Main Article Content
Abstract
Highlights:
- This article presents an understudied topic of nursing workloads in a hemodialysis unit and concludes that directly and indirectly productive activities occupied the majority of the nurses' working time.
- An analysis using the Workload Indicators of Staffing Need produced a general report that may prompt re-evaluation of nursing staff requirements and policy-making for workload distribution.
Abstract
The number of hemodialysis patients continues to increase almost every month, while the number of nurses in the Hemodialysis Unit at Rasyida Renal Specialist Hospital, Medan, Indonesia, remains constant. This situation has increased the nurses' workload and responsibilities. Therefore, it is necessary to examine the balance between the workload and the number of required nursing staff in the Hemodialysis Unit at Rasyida Renal Specialist Hospital. This study aimed to identify the optimal number of nursing staff required in the Hemodialysis Unit at the hospital in 2022. This study used a mixed-methods approach using the Workload Indicators of Staffing Need (WISN) method. This study included 44 nurses working in the Hemodialysis Unit at Rasyida Renal Specialist Hospital. Primary data included questionnaires, observations, and interviews during working hours, while secondary data included document reviews and staffing data. WISN calculations showed that the Hemodialysis Unit required a total of 65 nursing staff. In other words, an addition of 21 nursing staff was needed to meet the current workload. In conclusion, the current human resources available are not sufficient, and the workload is beyond the capacity of the nursing staff at the hospital.
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References
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- Bonfim D, Laus AM, Leal AE, et al (2016). Application of the workload indicators of staffing need method to predict nursing human resources at a family health service. Revista Latino-Americana de Enfermagem. doi: 10.1590/1518-8345.1010.2683.
- Destiani W, Mediawati AS, Permana RH (2020). The mental workload of nurses in the role of nursing care providers. Journal of Nursing Care. doi: 10.24198/jnc.v3i1.22938.
- Efendi F, Aurizki GE, Auwalin I, et al (2022). The paradox of surplus and shortage: A policy analysis of nursing labor markets in Indonesia. Journal of Multidisciplinary Healthcare 15, 627–639. doi: 10.2147/JMDH.S354400.
- Efendi F, Chen C-M, Kurniati A, et al (2018). The situational analysis of nursing education and workforce in Indonesia. The Malaysian Journal of Nursing 9, 20–29. Available at: https://ejournal .lucp.net/index.php/mjn/article/view/338
- Ekawati A (2018). The analysis of workload and need of nurse with wisn method in inpatient room in hospital x in Yogyakarta. Jurnal Medicoeticolegal dan Manajemen Rumah Sakit. doi: 10.18196/jmmr.7158.
- Elarabi HM, Johari F (2014). The impact of human resources management on healthcare quality. Asian Journal of Management Sciences & Education 3, 13–22. Available at: http://www.ajmse.leena-luna.co.jp/AJMSEPDFs/ Vol.3(1)/AJMSE2014(3.1-02).pdf.
- Farrasizdihar D, Girsang E, Ramadhani Nasution SL (2021). Analysis of workforce requirements based on WISN in radiology installation of RSU X. JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit) 10. doi: 10.18196/jmmr.v10i1. 10376.
- Frota MA, Wermelinger MC de MW, Vieira LJE de S, et al (2020). Mapping nursing training in Brazil: challenges for actions in complex and globalized scenarios. Ciíªncia & Saúde Coletiva 25, 25–35. doi: 10.1590/1413-81232020251.27672019.
- Govasli L, Solvoll B (2020). Nurses' experiences of busyness in their daily work. Nursing Inquiry. doi: 10.1111/nin.12350.
- Gunawan J (2016). Unequal distribution of nurses in Indonesia: A perspective from a nurse. Belitung Nursing Journal 2, 8–9. doi: 10.33546/bnj.8.
- Minister of Health (2013). Development and empowerment agency for health human resources (BPPSDMK). Jakarta.
- Hossny EK (2022). Studying nursing activities in inpatient units: a road to sustainability for hospitals. BMC Nursing 21, 148. doi: 10.1186/s12912-022-00926-x.
