Introduction
Today, an essential role in improving the effectiveness of medical care is assigned to specialists with secondary and higher nursing education. Nurses make up more than half of all healthcare workers globally and provide vital services at all levels of the healthcare system. However, the staffing of medical organizations with nursing specialists is decreasing annually. The so-called global crisis of nursing personnel is associated with many factors, including low wages and an exorbitantly high workload. The number of patients in some hospitals is ten times the number of nurses, so they do not have the opportunity to use various affordable, cost-effective nursing services. Internal conflicts, lack of support from the administration, and organizational culture are also reasons for personnel losses. In addition, as a result of optimization of nurses, paramedics, and midwives, there is a negative personnel dynamic of the average medical staff in the primary care unit.
The problem with the shortage of nurses is observed in many countries, including European ones. In some medical institutions, there is an average of 25 patients per nurse, often more. This is five times higher than the standards of the World Health Organization. The shortage of nurses is becoming more noticeable as forced hourly overtime, and additional shifts become the norm. The clinic staff is forced to work hard because there is no one to replace them. Wages remain low; because of this, nurses, trying to increase income, work at the limit of their capabilities, and sometimes beyond. They experience chronic fatigue; it is easy to make a mistake in this state. Given the importance of all of the above factors, the purpose of my work is to determine whether the allocation of nurses and patients is adequate to provide quality services.
Due to the heavy workload and stress associated with exceeding the number of patients per medical employee it is possible to distinguish many negative trends among them. These include irrational use of medications, depression, fear of work, skipping work, leaving a job, reducing responsibility for patients’ health, and making mistakes in treatment. In addition, such problems as low salaries of medical workers compared to their work and workload are significant, which causes higher turnover and withdrawal from this industry. This shows that the problems of labor assessment, workload, and management of the medical sector remain the most urgent and acute. Too many patients and the associated limited amount of time for an appointment reduces the motivation of a medical specialist and can harm the quality of medical care. Considering the above, this research was conducted to study the modern system of the workload of average medical workers. In addition, the distribution of time per patient is of interest for forming the most favorable conditions aimed at stimulating the quality of work of a nurse.
The lack of personnel causes an uneven distribution of job responsibilities; the total workload in medical institutions varies depending on staffing levels. Thus, this serves as an additional factor in the uneven distribution of medical services and workload. Another acute problem is that the staffing of specialists in medical institutions is approved based on the practice of previous years. Since hardly any studies of workplaces or job descriptions are supported, nurses do work that is not part of their direct functional responsibility. They do not perform specific tasks, and as a result, it turns out that nurses do not have the opportunity to devote enough time to each patient (Krisda et al., 2019). This situation makes it difficult to plan what specializations, experience, or skills will be needed for specific job functions. This creates difficulties in planning, organizing, and conducting training and activities to develop nursing care. According to a single standard, this can make it difficult to assess and measure the workload and, consequently, the distribution of time among patients.
Nurses’ workload varies depending on the main activities, type, category, and level of medical organizations, and its location. The actual workload and wages, as an assessment of their work, are not comparable. However, it is possible to identify general trends that concern most nurses. For example, this is the lack of work on human resource planning, the study and analysis of actual conditions, or feedback control. As a result, the total workload is unevenly distributed among the staff, and the staffing table is not observed.
Today, a nurse should act as an organizer of conditions for maintaining and restoring the patient’s health, consultant, and direct executor of measures to achieve the goals set. To do this, it is necessary to define a new role of a nurse in the treatment process. This implies a clear delineation of the duties of a doctor and a nurse, and the introduction of precise load standards for a nurse. The nurse can no longer remain a technical executor of the doctor’s instructions; they must become partners acting independently within their competence. One of the aspects of this multifaceted problem is the study of the functioning of the outpatient care system for the population. The role and importance of this system are increasing in the context of the transition of healthcare institutions to new economic relations. Within the framework of this new approach people are served on the principle of insurance medicine. One of its main components is allocating the time needed to provide quality nursing services to each patient.
A nurse should be able to solve the patient’s problems, make decisions, determine the amount of care, plan, implement it, and evaluate the quality of nursing care provided. The provision of medical care in the primary unit is a tremendous amount of work. This work must be optimally divided between the doctor and the nurse. Thus, it provides an opportunity to focus on issues of diagnosis and treatment for the doctor, and the nurse can devote a sufficient amount of time to patients. A unique side of nursing care, closely related to the above aspects, is the moral and ethical side of the relationship between nurses and patients. The psychology of the relationship between health workers and patients is noticeably affected by the lack of time for nurses. Few have the qualities necessary to establish communication with patients in too short a time.
To improve the quality of work of a nurse, it is necessary to release them as much as possible from work that is not directly related to the patient. It is required to investigate the possibility of rational distribution of responsibilities with a delegation of authority from the doctor to the nurse. That will provide the nurse with enough time for every patient. To fulfill these tasks, a rational organization of the work of nursing staff and a precise distribution of working hours is necessary. In addition, during the period of changing socio-economic relations, the importance of the psychological component in the relationship between health workers and patients is sharply increasing. Therefore, the availability of time for nurses to establish contact with the patient is critical.
The experience of medical and preventive institutions shows that with a sufficiently high clinical effectiveness of medical services, their economic efficiency is often low. This is due to the fact that medical personnel are not always used rationally and cannot efficiently distribute time between patients. With a high annual turnover of beds, the recommended number of doctors and nurses is most often not observed in various departments. This leads to an increase in the workload of procedural nurses, which, in turn, results in reducing their time for patients. Excessive workload reduces job satisfaction: workload may not allow the procedural nurse to promptly respond to patients ‘ requests.
