27 August 1999

Patient Nurse Dependency System Survey - Private Sector, Preliminary Results

As a result of a resolution passed at the 1998 Annual Conference, the QNU conducted a research project to analyse the appropriateness and use of Patient Nurse Dependency (PND) systems on the achievement of safe and adequate workloads in the private sector. The preliminary report from this research was presented at Annual Conference 1999.

The aim of the research was to test the following hypotheses:

• The clinical nursing safeguards built into the theoretical basis of current PNDs are not engaged by management in private hospitals; 
• Budgets drive nursing staff levels in private hospitals, not patient dependency and nursing practice; and
• Inappropriate use of PND systems contributes to overtime in private hospitals

Research methodology

The research was conducted by survey questionnaire in the first instance, sent to a randomly selected sample of QNU members from all 44 private hospitals in Queensland. This was followed by telephone interviews during the second phase of the research.

Emerging themes

As a result of the survey and subsequent interviews the following themes have been identified:

• Rostering practices within private hospitals are predominantly budget driven rather than driven by clinical care needs;
• Many private hospitals in Queensland use their PND data or HPPD benchmarks as the main, often sole determiner of nursing staff requirements; 
• Nurses in Queensland private hospitals felt the needs of most patients are being met, however, the needs of nurses themselves are not being met as the burden of budgetary restrictions falls upon them, resulting in unpaid overtime and cutbacks in professional development, nursing research and education;
• The practice of patient data being manipulated by management to fit into budget parameters is a regular occurrence;
• Management regularly disputes the data entered by clinicians at the unit level;
• Nurses working in clinical areas do not accept that PND results or the designated HPPD reflect the true needs of patients either in relation to the complexity of care required or the required skill mix or nursing staff;
• The majority of private hospitals audited the results of PND data collection against care outcomes away from the clinical area leaving its reliability in question. Most respondents to our survey did not know how the auditing process was carried out, and as a result of our survey there appears to be very little clinician input into the auditing process;
• Private hospitals have reduced numbers of permanent staff to cut costs and use large pools of casuals and agency nurses to make up for the shortfall in staff numbers. Permanent staff reported added pressure and stress from this constant influx of itinerant staff which they felt was increasing their already excessive workload.

Conclusion

As a result of this preliminary analysis of the data the following is asserted:

• The research to date validates members' anecdotal evidence that PND system use within the private hospital sector in Queensland is at best questionable and at worst inappropriate;
• Nurses in private hospitals continue to meet the clinical needs of their patients at the expense of their own industrial entitlements to paid overtime and to the achievement of recognisable and achievable workloads;
• The manipulation of data in PND systems by hospital management in order to meet budget requirements is widespread;
• Where such data manipulation occurs, claims that rostering benchmarks are being met are questionable and therefore are a false indicator of 'quality of care' outcomes;
• Currently, nearly one fifth of private hospitals in this state rely either partially or fully on a benchmarking system for rostering practices that is not open to any professional nursing scrutiny;
• Appropriate and transparent auditing of PND outcomes at the clinical level should be given urgent priority within private hospitals in Queensland.
• The final report of this research will be available following the conduct of further interviews with members and will form the basis for negotiations on workload management and staffing within the private hospital sector in Queensland.