients with MI was cardiovascular assessment; in patients with diabetes and pneumonia, it was routine teaching/emotional support; in patients with schizophrenia, it was ongoing assessment; and in patients with stroke, it was administration of medications. Pulmonary artery pressure monitoring consumed the most time in the nursing of patients with MI (110.83 minutes), whereas one-to-one supervision of a patient by a nurse (i.e. 1___1 sitter) consumed the most time in patients with diabetes, pneumonia, schizophrenia, and stroke. Conclusion: A standard table of time values for task-specific nursing workload in five indications was created using data obtained from the GRASP(R) system. Patients with MI required the most nursing care, and those with stroke required the least. This type of data will be important for future studies to determine nursing resource allocation as well as for evaluating the impact of new treatments on the nursing times associated with specific tasks.