Nursing Workforce Planning

Nursing Workforce Planning demystifies one of the most consequential and complex tasks in health service management: deciding how many nurses of which grades a ward actually needs. Drawing on empirical data from close to 300 UK hospital wards and the most extensive review of workforce planning systems since the DHSS manpower study, Keith Hurst classifies the eighty-plus methods in the literature into a handful of usable approaches — professional judgement, nurses per occupied bed, dependency-activity, and timed nursing interventions. Through hospital vignettes, worked examples, and step-by-step algorithms, the book shows readers how to measure patient dependency, analyse how nurses spend their time, link staffing to nursing quality, and convert all of this into defensible whole-time-equivalent establishments and grade mixes. It candidly weighs the strengths, weaknesses, costs, and validity/reliability concerns of each method, warning throughout against importing off-the-shelf data without local checks. For managers under financial pressure to tap the 'large and rich vein of nursing money,' it offers a rigorous alternative to unsystematic, superficial, or suspect staffing decisions.

What it argues

A causal model linking design levers and contextual conditions (patient dependency, nursing activity, staffing method choice, grade mix decisions) through psychological and behavioural states (nurse deployment, misuse of skills) to outcomes (quality of care, cost-effectiveness, job satisfaction, learner education).

Key ideas it contributes

• Patient Dependency — The extent to which a patient's functional capacity dictates the time and type of nursing care required, arranged hierarchically from least to most dependent.
• Nursing Activity Pattern — How nursing time is distributed across the categories of care and non-care work in a ward.
• Staffing Method Choice — The workforce planning approach a planner selects to derive nursing establishments and grade mixes.
• Nurse Grade Mix — The balance and distribution of nursing grades, including qualified nurses and support workers, within a ward team.
• Nursing Establishment Size — The pre-determined number of nurses in whole-time equivalents required to meet a ward's nursing workload.
• Misuse of Nursing Skills — The degree to which qualified nurses perform tasks below or outside their skill level, diverting them from direct patient care.
• Quality of Patient Care — The standard of nursing care specified, measured, and maintained or improved in a ward.
• Cost-Effectiveness of Staffing — Achieving acceptable care at the least cost by matching nursing resources to workload.