INTRODUCTION
Today
performance measurement has become a hot topic in many developed countries.
National and international companies are trying to be one step ahead in
realizing a competitive environment. Good organizational management is an
urgent matter in winning the business competition. For this reason, based on
its business environment, every organization needs to formulate a management
strategy to achieve excellent service. Service maximization is expected to be
able to provide value-added for an organization in order to achieve effective
and efficient goals. The purpose of an organization varies according to its
orientation. Profit-oriented organizations expect high profitability, in
contrast to non-profit organizations, namely their orientation focuses on the best
service to the community (Andi R., 2019).
Nurse
workload is all activities carried out by nurses based on calculations and
experience in a given unit of time. The analysis of the nurse's workload can be
seen from aspects such as the tasks carried out based on the main functions and
additional tasks performed, the number of patients to be treated, the working
capacity according to the education obtained, the working time used to perform
her work according to the working hours that take place every day, and the
overall facilities that can help the nurse complete her work well (Noprianty et al., 2020).
Some of the
methods used to calculate the number of nurses needed include: Douglas Method,
Ratio Method, Gillies Method, PPNI Workshop Method, Ministry of Health Method,
Ilyas Method, and WISN Method (Nursalam, 2015). Of the several methods of
calculating nurse needs, the closest result to the reality of nurse capacity
needs is to calculate the workload of nurses in the room with activity
standards applied to each component of the task (Ministry of Health of the
Republic of Indonesia, 2010).
MATERIALS
AND METHODS
Diagram
Flow Literature review berdsarakan PRISMA 2009 (Polit &
Beck, 2013).
Literature
Review research is carried out by searching for articles through several databases,
namely Google Scholar, Google Scholar, and Pubmed with the keyword "nurse
workload", inclusion criteria included articles published between 2015 to
2022, full text both in English and Indonesian. A literature search found 72
articles, then 51 articles were issued according to the exclusion criteria, so
only 9 articles were identified. The 9 articles were analyzed and nothing was
issued, then the articles were extracted into a table and further analyzed for
discussion and conclusion. A summary of the 9 articles that the author analyzed
and in accordance with the inclusion and exclusion criteria that the author has
applied, can be seen in table 1 as follows:
RESULTS
AND DISCUSSION
Research
conducted by (Noprianty et al., 2020) with the
title Analysis of Nurses Staff Needs Using Workload Indicate Staff Needs in
Pediatric Ward with Time Motion Study. The purpose of this study was to
determine the analysis of the needs of nurses based on the WISN method. The
method in this study is an observational descriptive method with a One-Shot method
approach model. The number of samples was 9 room nurses when performing
in-person nursing actions, indirect and personal nursing, both in the morning,
afternoon, and evening shifts so a total of 27 observations were obtained with
a total of 12,960 minutes. Observations are carried out by means of time and
motion study with 5 steps. From the results of the study, it was shown that in
the morning shift, the results of direct activities were obtained as much as
609.35, indirect as many as 1783.13, and personal as many as 386.23, while the
afternoon shift obtained the results of direct activities as much as 1119.26,
indirect as many as 1413.46, and personal as much as 466.18, and while the
night shift obtained the results of direct activities as much as 700.1,
indirect as many as 1541.7, and personal as many as 2126.22, with the number
of standard workloads 422773.6674 hours/year, the standard allowance
0.023775782, so that the final result of the number of nursing staff needs is
28 people, while the available ones are 24 people. The result of the WISN Ratio
was obtained that 0.8 is less than 1. It can be concluded that there is a
shortage of nursing personnel. The results of this study can be taken into
consideration in reducing the number of nursing staff on the morning shift and adding
in the afternoon shift.
The
results of the research of (Joarder et al., 2020)
The results of this study show that the doctor's results are very high (WISN
ratio 0.43) and the nurse's workload pressure is high (WISN ratio 0.69). 50% of
the time nurses are preoccupied with support activities, instead of nursing
care. There are different workloads between the same categories of staff in
different healthcare facilities. If only vacant positions were filled, the
workload would be reduced. In fact, the number of approved doctors and nurses
is more than the actual need.
