Nursing workload in UK tertiary neonatal units

David WA Milligan ^1*, Philip Carruthers ², Brian Mackley ³, Martin P Ward Platt ¹, Yve Collingwood ¹, Lesley Wooler ¹, Judith Gibbons ¹, Elizabeth Draper ⁴ and Bradley N Manktelow ⁴

¹ Royal Victoria Infrimary newcastle upon Tyne, United Kingdom
² Northumberland Care Trust, United Kingdom
³ Mackley Management Consulting Services, United Kingdom
⁴ University of Leicester, United Kingdom

^* To whom correspondence should be addressed. E-mail: d.w.a.milligan{at}ncl.ac.uk.

Accepted 16 June 2008

Abstract

Background Neonatal intensive care requires adequate numbers of trained neonatal nurses to provide safe, effective care; but existing research into the relation between nurse numbers and the care needs of babies is over ten years old. Since then, the preterm population and treatment practices have changed considerably.

Aims To validate the dependency categories of the British Association of Perinatal Medicine (BAPM, 2001) and to revalidate the Northern Region categories (NR, 1993) in relation to contemporary nursing workload. Setting Three tertiary neonatal intensive care services in England.

Methods Direct observations by trained observers captured nursing activity around each baby every ten minutes. Time spent on each nursing activity was related to the dependency category of the baby and the grade of the nurse.

Results Both scales detected differences between categories. Discrimination between individual categories was improved when nasal continuous positive airway pressure (nCPAP) was distinguished from ventilation and combined with BAPM2/NRA.. On this revised four point scale babies in BAPM1/NRA occupied nursing time for a median of 56 minutes per hour ( IQR 48-70); those on nCPAP or BAPM2/NRB for 36 minutes , (27-42); those in BAPM3/NRC for 20-22 minutes, (15-33); and those in BAPM4/NRD for 31-32 minutes (24-36). The NR scale was easier to apply and had greater interobserver agreement (98.5%) than the BAPM scale (93%). All categories attracted more time compared to 1993.

Conclusions Both scales predict average nursing workload. A revised categorisation which separates nCPAP from ventilation is more robust and practical. Nursing time attracted in all categories has increased since 1993.