Thus, the significant losses of working time that could be allocated for interaction with the patient are often associated with work disorganization in departments. To achieve high labor productivity in health care facilities at each workplace, it is necessary to identify and eliminate the factors that lead to unproductive time losses. Perhaps, to increase the time allocated to the patient, it is essential to involve a nurse with higher nursing education in this work. They should be guided by modern theories of leadership and management and can ensure the practical work of departments and institutions.
The right of citizens to receive care when providing them with medical care is guaranteed by law. The priority of the patient’s interests is carried out, among other things, by providing care during medical care. However, unfortunately, the legislator does not disclose the term “care”; therefore, there are still no criteria for a shortage of care approved at the departmental level. Nevertheless, it is possible to consider the lack of allocation of the proper amount of time to the patient as a criterion of improper care.
The timing of the work of ward nurses shows that there is not enough time in the nurse’s work schedule to carry out the most direct patient care. Therefore, it is necessary to involve relatives or paid staff to provide care for seriously ill patients. Nurses in many countries complain about the lack of time to perform the procedures required for patients, as evidenced by numerous materials of nursing sites on the Internet. Thus, the problem of patient care is acute not only in the USA: for example, a massive scandal broke out in the UK. It happened due to the fact that it turned out that more than 3 thousand patients died in British hospitals due to lack of proper care.
Solving patient safety problems related to the amount of time spent by nurses in the country, of course, requires a solution at the government level. The legislator represented by the US Department of Health should provide physicians with a regulatory framework for care and adopt norms of care. By these standards, labor standards should be developed that includes a minimum amount of time per patient.
A lack of time resources also causes the increase in nurse errors recorded in recent decades. When studying the working conditions of nurses, it was singled out among the main factors that increased the risk of making mistakes. For example, this is due to the fact that during the patient’s admission, nurses solve various spatially scattered and short-time tasks. They are constantly distracted by external signals, such as phone calls, and calls from other patients. In addition, due to urgent orders of doctors, they often have to interrupt the reception of patients.
Under these conditions, no more than a quarter of the nurse’s working time remains for interacting with patients. However, this problem can be alleviated in departments and wards where the work of nurses is well thought out and organized. Walking takes less time, and the number of random disconnections from receiving the patient is significantly less. A good work organization is characterized by a clear division of functions between nurses, the correct layout of wards, and the allocation of functional sectors. Thus, even if there is a need to distract, the time deducted from the care of a particular patient is insignificant.
In addition, the reason for the uneven distribution of time between the reception of patients and other responsibilities may also result from another factor. The imperfection of information support for the work of ordinary medical workers strongly affects it. All over the world, the problem is the loss of information during the transfer of shifts. Few hospitals can boast clear regulations for transferring data from the nurse taking the change to the nurse taking the growth.
Illegible handwriting in the list of appointments, inarticulacy of information on numerous labels and labels takes a lot of time. It is proved that a well-readable title should have a matte surface so that glare does not disrupt visual perception. Unfortunately, no more than half of the drug labels meet these requirements. Packaging design is essential: it is unacceptable to have the same packaging design for different drugs. It is hazardous if the packaging of the same drug, but in different dosages, is no different.
The problem of recent years is errors when working with a computer. Very often, programs have an inconvenient, poorly readable interface, complex search systems. In this case, the laptop only complicates the nurse’s work, increasing the expenditure of time resources. Of course, this does not mean that it is necessary to abandon the computerization of nurses’ workplaces, but it should be done thoughtfully for a minimal time.
Labor rationing should also deal with their optimal proportions when performing a particular job, planning certain areas of health care development. This implies the need for a nurse manager who purposefully improves their ability to manage. They must have an objective attitude to introducing new working methods, making modern decisions, and a professional view of each specific situation. Rational planning of the labor process is also necessary to increase productivity and quality of labor.
The timekeeping measurements can make it possible to determine the average duration of individual labor operations and the structure of the working time spent by the heads of nursing services. The data of the time-based assessment of various types of work of senior nurses can be a methodological basis for developing recommendations for improving the regulatory framework of their activities (Foo et al., 2017). In the absence of approved estimated norms of time spent on a particular type of activity, they can be developed on the spot and agreed with the institution’s administration. Many issues of labor rationing in the healthcare system have not been resolved. Thus, the regulatory documents do not define the time spent by the heads of nursing services, complicating the allocation of time resources for patient care.
Nursing staff, on which the quality and effectiveness of medical services largely depend, plays a crucial role in solving the tasks of medical and social assistance to the population. American healthcare faces the task of continuously improving the quality of medical care. The solution to this problem should be accompanied by a constant reduction in the cost of medical services. Improving the quality of medical services is determined mainly by nursing participation in the treatment process and the time allocated to patients.
It is known that nursing staff contacts patients more often, so at this level, patients’ perception of the quality of medical care is formed. Therefore, improving the efficiency of the healthcare system mainly depends on the effectiveness of personnel and time resource management. The average medical staff is the largest group of medical workers. The quality of medical care and patients’ satisfaction with it depends on the efficiency of the time allocation of their activities.
Factors such as excessive filling of medical documentation and lack of time to attend scientific conferences and study medical literature have a negative impact on professional activity. It is also extremely important to have a high psychological burden, a mismatch of wages for the services actually provided, and a shortage of average medical staff. The effectiveness of treatment is the impossibility of a thorough examination of the patient as a result of too many patients per nurse.
