The Nurse Perceived Adequacy of Staffing Scale for general hospital wards: A development and psychometric validation study.

Background: Adequate staffing is crucial for high quality patient care and nurses' wellbeing. Nurses' professional assessment on adequacy of staffing is the gold standard in measuring staffing adequacy. However, available measurement instruments lack reliability and validity. Objectives: To develop and psychometrically test an instrument to measure nurses' perceived adequacy of staffing (PAS) of general hospital wards. Design: A multicenter cross-sectional psychometric instrument development and validation study using item response theory. Settings: Ten general nursing wards in three teaching hospitals in the Netherlands. Participants: A sample of 881 participants, including third and fourth year nursing students and nurse/care assistants. Methods: The 13-item self-reported questionnaire was developed based on a previous Delphi study and two focus groups. We interviewed five nurses to evaluate the content validity of the instrument. The field test for psychometric evaluation was conducted on ten general wards of three teaching hospitals in the Netherlands. Structural validity of the item bank was examined by fitting a graded response model (GRM) and inspecting GRM fit. Measurement invariance was assessed by evaluating differential item functioning (DIF) of education level and work experience. We examined convergent validity by testing the hypothesis that there was at least a moderate correlation between the PAS instrument and a single item measuring adequacy of staffing. Internal consistency and reliability across the scale were also examined. Results: A total of 881 measurements were included in the analysis. The data fitted the GRM adequately and item fit statistics were good. DIF was detected for work experience for the protocols item, but the impact on total scores was negligible. The hypothesis was confirmed and the item bank reliably measured two standard deviations around the mean. Conclusions: The Nurse Perceived Adequacy of Staffing Scale (NPASS) for nurses of general hospital wards in the Netherlands has sufficient reliability and validity and is ready for use in nurse staffing research and practice.

Defining adequacy of staffing in general hospital wards: a Delphi study.

OBJECTIVES: To gain consensus on the items that determine adequacy of shift staffing. DESIGN: This was a three-round Delphi study to establish consensus on what defines adequacy of shift staffing in a general hospital ward. A literature review, focus group and five semistructured expert interviews were used to generate items for the Delphi study. SETTING: Multicentre study in The Netherlands. PARTICIPANTS: Nurses, head nurses, nursing managers, and capacity consultants and managers working for Dutch hospitals. RESULTS: Twenty-six items were included in the Delphi study. One hundred and sixty-eight, 123 and 93 participants were included in the first, second and third round, respectively. After three rounds, six items were included (mostly related to direct patient care) and nine items were excluded. No consensus was reached on 12 items, including one item that was added after the first round. CONCLUSIONS: This is the first study to specify items that determine adequacy of staffing. These items can be used to measure adequacy of staffing, which is crucial for enhancing nurse staffing methods. Further research is needed to refine the items of staffing adequacy and to further develop and psychometrically test an instrument for measuring staffing adequacy.

Measuring perceived adequacy of staffing to incorporate nurses' judgement into hospital capacity management: a scoping review.

BACKGROUND: Matching demand and supply in nursing work continues to generate debate. Current approaches focus on objective measures, such as nurses per occupied bed or patient classification. However, staff numbers do not tell the whole staffing story. The subjective measure of nurses' perceived adequacy of staffing (PAS) has the potential to enhance nurse staffing methods in a way that goes beyond traditional workload measurement or workforce planning methods. OBJECTIVES: To detect outcomes associated with nurses' PAS and the factors that influence PAS and to review the psychometric properties of instruments used to measure PAS in a hospital setting. DESIGN AND METHODS: A scoping review was performed to identify outcomes associated with PAS, factors influencing PAS and instruments measuring PAS. A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Business Source Complete and Embase databases identified 2609 potentially relevant articles. Data were independently extracted, analysed and synthesised. The quality of studies describing influencing factors or outcomes of PAS and psychometric properties of instruments measuring PAS were assessed following the National Institute for Health and Care Excellence quality appraisal checklist and the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. RESULTS: Sixty-three studies were included, describing 60 outcomes of PAS, 79 factors influencing PAS and 21 instruments measuring PAS. In general, positive PAS was related to positive outcomes for the patient, nurse and organisation, supporting the relevance of PAS as a staffing measure. We identified a variety of factors that influence PAS, including demand for care, nurse supply and organisation of care delivery. Associations between these factors and PAS were inconsistent. The quality of studies investigating the development and evaluation of instruments measuring PAS was moderate. CONCLUSIONS: Measuring the PAS may enhance nurse staffing methods in a hospital setting. Further work is needed to refine and psychometrically evaluate instruments for measuring PAS.

Knowledge management, health information technology and nurses' work engagement.

BACKGROUND: Knowledge management (KM) extends the health information technology (HIT) literature by addressing its impact on creating knowledge by sharing and using the knowledge of health care professionals in hospitals. PURPOSE: The aim of the study was to provide insight into how HIT affects nurses' explicit and tacit knowledge of their ongoing work processes and work engagement. METHODOLOGY: Data were collected from 74 nurses in four wards of a Dutch hospital via a paper-and-pencil survey using validated measurement instruments. In a quasiexperimental research design, HIT was introduced in the two experimental wards in contrast to the two control wards. At the time of the HIT introduction, a pretest was administered in all four wards and was followed by a posttest after 3 months. Data were analyzed via partial least squares modeling. RESULTS: Generally, nurses' tacit knowledge (i.e., their insight into and their capacity to make sense of the work processes) appears to be a significant and strong predictor of their work engagement. In contrast, nurses' explicit knowledge (i.e., information feedback about patients and tasks) only indirectly affects work engagement via its effect on tacit knowledge. Its effect on work engagement therefore depends on the mediating role of tacit knowledge. Interestingly, introducing HIT significantly affects only nurses' explicit knowledge, not their tacit knowledge or work engagement. PRACTICE IMPLICATIONS: Nurses' tacit and explicit knowledge needs to be systematically distinguished when implementing HIT/KM programs to increase work engagement in the workplace. Tacit knowledge (insight into work processes) appears to be pivotal, whereas efforts aimed only at improving available information will not lead to a higher level of work engagement in nurses' work environments.