Planning for the Size of the Nursing Staff at an Outpatient Chemotherapy Unit

Analysis of home care nurses' workload: A time-motion study

This observational-descriptive time and motion study was conducted to determine how heavy home care nurses' workload is and how they allocate their work time to home healthcare. It was carried out in the home health services of the district municipality.The Information form, Nursing Activities Report Form, Cheltenham Patient Classification Scale were used. The time-motion study method was implemented to perform the workload analysis. The nurses allocated 68.02 minutes to direct care, 61.02 minutes to indirect care, 53.26 minutes to their work unit-related activities, and 119.42 minutes to their personal activities.Among all the activities performed during the day, the longest time was allocated to educational activities. Another area that took a long time was the registration procedures. Performing workload analysis with different methods that will measure many concrete and intangible attempts of home care nurses will contribute to workforce planning in home care services, resolving of the unmet home care needs of patients and continuous quality improvement.

A Two-Stage Method of Dimensioning and Scheduling Service Providers under Patient Demand Uncertainty

Many researchers have studied the problem of dimensioning service providers and making shift schedules and have proposed various methods to solve it. Considering the importance and complexity of health care, this research is conducted through the integrated dimensioning and scheduling of service providers under patient demand uncertainty. In the first stage, a robust approach is adopted to determine the minimum number of required service providers. In the second stage, a monthly schedule is devised for service providers, and a two-stage stochastic program is used to solve the problem. To this end, an improved sample average approximation method considers different contracts and skills to determine a near-optimal schedule by minimizing the service providers' regular working hours, overtime, and penalties for idle hours. In the first stage, considering the highest level of conservatism, equal to 7.6, a 19.38% cost increase is created compared to the nominal problem. In the second stage, by applying different clustering methods in the SAA algorithm and comparing them, the k-means++ algorithm obtains a good upper and lower bound and achieves a near-optimal solution in the shortest time. This research deals with the Iranian Health Control Center as a case study. The proposed method can yield the appropriate number of service providers based on monthly workloads and make the least undesirable schedules for service providers. Hence, managers can overcome patient issues' uncertainty by assigning various service providers to each scheduling period.

Clinicians Report Barriers and Facilitators to High-Quality Ambulatory Oncology Care

BACKGROUND

Ambulatory oncology practices treat thousands of Americans on a daily basis with high-risk and high-cost antineoplastic agents. However, we know relatively little about these diverse practices and the organizational structures influencing care delivery.

OBJECTIVE

The aim of this study was to examine clinician-reported factors within ambulatory oncology practices that affect care delivery processes and outcomes for patients and clinicians.

METHODS

Survey data were collected in 2017 from 298 clinicians (nurses, physicians, nurse practitioners, and physician assistants) across 29 ambulatory practices in Michigan. Clinicians provided written comments about favorable and unfavorable aspects of their work environments that affected their ability to deliver high-quality care. We conducted inductive content analysis and used the Systems Engineering Initiative for Patient Safety work system model to organize and explain our findings.

RESULTS

Clinicians reported factors within all 5 work-system components of the Systems Engineering Initiative for Patient Safety model that affected care delivery and outcomes. Common themes surfaced, such as unfavorable aspects including staffing inadequacy and high patient volume, limited physical space, electronic health record usability issues, and order entry. Frequent favorable aspects focused on the skills of colleagues, collaboration, and teamwork. Some clinicians explicitly reported how work system factors were relational and influenced patient, clinician, and organizational outcomes.

CONCLUSIONS

These findings show how work-system components are interactive and relational reflecting the complex nature of care delivery.

IMPLICATIONS FOR NURSING PRACTICE

Data obtained from frontline clinicians can support leaders in making organizational changes that are congruent with clinician observations of practices' strengths and opportunities for improvement.

Dimensioning of nursing staff in outpatient chemotherapy: application of the Workload Indicators of Staffing Need

OBJECTIVE

To apply the method developed by the World Health Organization, called Workload Indicators of Staffing Need for dimensioning the nursing staff for the care of cancer patients in a Chemotherapy outpatient clinic.

METHOD

This is a quantitative, observational, documentary field study with an intentional sample. Prospective data were collected through the work sampling method.

RESULTS

Seventeen nurses and 12 nursing technicians participated in the study. A total of 3,727 observations were performed and were obtained the mean times and the relative working time of 23 nurses' interventions and 18 nursing technicians' interventions. The interventions corresponded to 88.5% of the relative working time of nurses and 83.9% of nursing technicians. Personal activities accounted for 8.2% of the relative working time of nurses and 7.9% of nursing technicians. The reliability test resulted in 86.3% concordance.

CONCLUSION

The similarity between the staff required according to the method studied and the current staff showed that the Workload Indicators of Staffing Need has great potential and applicability for dimensioning nursing professionals safely.