The activity of a nurse is associated with increased psycho-emotional stress combined with responsibility in decision-making in various extreme situations. Nursing staff in the course of their professional activities are often exposed to various negative factors. These include excessive physical and psychological stress associated with too many patients. Health workers overloaded with the number of patients are more likely to have symptoms of depression, anxiety, insomnia and distress. They have high levels of anxiety, stress, and not very good sleep quality.
The nurse has to carry out leadership, educational, educational activities. They promote the practice of a healthy lifestyle, physical and mental hygiene, help the patient to develop. One of the principles of a nurse’s work is that a nurse should be empathetic. At the same time, empathy often turns into a quality that a person should possess regardless of circumstances. Along with the need to have appropriate feelings, the nurse often has to hide her spontaneously arising natural feelings that do not correspond to the situation. A lot of effort is spent, for example, on suppressing feelings of irritation, fatigue, anger that arise when communicating with a patient. Their manifestations become more pronounced when it is necessary to switch frequently and quickly from one patient to another.
Negative emotions (fear, irritation, despair) that arise in a nurse during or after work are often associated with negative experiences of the patient. The poor condition of the nurse is, as it were, a consequence of emotional involvement in the negative experiences of the patient. A large number of different situations, schemes and ideas about life that a nurse encounters often worsen the emotional background of an average medical employee. At the same time, in conditions of compressed time, there is often no possibility of generalizing and systematizing one’s experience, working out emerging communicative problems. One of the first places of specialties at high risk of emotional burnout syndrome is occupied by the profession of a nurse. When faced with negative emotions, the nurse unwittingly becomes involved in them, which is why they begin to experience increased emotional stress themselves. Most of all, people who have an excessively high level of workload at work are at risk of this phenomenon.
The causes of fatigue and nervousness can also be called exceeding the standard number of patients, a large amount of clerical and design work, low technical equipment of workplaces. Of the ergonomic factors, the nurse most often notes the strain of vision, overload of the musculoskeletal system. most medical workers have irregular working hours, overtime work associated with the combination of positions or additional professional workload. Low wages in a developing market economy forces nurses to work, often neglecting the time provided for restoring the physical and emotional balance of the body.
Thus, the timing of the work of nursing staff and the distribution of time and number of nursing staff is critical. Therefore, in this study, special attention will be paid to the main reasons for the decrease in the time allocated to patients. First of all, these are excessive workload, insufficient staffing, and the lack of temporary standards of medical care.
Literature Review
Review of ‘Factors Influencing How Intensive Care Unit Nurses Allocate Their Time Show Less’
This article shows the importance of the amount of time devoted by nursing staff in the intensive care unit to maintaining health and the quality of patient care. It identifies factors that change nursing care priorities in the direction of giving less time to one patient. Attention is paid to various labor costs of a nurse, caring for patients, and the percentage of the duration of their performance. For example, the amount of work with documentation, searching and viewing the results of tests and outpatient records at an appointment with a doctor is studied.
The study aims to calculate the average time spent by the intensive care unit nurse and identify factors that do not allow them to devote patients enough time. It was also planned to focus on activities that are not directly related to the provision of medical care to patients but are included in the functional duties of nurses. The study was also aimed at determining the average estimated time of an intensive care unit nurse for servicing one patient. Time costs should also have been taken into account, depending on the provision of medical care.
The study used an empirical medical method: intensive care unit nurses were monitored and then their working day was described. The study was designed to calculate the average time per nurse visit. The variables were the nurse’s tasks, which can affect the amount of time spent on the patient. Data collection was carried out by monitoring the nurses’ working day, and the analysis of this data was carried out by tabulating it and using simple mathematical calculations.
The strengths of this study are the consideration of a large number of factors and a diverse sample, which included intensive care unit nurses from different hospitals. The present study determined the scope of nursing interventions in patients in the department of anesthesiology and intensive care. At the same time, large psychological and physical loads, dynamics, and saturation with extreme situations were also taken into account. The data calculation was carried out under conditions of intense attention and responsible fulfillment of the doctor’s prescriptions.
The value of this study is that it describes in detail the work schedule of the average medical staff of intensive care wards in compliance with internal safety regulations. Also, the conducted calculation made it possible to establish the actual number of patients per nurse. This factor is essential when organizing intensive monitoring of patients and their treatment. The obtained dependence of the number of patients and the performance of post, procedural and operational duties is essential in forming the hospital’s medical team.
The main conclusion of this study can be considered ways to optimize the work of nurses in the intensive care unit. An essential role in optimizing the work can be played by the impact on resource-intensive parts of the activities of nursing staff. This includes the implementation of medical appointments in their simplification and the elimination of polypragmasia and other things. It is also proposed to use large-capacity solutions in the infusion therapy program, significantly reducing the time and resources spent on changing vials.
These conclusions apply to the topic of my work, as they affect an important area for optimizing the activities of intensive care units. The measures proposed in the research are aimed at increasing the time that will fall on patient care. For example, in the light of the trend towards the openness of departments, the possibility of involving relatives of patients in inpatient care should be considered. It is assumed that this will unload nurses and allow the patient’s relatives to gain skills that can be useful in case of his long-term dependence on outside care.
Review of ‘Nursing Workload, Nurse Staffing Methodologies and Tools: A Systematic Scoping Review and Discussion’
This article touches on a more specific aspect than the previous one. It examines the working hours and rest hours of nurses and special rules for part-time work. Documents regulating the result of a medical worker and the number of patients per nurse are also being discussed. Attention is paid to methods that allow reducing the intensity of psychophysical loads due to the specifics and nature of medical and other activities to protect public health.
