Nurse Staffing Norm in Iran Hospitals: What Features Should be Included for Success?

BACKGROUND

Designing and implementing a model for estimation and distribution of required nurse is one of strategies to prevent unequal distribution of nurses within and between hospitals. The purpose of this research was to determine required features for hospital nursing staff estimation model.

METHODS

We conducted a qualitative study using a Colaizzi analysis approach. We used semi-structure and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in area of policy making in human resources in Ministry of Health, 10 decisions making in employment and distribution of human resources in treatment and administrative chancellors of medical universities, and 12 process owners in hospitals). The data were analyzed using ATLAS.ti software version 6.0.15.

RESULTS

The ten following sub-themes emerged from data analysis: Skill mix and task shifting, work measurement, legal support, stakeholder involvement in designing a model, considering the ward activity, considering type and extent of care patients required, model development by experts predominate in nursing process, considering the nurses availability, considering the capabilities and professional merits of nurses, fitness with social, cultural, and belief of people. The main themes were occupation analysis, planning and policy making, real workload, acceptability, nurses' efficiency, and being a native.

CONCLUSIONS

Given that standardization of nursing staff estimation is announced as one of the challenges in reaching Iran's 20-year vision plan. Hence, design and implementation of a nursing staff estimation model in regard to identified features could be part of priorities in Ministry of Health in Iran.

Barriers against required nurse estimation models applying in Iran hospitals from health system experts' point of view

Introduction

One of the strategies for accessing effective nursing care is to design and implement a nursing estimation model. The purpose of this research was to determine barriers in applying models or norms for estimating the size of a hospital’s nursing team.

Methods

This study was conducted from November 2015 to March 2016 among three levels of managers at the Ministry of Health, medical universities, and hospitals in Iran. We carried out a qualitative study using a Colaizzi method. We used semistructured and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in the area of policymaking in human resources in the Ministry of Health, 10 decision makers in employment and distribution of human resources in treatment and administrative chancellors of Medical Universities, and 12 nursing managers in hospitals). The data were analyzed by Atlas.ti software version 6.0.15.

Results

The following 14 subthemes emerged from data analysis: Lack of specific steward, weakness in attracting stakeholder contributions, lack of authorities trust to the models, lack of mutual interests between stakeholders, shortage of nurses, financial deficit, non-native models, designing models by people unfamiliar with nursing process, lack of attention to the nature of work in each ward, lack of attention to hospital classification, lack of transparency in defining models, reduced nurses available time, increased indirect activity of nurses, and outdated norms. The main themes were inappropriate planning and policymaking in high levels, resource constraints, and poor design of models and lack of updating the model.

Conclusion

The results of present study indicate that many barriers exist in applying models for estimating the size of a hospital’s nursing team. Therefore, for designing an appropriate nursing staff estimation model and implementing it, in addition to considering the present barriers, identifying the norm required features may positively impact on norm acceptance and implementation.