The methods used to count the needs of nurses in hospitals
may give different results even though the settings used are the same. For
example, the “Republic of Indonesia Department of Health” method and the FTE
method give different results. The results nurses number count using the FTE
method are more often used by hospitals that have inpatient rooms with more bed
capacities, this method is not suitable for inpatient rooms with relatively few
beds (10 beds or less). In the FTE method, it is possible that the calculation
results of the number of nurses needed will not be sufficient to carry out
shift changes when used in inpatient rooms with low patient dependence (Susilo & Yustiawan, 2015). The nurse's
workload will be greater if using the FTE method in the inpatient room which
will make it difficult when regulate service time so that it can reduce patient
and nurse satisfaction (Susilo & Yustiawan, 2015).
The Gillies method and the Workload Indicator Staffing
Needs (WISN) method were used in the same setting but gave different results.
Based on the calculation of the results using the Gillies method, the need for
nurses is greater than the results from the calculation using the WISN method (Kastuti, 2018). This is because
there are differences in treatment hours. The WISN method refers to the
calculation of the length of time for activities carried out by nurses with
observation, while the Gillies formula uses the average time needed for care
per 24 hours (the treatment time needed by the patient) based on a reference,
not a real calculation of the workload in that setting. The WISN method uses
workload as a calculation in the formula so that the needs can be calculated
properly.
However, another method calculates the workload of nurses
based on the pure workload of patient care, which is clearly what care needs to
be done (Margadant et al., 2021). This method is a
Nurse Operating Workload (NOW) method. In this method, actions that are not
related to the patient such as lecturing a student, medical or other training,
join an emergency schedule are not counted in determining the workload (Margadant et al., 2021). There is already
a checklist of what examinations are carried out by nurses so that users of
this method clearly measure what activities need to be measured. This method is
the latest method recommended in the Netherlands
CONCLUSION
There is no definite requirement
which method should be used from a country in the literature to calculate
nursing staff compliance. There are only recommendations from the government or
associations rather than professional organizations from each country.
Each method has its own way of
providing insight into the number of nurses needed in the inpatient room. Each
method is interrelated and the calculation results often differ from one method
to another. The method used in a hospital inpatient room can be more than one
method used depending on the purpose used in the method. For retrospective
purposes, the Gillies, MOH RI, Nurse to Patient Ratio method can be used
because this number can be predicted because it does not use real time in its
use. For urgent needs, the Safe Nurse Care Tool (SNCT) method can be used or by
using software equivalent to the SNCT method, such as the Allocate Software
System. For retrospective evaluation methods as well as future planning, you
can use workload-based methods such as the Workload Indicator Staffing Need
(WISN) in collaboration with the Nurse Operating Workload (NOW) method, which
is the latest recommendation, although there have not been many studies related
to this method.
The WISN method has a subjective
weakness, because this method depends on the completeness of the data and the
accuracy of the measurements related to the workload. Errors that can occur in
the time and motion study method are in the researcher or observer because at
the time of the measurement the observer must continue to follow the activities
of the research subject while on duty and this can be inaccurate because the
observer also needs time for personal purposes when making observations, for
example going to the bathroom, resting, and so on, so that not 100% accurate
measurements can be made .
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