The purpose of this study is to identify the rate of patient admission for a nurse. In addition, the tools are identified, which allows the organization of the work process of employees of a medical organization. They are aimed at excluding or minimizing fluctuations in the time of performing actions by individual specialists in one working room. The most effective tools of aggregation and visualization of information for operational management and monitoring of medical care processes in a medical organization are also determined.
A theoretical research method was used, namely general logical methods (analysis and synthesis). This scientific work is designed to measure the effectiveness of human resources in conditions of increased workload. The variables are the number of patients and the nurse’s ability to work. Data collection is carried out during scientific papers on this topic; their analysis is fulfilled using synthesis. The strength of this study is taking into account the management methods of a medical organization and its logistics system. It considers the relationship between patient flows, the quality of medical care, and the involvement of nursing staff in improving processes. The problem of the intersection of patient flows which leads to an increase in the workload of nurses is raised.
This study is valuable because it offers an effective solution to reduce the flow of patients per nurse. It is proposed to draw up a diagram of the movement of patients, analyze their routes, and then determine the number of intersections in the flow. Next, separate entrances for departments where intersections are detected can be created (Foo et al., 2017). The methods proposed in the study are practical tools to reduce the workload on the nurse.
The study’s main conclusions were the need to map the processes that are an integral part of providing medical services. Thus, it will be possible to identify the intersection of patient flows, increasing nurses’ burden. The conclusion also indicates the need to correct the sequence of actions of the patient in the flow of the passage process. The necessity of the line of activities of the nurse in the provision of medical care is proved.
The conclusions obtained in the study apply to this work, as they affect the causes of the uneven allocation of patients. The reduction of the queue and the unified schedule of specialists of the polyclinic or hospital increases the efficiency of the use of human resources of the medical organization. Thus, the nurse saves time on providing services, and the patient does not stand in line. With the help of electronic queues, all the needs of patients are closed, and nurses’ workload is unloaded.
Review of ‘Capacity Constraints and Time Allocation in Public Health Clinics’
This study considers the problem not from the point of view of a nurse, as the previous article, but from the point of view of the management of the institution. It discusses the justification of introducing time for one patient to visit doctors of various specialties. This phenomenon is correlated with an increase in the workload of nurses and a drop in the availability of medical care. The lack of time and resources for interviewing, examining the patient, and getting acquainted with their medical history is being raised. It is also said that nurses need to have high cognitive abilities to switch from one patient to another quickly.
The purpose of this study is to find a solution to combat the outflow of nursing staff from public clinics associated with the increased workload. The study is aimed at finding the optimal amount of time that nurses devote to the patient. At the same time, the goal is also to prevent the abuse of this time, for example, filling out dispatch sheets at the reception instead of receiving patients. To do this, the time is searched in the schedule for working with papers.
The study uses an empirical research method: analyzing various scientific sources of information and a sample of data. The study is designed to establish new standards for nurse appointment times. The variables are the number of minutes that can be given to one patient and the capacity constraints of the nurse. Data collection is carried out by studying reliable sources, and the analysis of the information is obtained by searching for confirmation and similarity of materials from different sources.
The strengths of the study are the scientific justification of the obtained standards based on chronometric studies. The proposed solution reveals the problem of the need for nurses to devote more time to the patient. A nurse should spend exactly as much time on a patient as the state of a person’s health requires. To calculate the load on the average medical staff, it is necessary to consider their work correctly. The number of specialists in public hospitals who must meet the population’s needs for a specific type of medical care also plays a role.
The value of the study lies in a practical algorithm for calculating the norm of the nurse’s appointment time, depending on the number of nursing staff and the patient’s condition. The time of the primary and repeated visits of the nurse is differentiated. After analyzing the nurse’s actions when receiving a patient, the necessary amount of time is allocated. It also takes into account the time that the nurse spends working with documents and other activities.
The conclusions of this study are the need to calculate and approve the maximum time spent by a nurse per patient in each specific public clinic. The regulatory framework for the admission of patients should be determined by the number of nurses and their average monthly workload. There should also be a separate time for filling out documentation. These standards of time for receiving patients are necessary to calculate the load on nurses.
The conclusions apply to the topic of this study, as they enable the economists of a medical institution to calculate the number of nurses needed to serve patients. In addition, after the calculation, these data can be used to predict the need for specialists in this profile based on morbidity statistics and regulatory load. In addition, the results will also help take into account the demand for a specialty in medical universities.
Review of ‘A Comparative Study of Patients’ and Nurses’ Perceptions of The Quality of Nursing Services, Satisfaction and Intent to Revisit the Hospital: A Questionnaire Survey’
This article contains more data obtained experimentally than the previous one. It allows to get an assessment of the quality of the nurse’s service. This involves the analysis by patients of their professional knowledge, skills and abilities, compliance with professional requirements, and qualifications. Patients also evaluate the quality of the final outcome of an individual treated by a nurse for a certain period. Attention is paid to the importance of nursing technologies, compliance with standards, and the specific situation (hospital or polyclinic care).
The objectives of this article are to establish the compliance of nursing activities with existing standards, protocols, or accepted norms of the organization. The search for qualitative criteria, from the point of view of patients, care, preparation for diagnostic procedures, rehabilitation is carried out. Also, the goal is to establish compliance of the achieved results of nursing activities with the planned ones. Patients should carry out a final control and evaluate the results achieved after the service is provided.