The
results of the study of Angélica Araújo de Menezes et al, 2022 The results of
this study show that the Results of interventions/activities observed in data
collection at UCC initially focused on calculating the time spent on
examination and re-examination in care for 26 patients, with procedures ranging
from admission to discharge from the maternity hospital. The main emergencies
identified in this process involve women with preeclampsia, sepsis, and a
suspected diagnosis of uterine cancer with active bleeding. In OD, researchers
recorded the duration of activities performed during the stay of 44 patients,
20 of whom were in normal labor, two of whom gave birth involving
instrumentation, and 24 of whom underwent cesarean delivery, three with serious
complications. Researchers also estimated the procedure was performed on 20
patients who came to the unit after the abortion, 14 developed with manual
vacuum aspiration (MVA) and six with uterine curettage. Per day, four routine
check-ups were performed per patient in prenatal, maternity, and postpartum
beds, but not all of them were observed by researchers. The workshop and data
collection and treatment were followed by the establishment of a list of seven
patient care activities at OD and two at UCC.
Results
from the study of Fotini Gialama et al,2019 The results of this study showed
that the results for both private hospitals showed a shortage in the number of
midwives. However, after combining the interpretation of the results, as
demonstrated by the WISN methodology and structured interviews, the current and
required staff are balanced in both. On the other hand, both general hospitals
showed a surplus of midwives (1.83 and 1.33 ratios for General Hospitals in
Corinthos and Kalamata, respectively).
The
results of the study of (Noprianty et al., 2020)
The results of this study showed that the morning shift obtained the results of
direct activities 609.35, indirect activities 1783.13, and personal 386.23,
while night shifts obtained the results of direct activities 1119.26, indirect
activities 1413.46, and personal 466.18, and evenings obtained the results of
direct activities 700.1, indirect activities 1541.7, and personal 2126.22,
with a total workload standard of 422773.6674 hours/year. The final result
obtained by the needs of nurses was 28 people, while the available 24 nurses,
with the WISN Ratio result, obtained 0.8 less than 1. The results of this study
can be taken into consideration in reducing the number of nurses on the morning
shift and adding it to the afternoon shift.
The
results of Alon Ekawati's research, 2018 The results of this study show that
the WISN ratio is 0.7, this shows that the WISN ratio <1 means that the
human resources in the unit are insufficient and not in accordance with the
workload. The number of human resources in the Al-Kausar inpatient room is
currently 15 nurses while the need according to the WISN method is 21 nurses so
the total shortage is 6 nurses.
The
results of the research of (Antonny Halim Gunawan,
2015) The results of this study show that the data on the
characteristics of nurses in the intensive care unit are presented in table 1.
Based on the characteristic data obtained, it can be seen that based on gender,
84.21% (32 people) of intensive care unit nurses are women and 15.79% (6 people)
are men. Based on work experience seen from the length of time working at dr
Oen Solo Baru Hospital, it is known that 10.52% (4 people) have only worked for
less than 5 years, while the remaining 89.48% (34 people) have worked for more
than 5 years. Based on education, 100% (38 people) are D III Nursing graduates.
Based on non-formal education, it is known that 71.05% (27 people) attended BHD
competency training, 26.31% (10 people) attended Basic ICU competency training,
26.31% (10 people) attended ACLS competency training, 18.42% (7 people)
attended Basic Cardiology competency training, 2.63% (1 person) attended BACLS
competency training, 5.26% (2 people) attended Mini ICU competency training,
5.26% (2 people) attended ECG competency training, 2.63% (1 person) attended
PPGD competency training, 10.52% (4 people) attended Mechanical Ventilation
competency training, 2.63% (1 person) attended Basic PICU competency training,
5.26% (2 people) attended Fluid Therapy competency training.
The
results of the research of (Andi R., 2019) The
results of the study showed in general that 1) Sultan Dg. Raja Bulukumba
Hospital makes it possible to apply a Balanced Scorecard to measuring
organizational performance because, with a Balanced Scorecard, all aspects can
be measured. The application of the Balanced Scorecard is possible because of
Sultan Dg. Raja Bulukumba Hospital has formulated its vision, mission, and
strategy and the results of the study show that the performance of Sultan Dg.
Raja Bulukumba Hospital is said to be quite good when using the Balanced
Scorecard. 2) performance measurement of Sultan Dg. Raja Bulukumba Hospital
using a Balanced Scorecard for a period of 2 years showed good results.