- Jayanti D (2018). Analisis kebutuhan tenaga kerja perawat rawat inap Rumah Sakit Umum Bunda Thamrin Medan berdasarkan metode workload indicator staff Need (WISN) (thesis). Universitas Sumatera Utara. Available at: http://repositori. usu.ac.id/handle/123456789/5915.
- Joarder T, Tune SNBK, Nuruzzaman M, et al (2020). Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method. BMJ Open 10, e035183. doi: 10.1136/bmjopen-2019-035183.
- Kieft RA, de Brouwer BB, Francke AL, et al (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Services Research 14, 249. doi: 10.1186/1472-6963-14-249.
- Kokoroko E, Sanda MA (2019). Effect of workload on job stress of ghanaian OPD nurses: The role of coworker support. Safety and Health at Work 10, 341–346. doi: 10.1016/j.shaw.2019.04.002.
- Leal JAL, Melo CMM de (2018). The nurses' work process in different countries: an integrative review. Revista Brasileira de Enfermagem 71, 413–423. doi: 10.1590/0034-7167-2016-0468.
- Maghsoud F, Rezaei M, Asgarian FS, et al (2022). Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach. BMC Nursing 21, 273. doi: 10.1186/s12912-022-01055-1.
- Martono M, Satino S, Nursalam N, et al (2019). Indonesian nurses' perception of disaster management preparedness. Chinese Journal of Traumatology 22, 41–46. doi: 10.1016/j.cjtee. 2018.09.002.
- McQuide PA, Kolehmainen-Aitken R-L, Forster N (2013). Applying the workload indicators of staffing need (WISN) method in Namibia: challenges and implications for human resources for health policy. Human Resources for Health 11, 64. doi: 10.1186/1478-4491-11-64.
- Moghadam KN, Chehrzad MM, Reza Masouleh S, et al (2021). Nursing physical workload and mental workload in intensive care units: Are they related? Nursing Open 8, 1625–1633. doi: 10.1002/nop2.785.
- Nuruzzaman M, Zapata T, De Oliveira Cruz V, et al (2022). Adopting workload-based staffing norms at public sector health facilities in Bangladesh: evidence from two districts. Human Resources for Health 19, 151. doi: 10.1186/s12960-021-00697-7.
- Pangaribuan E (2015). Analisis kebutuhan tenaga perawat berdasarkan beban kerja dengan metode time and motion study dan metode Workload Indicators of Staffing Need (WISN) di Instalasi Hemodialisa RSUD dr. Djasamen Saragih Pematangsiantar (thesis). Universitas Sumatera Utara. Available at: https://repositori.usu.ac.id /handle/123456789/39557.
- Raeissi P, Nasiripour AA, Reisi N (2015). Comparison of direct and indirect nursing care time in 8-hour and 12-hour shifts. Advances in Nursing & Midwifery 24, 45–51. Available at: https://journals.sbmu.ac.ir/en-jnm/article/view/ 7321
- Rifani NK, Djamil M (2022). The effect of workload and work discipline on nurse performance with work stress as an intervening variable. Endless: International Journal of Future Studies. Available at: https://endless-journal.com/index.php/endless/ article/view/81.
- Sharma S, Rani R (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks. Journal of Family Medicine and Primary Care 9, 2631. doi: 10.4103/jfmpc.jfmpc_248_20.
- Shivam S, Roy RN, Dasgupta S, et al. (2014). Nursing personnel planning for rural hospitals in Burdwan District, West Bengal, India, using workload indicators of staffing needs. Journal of Health, Population, and Nutrition 32, 658–664. Available at: http://www.pubmedcentral.nih.gov/ articlerender.fcgi?artid=PMC4438696
- Spurgeon P, Cooper C., Burke R. (2012). The innovation imperative in health care organisations: critical role of human resource management in the cost, quality and productivity equation. Gloucestershire, UK, Edward Elgar. Available at: https://books.google.co.id/books?hl=en&lr=&id=wInB3TQUbT8C&oi=fnd&pg=PR1&dq=Hospital+human+resource+planning+formula&ots=-IFDsxXS1G&sig=vnk0NW8IkUpYTL9o-9bJh0vZzJ8&redir_esc=y#v=onepage&q=Hospital human resource planning formula&f=false.