The research method was a survey; a written questionnaire of patients was used. The study was designed so that patients could help determine the criteria for quality care, including the amount of time devoted to a particular patient. The variables were patient satisfaction with the quality of nursing care, the time spent on patient admission, and healing outcomes. After collecting data through a survey, their analysis took place during the formulation of its results in text, diagrams, and tables.
The strengths of this study are a practical algorithm for ensuring the quality of activity by nurses themselves. This were an incentive for awareness of problems, desire for changes, formulation of a standard, including temporary, and changes in the implementation of measures. The conclusions of the examination gave a comprehensive decision on the quality of nursing activities. If a defect is detected, its type is determined, it’s causes, for example, insufficient time to devote to patients and the nurse’s reboot, and the consequences.
The value of this study lies in the establishment of dependent and independent causes of defects in the quality of nurse services. The level of satisfaction of patients, relatives, a society with nursing services did not meet the consumer’s expectations for various reasons. One of the most common independent causes of defects in the quality of nurse services was a shortage of time resources and medical personnel. Due to the combination of these factors, the nursing care provided does not meet the needs of the patient or population, their expectations, the current level of medical science and technology.
The conclusions of this study demonstrate the need to improve the quality of nursing care, including with the help of additional human and time resources. Objective reasons were identified that determine the need to ensure the quality of nursing care and the level of public health. Firstly, it is the consumer’s rejection of medical services with a relatively low level of quality. The second reason was the tightening of the requirements for improving the effectiveness of nursing care as a condition for the functioning of a medical and preventive institution.
The conclusions are essential for this topic since one of the ways to improve the quality of medical care was to increase the time allocated to the patient. Thus, nursing services for the organization and measures to preserve the patient’s health will be performed more efficiently. Patients will increase their satisfaction with performing manipulations, preparing for research, and conducting rehabilitation activities. The conclusions show that it is necessary to strive for an optimal ratio of the expectations of the patient and the time and attention paid by the nurse.
Review of ‘Senior Nurse and Chief Exec Pay Gap Widens’
Unlike the articles discussed above, this article also takes into account the issue of nurses’ salaries, which vary significantly in different regions. The influence of experience, skills, seniority, qualifications, and additional education on labor remuneration is noted. On average, there is a gap in the salaries of nurses and other specialties in the country. Although the income received is enough to live with dignity and support a family, the nursing profession is not highly paid.
The purpose of this article is to compare the workload of a nurse and her salary. The aim is also to compare the salary of a nurse with the wages of representatives of other professions and the ratio of the absolute value of labor. The study aims to establish fluctuations in the salary of a nurse from different regions, hospitals, and departments. A review is done on compensatory and incentive payments, their size, and conditions of implementation.
The study uses a practical comparison method – nurses’ salaries are compared based on size. The study was designed to establish how much payments to a nurse on an official wage correspond to the work performed. The variables are fixed monthly payments, the region of residence, the department, and the nurse’s qualification. Data collection is carried out by analyzing official salary statistics, which are further explored compared to the statistics of average wages.
The strengths of this study are the identification of insufficient payment for the increased workload of nurses. It certainly affects the quality of work and leads to a shortage of specialists. The factors influencing the salary of a nurse are highlighted, such as specialization of a particular direction, work experience, category, qualification, and prestige of a medical institution. Due to the high competition in the labor market in this area and the small number of young professionals, the salary level affects the staffing. A correlation has been established between a high level of income and additional requirements for service and patient care.
The article is helpful for this study because it establishes causal relationships that low wages entail. It leads to an increased workload of nurses, a small amount of time devoted to each patient, and a shortage of workers. Due to the acute deficiency of personnel and the lack of decent pay, a significant burden falls on nurses. An extensive range of everyday duties often does not allow the nurse to pay attention to each patient.
The conclusions of this study include the fact that one of the main problems in the medical industry is the low pay of junior medical staff and nurses. The constantly expanding list of job responsibilities of the nursing staff makes it time-consuming to provide high-quality and attentive care for all patients at all stages of treatment. It was concluded that the number of allowances, incentive payments, and even coefficients for processing is set by the hospital management. Thus, the value of the average income of a nurse can vary greatly and often does not correspond to the workload.
The findings can be practically applied in this study; it highlights the cause of nurses receiving incredibly responsible and challenging work with low wages. It was found that orders to increase incomes force hospital management to take extreme measures – staff reduction with the transfer of responsibilities to the remaining doctors. Therefore, they cannot devote the proper amount of time to patients, which is caused by a lack of time resources.
Review of ‘Evaluation of Nursing Workload and Efficiency of Staff Allocation in A Trauma Intensive Care Unit’
Unlike the rest of the articles, this one has a narrower field of research: nurses of a particular department. This study proves how the ratio of the number of nurses and patients can substantially impact the quality of treatment and care in the intensive care unit. It is shown how an increase in the burden on nursing staff increases the harmful risks of patient outcomes. In addition, the issue of improved medical care costs due to repeated hospitalization and financial costs of patients is raised.
This article has the following objectives: to provide convincing evidence that the staffing of nurses in the intensive care unit significantly affects the outcome of patients. Thus, the researchers seek to identify a correlation of the increased possibility of an outbreak of infectious diseases with understaffed nurses. The aim is also to establish the relationship between the monthly frequency of hospital-acquired infections in the department and the ratio of nurses’ working hours.
Such a research method as observation was used – a description of the nurses’ work schedule and progress in the treatment of intensive care patients. The study was designed to establish a link between infections and the number of nurses work hours. Data collection was carried out by studying medical histories and descriptions of nurses’ labour; then, the information was analyzed when it was organized.