The
results of the study of Isti Qomah et all, 2021 The results of study showed
that the working time in the hospital was 0.4. hours in the assembling section,
1 hour in the filling section, and 1 hour in the reporting section with a
workload of 6670 workloads per day, and relaxation standards 76 leniency
standards. There is an imbalance between the workload and the manpower in the
medical records unit, so it still needs medical record manpower, so that the
work does not double. The conclusion of the study showed that hospitals still
need 7 medical record personnel with the PPNI method, namely 1 in the
assembling section, 3 in the filling section, and 3 in the reporting section.
It must be added energy so that the effort does not double.
DISCUSSION
Nursing
Workload is all activities or activities carried out by a nurse while on duty
in a nursing service unit. The workload is usually defined as patient days
which refer to a number of procedures, examinations, visits to
patients,
injections, and so on. The definition of workload in general is an effort to
detail the components and target volume of work in a certain unit of time and
unit of results.
WISN
is Based on manual guidance issued by WHO, WISN's Workload Indicators of
Staffing Need is a standard for measuring the needs of health workers based on
workload indicators that were first tested around 1998. The WISN method is a
resource management tool that calculates staff needs based on workload for
specific staff categories and types of health facilities. This tool can be
applied nationally, regionally, in a single health facility, or even a unit or
ward in a hospital. WISN is also a method of calculating HR needs as stated in
the Decree of the Minister of Health of the Republic of Indonesia Number: 81MenkesSKI2004
concerning Guidelines for the Preparation of Health Human Resource Planning at
the Provincial, City District and Hospital Levels. The WISN method has the
advantage that it is easy to use both techniques, comprehensively, and realistically
and provides convenience in determining the variety of HR needs in various
types of health services such as Puskesmas and Hospitals. However, the WISN
method has weaknesses, where it is very necessary to have completeness of data
that will later be analyzed statistically and will affect the accuracy of the
results of WISN WHO, 2010.
PPNI
(PPNI Formula), where this formula requires a component consisting of the
results of the percentage of Bed Occupancy Ratio (BOR), TT (Bed) of the
hospital at one specific time, the number of working hours of the medical
recorder for 24 hours, the number of effective working hours and the number of
effective working days.
Ilyas
is Calculating the workload of a labor-intensive organizational unit is
important but at the same time very difficult. Many personnel managers and Unit
managers struggle when asked: "What is the personnel workload to produce
the main and supporting products or services in the sister unit"? Scientific
methods that have been developed by experts such as Work Sampling and
Time
and Motion Study can actually produce accurate results. The problem is, in this
method, takes experts, many observers and a long time. This has consequences
for costs and usually has to be implemented by other parties such as: sultans
and research institutions. The hospital management will find it difficult to
implement this method itself because of the difficulty of the instrument and
the implementation of its own research. In addition, there is a possibility of
bias because the personnel factor calculates the workload itself. In
the daily log method that records
and calculates the workload itself, the accuracy is very doubtful so from the
aspect of validity and reliability it is difficult to use as a reference for
employee workload.
Balanced
Scorecard is Balanced Scorecard (BSC) can be said to be the simplest measuring
tool in a company so there are many weaknesses. One of the drawbacks is that
the information presented is limited and lacks accuracy. So you can't see other
factors that can affect the company's performance. At first, BSC was only used
to improve the financial measurement system. It then expanded and was used to
measure four objectives namely finance, customer, internal business processes,
and learning and growth.
Based
on the results of several researchers, WISN is a resource management tool that
calculates staff needs based on workload for certain categories of staff and
types of health facilities. This tool can be applied nationally, regionally, in
a single health facility, even a unit or ward in a hospital. WISN is also a
method of calculating HR needs as stated in the Decree of the Minister of
Health of the Republic of Indonesia Number: 81MenkesSKI2004 concerning
Guidelines for the Preparation of Health Human Resource Planning at the
Provincial, City District and Hospital Levels. The WISN method has the
advantage that it is easy to use both techniques, comprehensively, and realistically
and provides convenience in determining the variety of HR needs in various
types of health services such as Puskesmas and Hospitals. However, the WISN
method has weaknesses, where it is very necessary to have completeness of data
that will later be analyzed statistically and will affect the accuracy of the
results of WISN WHO, 2010.
