Abstract
INTRODUCTION
Nurses are at the forefront of direct patient care, playing a critical role in improving quality. However, nurse workload and adequate nurse staffing levels are difficult to determine, affected by changing patient numbers and acuity, nurses' knowledge and experience, and the work environment. Currently, MSF's nurse management decision-making can be based on expert panels rather than on data-based methodologies. By taking a novel approach in an MSF setting, we aimed to collect data, using a smartphone app (CommCare), that would outline a holistic view of a day in the life of a MSF nursing team, in order to understand what they do and why.
METHODS
Data were collected throughout 56 shifts, over 4 weeks between September and October 2018, in the under and over 5-years wards of the MSF Kutupalong hospital, Cox's Bazar District, Bangladesh. The site selection was based on the availability of qualified nurses and high workloads. 19 nurse participants used CommCare to capture the frequency and length of nursing tasks, shift characteristics (e.g. staff and patient demographics), and the qualifications and experience of nurse participants. As part of the data collection, and by using an extension of the original nursing app, the study nurse filled in information outlining the environment nurse participants worked in and the extent to which they adhered to the MSF Nursing Guidelines where available. Sampling to recruit nurse participants was purposive and voluntary.
ETHICS
This research met the requirements for exemption from MSF Ethics Review Board review. It was conducted with permission from Sidney Wong, Medical Director, Operational Centre Amsterdam, MSF.
RESULTS
Data collected accounted for 76% of nurse participants’ time. Despite differences in bed occupancy rate per shift (11 vs 8) and acuity (1.3 vs 1) between the under and over 5-years wards, both wards followed a similar pattern of task frequency (workload) with circa 27 tasks performed per nurse per shift, and times that specific tasks took place. No correlations between patient numbers or acuity and task duration were found. Interruption rates on tasks associated with clinical errors were 10% (administrating medication) and 20% (taking vital signs). On average 20% (+/- 2%) of all tasks conducted while 1 or 2 nurses were on the ward required nurses to leave the ward, meaning the ward was either left understaffed or completely unattended 20% of the time.
CONCLUSION
We obtained a holistic view of a 24-hour period of nursing care in a humanitarian setting; we were able to capture a substantive amount of nurses’ time; however, we could not account for multi-tasking. The similarities between the wards in task frequency, timing, and length, as well as the rate of interruptions and having to leave the ward unattended outline a need for nurse management to be reviewed to assist the delivery of safe and quality nursing care.