The study’s strengths are considered to be the determination of the optimal load on the intensive care unit nurses. It was revealed that a nurse caring for more than two patients at night increases the risk of several postoperative and infectious complications. This study is of particular value, as it shows that intensive care patients have a more negative outcome of complications if there are more than two patients per nurse. It provides recommendations for the optimal ratio of nurses to patients to avoid their infection. In addition, the study showed that an increase in the nurse-patient ratio increases the mortality rate of patients.
As a result of the study, the following conclusions were made: each additional patient added to the workload of a nurse is associated with an increase in hospital mortality. The chances of staying a day longer in the hospital are also increased, which is a major cost factor. Therefore, expanding the number of nurses is more economical, because then the length of stay of patients in the hospital will be shorter and this will help to avoid re-hospitalization.
It is essential to consider the findings in this study since the severity and intensity of the nursing labor process often exceed the norm. Nurses working in the intensive care unit should take care of patients and maintain a specific microbiological state of the environment and the smooth operation of medical equipment. Thus, they face an excessive workload, and, in this regard, the amount of time per patient is reduced.
Review of ‘A Conceptual Framework for Quality of Care’
The article reflects the most significant structural elements of providing medical care to the population at the present stage. The issues of organization and legal regulation of the system of medical care are considered. The medical provision of the people and the quality management system of medical care are described. In addition, the authors analyzed the leading demographic indicators and staffing of the healthcare system.
The purpose of this article is to identify the components of monitoring the quality control of medical care. It aims to obtain information about the state and dynamics of nurses’ work, continuous improvement of their activities, studying the level and trends of professional development. The study should identify external and internal factors on which the success of nursing activities depends. Attention will also be paid to the factors under which the quality of the medical and diagnostic process inevitably decreases in healthcare institutions.
The research method was a generalization – combining the components into one concept of quality nursing care and describing them in a standard system. The study was designed to form an internal environment of a medical organization in which employees are actively involved in patient care. The variables were the policy and action plan in the medical institution, the adopted strategy, and tactics in improving the culture of medical care. Data collection was carried out by studying state documents and local documents of participating hospitals; then, an appropriate concept of quality patient care was formed from the information received.
Among the study’s strengths is the popularization of a quality care policy to increase nursing staff awareness, motivation, and involvement. The article also focuses on implementing processes that allow meeting the requirements of patients and achieving high quality level. The authors recommend hospital management develop, implement and maintain an effective work schedule of nurses to reach quality goals. To involve employees in accomplishing effective care, appropriate working conditions should be created for them.
This article is helpful because it emphasizes that average healthcare professionals form the basis of medical care organizations. It is necessary to determine their needs and expectations from the work schedule, workload, and job satisfaction. It is required to create working conditions that will help ensure the full involvement of employees in the care process and increase work motivation. This is possible only through expanding the number of medical workers and devoting more time to each patient.
The article’s conclusions indicate the need to encourage proactive work behavior and the professional development of employees. It is recommended to achieve this by developing individual and group process management goals and evaluating the results. It is also necessary to investigate the reasons for the arrival of employees in the organization and their dismissal. If the nurse left due to too much workload and the associated inability to provide quality care to all patients, it is necessary to expand the medical staff.
The conclusions obtained in the article are directly related to the topic under study. They confirm that improving the quality of medical processes and services should allow nurses to devote more individual time to each patient. Recovery will be achieved faster and more efficiently when the activities of the nursing staff are carried out in less compressed time resources. System analysis and optimization of processes will increase the labor activity and motivation of medical workers. Therefore, it is advisable to use standard principles and process management methods to achieve quality care without overloading the staff.
Review of ‘Nurse Staffing: The Knowns and Unknowns’
This article was chosen due to the fact that it considers the constant expansion of the nurse’s responsibilities. The most important personality traits of the psyche, which a nurse must necessarily possess, are discussed. Such characteristics of the average medical staff representative as the ability to make decisions independently and quickly respond to changes in the situation in any circumstances are described. The purpose of the article is to establish the direct impact of psychological state on patient survival. The goal was also set to study the burnout syndrome of the average medical staff and the working conditions leading to it. In addition, it was necessary to identify the percentage of nurses leaving the profession because of this phenomenon.
The research method was a conversation and an interview: nurses from different departments answered questions about their psychological state. The study was designed to identify the problems caused by constant overtime work. Data collection was carried out during the interviewing of nurses, and analysis was fulfilled when synthesizing the information received. The study’s strengths are the problem of overtime labor of nurses who regularly work either part-time or overtime. It is proved that fatigue and lack of sleep lead to emotional, social, and cognitive disorders. This reduces the ability of nurses to cooperate with both the doctor and the patient.
The article is relevant for the study, as it also analyzes the level of satisfaction with work among the average medical staff. During the interview, more than half of the employees expressed dissatisfaction with the working conditions and the number of earnings, and the lack of support from management. Professional burnout is associated with these factors, constant processing, emotional exhaustion, and the inability to give each patient the proper amount of time.
The findings obtained by scientists show that working as a nurse is one of the most challenging and harmful to health. Nurses get emotional and physical injuries several times more often than representatives of other professions. The researchers concluded that it is necessary to develop an algorithm of psychological assistance. It is supposed to help nurses maintain mental well-being and not harm themselves even as part of caring for a patient.
The conclusions given in the article are helpful for this study since nurses working under stress are more likely than others to make mistakes when caring for patients. With emotional burnout, cognitive abilities decrease, so the risks become higher when performing manipulations such as working with wounds, injections, and blood sampling. To avoid negative consequences, it is necessary to reduce the workload and the number of patients assigned to one nurse.