CONCLUSIONS
Based on the
results of several articles that can show that the WISN method is most often
used compared to other methods, for example, one of the articles created by
several people including (Noprianty et al., 2020)
with the topic Analysis of Nurses Staff Needs Using Workload Indicate Staff Needs
in Pediatric Ward with Time Motion Study, (Joarder et
al., 2020) with the topic Assessment of staffing needs for physicians
and nurses at Upazila health complexes in Bangladesh using WHO workload
indicators of staffing need (WISN) method and Angélica Araújo de Menezes et al,
2022 with the topic Application of the workload indicators of staffing need a method
to calculate the size of the medical staff at a maternity hospital in the state
of Bahia, Brazil. But beyond that, it does not mean that other methods are
ineffective, because each method must have its own disadvantages and
advantages, go back to the choice of the researcher or the hospital to use
which method.
REFERENCES
Andi
R., I. R, & A. NA. (2019). Performance Measurement Analysis With A Balanced
Scorecard Approach At Sultan Dg Hospital. King Bulukumba.
Antonny
Halim Gunawan. (2015). Analysis of the Needs of Intensive Service Unit Nurses
Based on Workload and Competence in the Intensive Care Unit of Dr Oen Solo Baru
Hospital.
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, 7(1), 69–75.
Gialama,
F., Saridi, M., Prezerakos, P., Pollalis, Y., Contiades, X., & Souliotis,
K. (2019). The implementation process of the Workload Indicators Staffing Need
(WISN) method by WHO in determining midwifery staff requirements in Greek
Hospitals. European Journal of Midwifery, 3.
Hamdan,
M., & Hamra, A. (2015). Workplace violence towards workers in the emergency
departments of Palestinian hospitals: a cross-sectional study. Human Resources
for Health, 13(1), 1–9.
Isti
Q., Moh. R. A. , & U. K. (2021). Analysis of Medical Record Manpower Needs
Based on Workload With PPNI Method at Pekanbaru Medical Center (PMC) Hospital.
Joarder,
T., Tune, S. N. B. K., Nuruzzaman, M., Alam, S., de Oliveira Cruz, V., &
Zapata, T. (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(2), e035183.
Noprianty,
R., Febianti, S. A., & Fikri, J. (2020). Analysis of nurses staff needs
using workload indicate staff need in pediatric ward with time motion study.
JMMR (Jurnal Medicoeticolegal Dan Manajemen Rumah Sakit), 9(1), 13–22.
Polit,
D. F., & Beck, C. T. (2013). Is there still gender bias in nursing
research? An update. Research in Nursing & Health, 36(1), 75–83.
© 2023 by the authors.
Submitted
for possible open access
publication
under the terms and conditions of the
Creative Commons Attribution (CC BY SA) license
(https://creativecommons.org/licenses/by-sa/4.0/).
Abstract:
Nurse workload is all activities, activities, and actions taken by a nurse
while the nurse is on duty in a hospital service unit. The purpose of this
literature is to identify which method is more effective and efficient to
measure the workload of nurses. Article review was carried out through several
electronic databases including Google Scholar, and Pubmed with the keyword
"nurse workload", inclusion criteria included articles published
between 2015 and 2022, full text in both English and Indonesian. A literature
search found 72 articles, then 51 articles were removed according to the
exclusion criteria so that only 8 articles were identified. The results of the
literature study show that the WISN method is most often used to determine the
workload of health workers, not only nurses. made by several people including
Richa Noprianty et al, 2020 with the topic Analysis of Nurses Staff Needs Using
Workload Indicate Staff Needs in Pediatric Ward with Time Motion Study,
Taufique Joarder et al, 2020 with the topic Assessment of staffing needs for
physicians and nurses at Upazila health complexes in Bangladesh using WHO
workload indicators of staffing need (WISN) method and Angélica Araújo de
Menezes et al, 2022 with the topic Application of the workload indicators of
staffing need a method to calculate the size of the medical staff at a
maternity hospital in the state of Bahia, Brazil. But beyond that, it doesn't
mean that other methods are ineffective, because each method has its own
advantages and disadvantages, it's up to the researchers or the hospital to
choose which method to use.