As the drive within a market-led National Health Service is towards cost-efficiency and through-put, nurses are now more than ever having to 'prove their worth'. This has led to various workload measurement systems being used throughout nursing. Before examining the accuracy of these measurement tools this paper attempts to define workload and investigates how measurement is limited by an unclear definition of what 'nursing' actually is. There is little argument as to some of the beneficial effects of monitoring workload where changes in practice, rostering, skill mix and establishments have occurred. It is, however, necessary to examine the accuracy of workload measurement within the current framework of nursing to see if it is the promised panacea. The issues surrounding patient dependency and professional judgement are discussed and the seeming unacceptability of such 'soft data' to non-nursing personnel. Both the 'bottom-up' and 'top-down' approaches of workload measurement are explored within the context of equity, neutrality and bias. The conclusion is drawn that accuracy in nursing workload measurement is not possible in the current economic climate and that a compromise solution that uses patient dependency as an assessment tool is the best that can be hoped for without limiting nursing to inflexible and restrictive practices.
Issues of "cost vs quality" and the needs for "pairs of hands" rather than "pair of eyes" has meant that nursing service managers are having to look closely at the skill mix of the staff they employ. This paper outlines the need to define the role of the nurse and the function of skill mix review. Arguments are discussed surrounding the issues of an all qualified nursing staff in a traditional hospital or the use of a generic "multiskilled" workforce within a "patient-focused" environment. The reasons for developing the role of the National Vocational Qualification (NVQ) Support Worker are examined and how they, and the Project 2000 trained staff nurse compare, against each other when looking for staff to employ. This paper looks at the paediatric field of health care in the light of the recommendations made by the 1991 Clothier Report to increase the number of specialist trained staff within that environment and what the future role of the children's nurse may be
Issues of "cost vs quality" and the needs for "pairs of hands" rather than "pair of eyes" has meant that nursing service managers are having to look closely at the skill mix of the staff they employ. This paper outlines the need to define the role of the nurse and the function of skill mix review. Arguments are discussed surrounding the issues of an all qualified nursing staff in a traditional hospital or the use of a generic "multiskilled" workforce within a "patient-focused" environment. The reasons for developing the role of the National Vocational Qualification (NVQ) Support Worker are examined and how they, and the Project 2000 trained staff nurse compare, against each other when looking for staff to employ. This paper looks at the paediatric field of health care in the light of the recommendations made by the 1991 Clothier Report to increase the number of specialist trained staff within that environment and what the future role of the children's nurse may be
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