Review of ‘The Effect of Reflection on Nurse-patient Communication Skills in Emergency Medical Centers’
This article explores how the treatment of the disease depends on the psychological factor in the interaction of the patient and the medical worker. It is considered what effect the right attitude of the medical worker has on the emergency patient during their contact. This article aims to study the process of communication between a patient and a nurse and to identify factors that may affect the psychological characteristics of their interaction. The study also highlights the attributes of a complex multidimensional process of establishing and developing psychological contacts between people in the emergency medical center.
The research method was the modeling of psychological state in situations when it is necessary to provide urgent medical care. The study was designed considering the essential psychological aspects of nurse-patient interaction. The variables were the degree of deviation from the stable emotional state of the nursing staff and the patient. The study’s strengths were the study of the patterns of interaction between a nurse and an emergency patient from the point of view of medical psychology. The motives and values of the nursing staff, their ideas about the ideal patient, and the patient’s expectations of emergency care were studied in detail. This article was chosen as refereed because it proves the main point of building effective communication in constructing conflict-free communication. At the same time, in conditions of compressed time or overload, the health worker experiences stress, which increases the likelihood of conflicts.
The study’s conclusion confirms that communicative skill is the main professionally significant competence of an average medical worker in an emergency medical center. It is claimed that with a properly structured communication process between a medical worker and a patient, the application process goes much faster. The data given in the article apply to this research, as they link complications, the number of side effects in the emergency medical care with the nurse’s level of stress. It is confirmed that the nurse should not be severely limited in time and be in a state of chronic fatigue. Otherwise, difficulties may occur when forming contact between the participants in the treatment process.
Review of ‘Patients’ Perception of Quality in Healthcare’
This article reflects the assessment by the patient of various models of the relationship between them and the nurse. The factors influencing the patient’s satisfaction with the quality of medical care in a pronounced shortage of resources are identified. The study’s objectives are to determine the most appropriate combination of different types of medical care to the population and to ensure the excellent quality of this care. Special attention is paid to finding ways to effectively solve the problem of ensuring the quality of medical care that meets patients’ expectations in conditions of limited time resources.
Methods such as theoretical analysis and synthesis were used in the article. The study was designed to determine the appropriate volume and quality of medical care that would satisfy patients; the variables were the level of patient satisfaction. Data was collected during the analysis of scientific research, and their analysis was the result of the synthesis of the information received. The study’s strengths include orientation to the data of sociological surveys conducted among patients of different departments. The materials of this study can be effectively used to improve the provision of medical care.
The significance of this study is due to the particular importance of sociological studies of patient’s satisfaction with the quality of medical care provided to them. The study also offers valuable recommendations for improving the subjective assessment of the quality of nursing care. The conclusion given in the study states that it is necessary to take actions to improve the assessment of satisfaction with the quality of medical care in nursing professional activities. The authors also conclude that some of the existing approaches to the definition of quality of medical care require revision. The quality and efficiency problems of nursing work are among the most related to this research, as they are directly related to the limited time and human resources. Achieving an adequate distribution of nursing workload and time devoted to patients is one of the priorities for ensuring the proper provision of nursing services.
Review of ‘The Effects of Nurse to Patient Ratios’
This article is devoted to the requirements for the formation of the ratio of nurses and patients in the organization of the activities of medical organizations. The primary tool for solving this difficult task was the rationing of the work of medical workers. This article aims to determine the ratio of nursing staff and patients to provide high-quality and effective medical services. The report is also aimed at identifying criteria for the rational distribution and use of medical personnel.
The theoretical research methods used in this article are comparison and analysis. The study was designed to calculate the workload standards of medical workers providing primary specialized health care in outpatient settings. The ratio of nurses to patients was variable; data collection was carried out by studying data from scientific sources. The study’s strengths are a qualitative comparison of the average time spent on a separate technological operation, taking into account the actual repeatability coefficient of the process. The optimal ratio of nurses and patients was calculated, in which it is possible to maximize labor productivity and improve the effectiveness of the activities of the average medical staff.
This article is helpful because it provides practical methods for rationalizing working hours in a medical organization by regulating the nurse-patient ratio. Thus, the optimal distribution of the total temporary work cycle is achieved, and a time space is allocated for each of the patients. The conclusions of this study confirm the existence of the need for a local objective survey of the working hours of average medical workers. For its distribution and practical use, it is necessary to establish a ratio of patients and nurses. The findings can be used in this research when studying the distribution of working hours of nurses. Based on the data on the reasonable time spent by medical personnel, it is possible to determine the most optimal ratio of nurses and patients in a specific hospital.
Review of ‘Patients’ and Nurses’ Perceptions of Quality Nursing Activities’
This article examines the development of a patient-oriented approach and the correspondence of nursing activities to it. The assessment is carried out based on orientation to the patient’s interests, needs, values, and openness and involvement in the decision-making process regarding the provision of medical care. In the long term, high-quality nursing care leads to increased patient compliance and the implementation of continuity of treatment. In addition, patients desire to seek help again from the medical organization in which the patient-oriented approach is implemented. Thus, the favorable impact of high-quality nursing services on the financial condition of this medical organization is also evaluated.