- Vaismoradi M, Tella S, A. Logan P, et al (2020). Nurses' adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health 17, 2028. doi: 10.3390/ijerph17062028.
- World Health Organization (2010). Workload Indicators of Staffing Need (WISN). WHO. Available at: https://www.who.int/publications /i/item/9789241500197.
- Yulliswandi D, Megawati M, Nuraini N (2022). Nursing personnel needs analysis using the Workload Indicator Staff Need (WISN) method in installation emergency Datu Beru Hospital Central Aceh. Journal La Medihealtico 3, 249–255. doi: 10.37899/journallamedihealtico.v3i4.689.
References
Afzal R, Hardy S, Tukayo IJH, et al (2021). Improving public awareness on peritoneal dialysis through public health nurses: A document review. Jurnal Mitra Kesehatan 4, 25–32. doi: 10.47522/jmk.v1iIAHSC.109.
Bonfim D, Laus AM, Leal AE, et al (2016). Application of the workload indicators of staffing need method to predict nursing human resources at a family health service. Revista Latino-Americana de Enfermagem. doi: 10.1590/1518-8345.1010.2683.
Destiani W, Mediawati AS, Permana RH (2020). The mental workload of nurses in the role of nursing care providers. Journal of Nursing Care. doi: 10.24198/jnc.v3i1.22938.
Efendi F, Aurizki GE, Auwalin I, et al (2022). The paradox of surplus and shortage: A policy analysis of nursing labor markets in Indonesia. Journal of Multidisciplinary Healthcare 15, 627–639. doi: 10.2147/JMDH.S354400.
Efendi F, Chen C-M, Kurniati A, et al (2018). The situational analysis of nursing education and workforce in Indonesia. The Malaysian Journal of Nursing 9, 20–29. Available at: https://ejournal .lucp.net/index.php/mjn/article/view/338
Ekawati A (2018). The analysis of workload and need of nurse with wisn method in inpatient room in hospital x in Yogyakarta. Jurnal Medicoeticolegal dan Manajemen Rumah Sakit. doi: 10.18196/jmmr.7158.
Elarabi HM, Johari F (2014). The impact of human resources management on healthcare quality. Asian Journal of Management Sciences & Education 3, 13–22. Available at: http://www.ajmse.leena-luna.co.jp/AJMSEPDFs/ Vol.3(1)/AJMSE2014(3.1-02).pdf.
Farrasizdihar D, Girsang E, Ramadhani Nasution SL (2021). Analysis of workforce requirements based on WISN in radiology installation of RSU X. JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit) 10. doi: 10.18196/jmmr.v10i1. 10376.
Frota MA, Wermelinger MC de MW, Vieira LJE de S, et al (2020). Mapping nursing training in Brazil: challenges for actions in complex and globalized scenarios. Ciíªncia & Saúde Coletiva 25, 25–35. doi: 10.1590/1413-81232020251.27672019.
Govasli L, Solvoll B (2020). Nurses' experiences of busyness in their daily work. Nursing Inquiry. doi: 10.1111/nin.12350.
Gunawan J (2016). Unequal distribution of nurses in Indonesia: A perspective from a nurse. Belitung Nursing Journal 2, 8–9. doi: 10.33546/bnj.8.
Minister of Health (2013). Development and empowerment agency for health human resources (BPPSDMK). Jakarta.
Hossny EK (2022). Studying nursing activities in inpatient units: a road to sustainability for hospitals. BMC Nursing 21, 148. doi: 10.1186/s12912-022-00926-x.
Jayanti D (2018). Analisis kebutuhan tenaga kerja perawat rawat inap Rumah Sakit Umum Bunda Thamrin Medan berdasarkan metode workload indicator staff Need (WISN) (thesis). Universitas Sumatera Utara. Available at: http://repositori. usu.ac.id/handle/123456789/5915.
Joarder T, Tune SNBK, Nuruzzaman M, et al (2020). Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method. BMJ Open 10, e035183. doi: 10.1136/bmjopen-2019-035183.
Kieft RA, de Brouwer BB, Francke AL, et al (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Services Research 14, 249. doi: 10.1186/1472-6963-14-249.