The study aims to identify potential vectors of development in the direction of a patient-oriented approach. The quality of medical care is also assessed using an indicator demonstrating the degree of implementation of the patient-oriented method. This indicator is the level of satisfaction with the quality of medical care, reflecting the degree of compliance with the patient’s expectations, interests, and needs. In addition, the indicator reflects the nurses’ ideas about how a medical organization should function. Due to the widespread implementation of the measurement of this parameter, it becomes possible to realize the optimal development of medical organizations in areas relevant to the population.
The research method used in this article is a survey and questionnaire of nurses and their patients, followed by a mathematical analysis of the obtained indicators. The study was designed to conduct comparative research on the main criteria for satisfaction with the quality of medical care. The authors adhered to a patient-oriented concept, and the level of satisfaction with the medical services provided was used as a variable. Data collection was carried out through a survey of patients and nursing staff; then, the obtained data were generalized into numerical form.
The study’s strengths include a scientifically based assessment of hospital performance through a survey of patients and nurses and the development of methods to improve satisfaction indicators. The questionnaire provided allowed medical institutions to assess and improve the satisfaction of consumers and employees. Most of them contain sections for evaluating individual groups of factors that have an impact on happiness. Among them are also time characteristics, such as waiting for an appointment and the duration of an appointment with a nurse. The respondent is asked to evaluate a factor on a numerical scale. This allows determining the degree of compliance with certain expectations of the patient regarding any element in providing medical care.
The significance of this study is to provide an algorithm to increase satisfaction with the quality of medical care among patients and nursing staff. These measurement tools are based on standardized ones that were upgraded during the study, so the validation score of this measurement is relatively high. It is clarified that the study of the level of satisfaction in each region should be carried out using different methodological approaches (Krisda et al., 2019). Research aimed at developing a tool for determining the level of satisfaction requires a comprehensive approach, which was applied in this study.
The conclusions of this article are the criteria for the proper quality of medical care according to patients and nurses. The methods of determining the conformity of the provided medical care with the modern idea of its necessary level and volume were clarified. At the same time, it turned out to be important to take into account the specific pathology and individual characteristics of the patient and the capabilities of a particular medical institution. It was also possible to determine which medical care patients and nurses consider substandard, and the factors affecting its quality. diseases. At the same time, the assessment of the quality of care depends on the preferences of consumers and nurses. Thus, the concept of quality of medical care and its assessment in modern conditions were defined, based on new approaches and criteria.
The conclusions of the article are applicable to the topic of this study, since time factors influence an adequate assessment of the ultimate benefit of using a particular procedure. From the point of view of the impact of medical services on the quality of later life, the most beneficial effects are those that are performed in conditions of sufficient time and lack of overloading of the nurse. Related to this is also the characteristic of the availability of assistance, which is understood as the possibility for the consumer to receive the necessary assistance at the right time, in a place convenient for him, in sufficient volume and at moderate and acceptable costs.
Review of ‘Nurses’ Time Allocation and Multitasking of Nursing Activities: A Time Motion Study’
This paper examines the use of such a skill as multitasking by nurses and its effect on the distribution of time allocated to patients. The authors suggest that addressing a new task requires the brain to activate information about the rules that should be followed when performing it. The more difficult or unusual the task, the longer this process lasts. Therefore, the results of the use of multitasking in nurses is a high level of workload. This significantly increases the risk of professional burnout and emotional maladaptation in the form of symptoms of depression, anxiety and emotional distress in average medical workers.
The purpose of the study is to calculate the additional time it takes to switch attention from one patient to another, as well as to increase it if a new patient needs more complex interventions. The authors also intend to experimentally determine what is more time-consuming for a nurse: the transition from familiar to unfamiliar patients, or switching in the opposite direction. In addition, the article searches for an opportunity to either partially get away from multitasking, or find factors that will help neutralize the negative consequences of this phenomenon.
The method used in this study was observation: purposeful and systematic perception of medical processes requiring multitasking, the results of which were recorded. The study was designed to find an opportunity to minimize the number of tasks performed by one nurse. The variables were the number of new patients; throughout the study, the authors addressed the concept of multitasking. Data collection was carried out by analyzing the learned data, and their processing was carried out by calculating the net time spent using mathematical analysis formulas.
The strengths of the study are the existence of an algorithm for a clear distribution of nursing responsibilities, the lack of encouragement for the exchange of functions between secondary medical personnel without industrial necessity. The authors also give useful recommendations, including drawing up and following a strict schedule, according to which repetitive actions, if possible, should be implemented at a strictly defined time. It is also indicated that the change of tasks should not be too frequent, and the nurse should be given enough time to pay attention to each patient.
The value of this article for research is that it offers effective ways of competent use of time resources. The authors turn to the time management technique, which will allow both to effectively serve an ever-growing number of patients, and to perform the necessary amount of organizational work, and fill out the required number of administrative documents. To maintain a balance between productivity and rational time allocation, nurses need to learn how to improve efficiency within the limited resource of available time.
The conclusions obtained in the study state that the lack of a competent approach to time management negatively affects all aspects of the nurse’s work. Excessive workload due to multitasking hinders the professional growth of a nurse, hinders the accumulation of experience, slows down career advancement and undermines authority, which ultimately reduces her level of job satisfaction. A study of representatives of nursing staff of various profiles and specializations showed that employees who are forced to constantly resort to multitasking have numerous symptoms of emotional burnout syndrome.
Thus, the results of the article can be used in this study, since they are associated with the reduction of professional responsibilities as a result of limited time resources. The proposed time management in nursing helps nurses organize and prioritize time for patient care, internal administrative tasks, educational goals and personal responsibilities. Additional advantages of applying the principles of time allocation in the work of a nurse are increased efficiency and productivity, and reduced stress levels.
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