Kokoroko E, Sanda MA (2019). Effect of workload on job stress of ghanaian OPD nurses: The role of coworker support. Safety and Health at Work 10, 341–346. doi: 10.1016/j.shaw.2019.04.002.
Leal JAL, Melo CMM de (2018). The nurses' work process in different countries: an integrative review. Revista Brasileira de Enfermagem 71, 413–423. doi: 10.1590/0034-7167-2016-0468.
Maghsoud F, Rezaei M, Asgarian FS, et al (2022). Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach. BMC Nursing 21, 273. doi: 10.1186/s12912-022-01055-1.
Martono M, Satino S, Nursalam N, et al (2019). Indonesian nurses' perception of disaster management preparedness. Chinese Journal of Traumatology 22, 41–46. doi: 10.1016/j.cjtee. 2018.09.002.
McQuide PA, Kolehmainen-Aitken R-L, Forster N (2013). Applying the workload indicators of staffing need (WISN) method in Namibia: challenges and implications for human resources for health policy. Human Resources for Health 11, 64. doi: 10.1186/1478-4491-11-64.
Moghadam KN, Chehrzad MM, Reza Masouleh S, et al (2021). Nursing physical workload and mental workload in intensive care units: Are they related? Nursing Open 8, 1625–1633. doi: 10.1002/nop2.785.
Nuruzzaman M, Zapata T, De Oliveira Cruz V, et al (2022). Adopting workload-based staffing norms at public sector health facilities in Bangladesh: evidence from two districts. Human Resources for Health 19, 151. doi: 10.1186/s12960-021-00697-7.
Pangaribuan E (2015). Analisis kebutuhan tenaga perawat berdasarkan beban kerja dengan metode time and motion study dan metode Workload Indicators of Staffing Need (WISN) di Instalasi Hemodialisa RSUD dr. Djasamen Saragih Pematangsiantar (thesis). Universitas Sumatera Utara. Available at: https://repositori.usu.ac.id /handle/123456789/39557.
Raeissi P, Nasiripour AA, Reisi N (2015). Comparison of direct and indirect nursing care time in 8-hour and 12-hour shifts. Advances in Nursing & Midwifery 24, 45–51. Available at: https://journals.sbmu.ac.ir/en-jnm/article/view/ 7321
Rifani NK, Djamil M (2022). The effect of workload and work discipline on nurse performance with work stress as an intervening variable. Endless: International Journal of Future Studies. Available at: https://endless-journal.com/index.php/endless/ article/view/81.
Sharma S, Rani R (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks. Journal of Family Medicine and Primary Care 9, 2631. doi: 10.4103/jfmpc.jfmpc_248_20.
Shivam S, Roy RN, Dasgupta S, et al. (2014). Nursing personnel planning for rural hospitals in Burdwan District, West Bengal, India, using workload indicators of staffing needs. Journal of Health, Population, and Nutrition 32, 658–664. Available at: http://www.pubmedcentral.nih.gov/ articlerender.fcgi?artid=PMC4438696
Spurgeon P, Cooper C., Burke R. (2012). The innovation imperative in health care organisations: critical role of human resource management in the cost, quality and productivity equation. Gloucestershire, UK, Edward Elgar. Available at: https://books.google.co.id/books?hl=en&lr=&id=wInB3TQUbT8C&oi=fnd&pg=PR1&dq=Hospital+human+resource+planning+formula&ots=-IFDsxXS1G&sig=vnk0NW8IkUpYTL9o-9bJh0vZzJ8&redir_esc=y#v=onepage&q=Hospital human resource planning formula&f=false.
Vaismoradi M, Tella S, A. Logan P, et al (2020). Nurses' adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health 17, 2028. doi: 10.3390/ijerph17062028.
World Health Organization (2010). Workload Indicators of Staffing Need (WISN). WHO. Available at: https://www.who.int/publications /i/item/9789241500197.
Yulliswandi D, Megawati M, Nuraini N (2022). Nursing personnel needs analysis using the Workload Indicator Staff Need (WISN) method in installation emergency Datu Beru Hospital Central Aceh. Journal La Medihealtico 3, 249–255. doi: 10.37899/journallamedihealtico.v3i4.689.