Barriers against required nurse estimation models applying in Iran hospitals from health system experts' point of view
Keywords:
Qualitative Research, Nurse, Hospital, ModelAbstract
Introduction: One of the strategies for accessing effective nursing care is to design and implement a nursing estimation model. The purpose of this research was to determine barriers in applying models or norms for estimating the size of a hospital’s nursing team.
Methods: This study was conducted from November 2015 to March 2016 among three levels of managers at the Ministry of Health, medical universities, and hospitals in Iran. We carried out a qualitative study using a Colaizzi method. We used semistructured and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in the area of policymaking in human resources in the Ministry of Health, 10 decision makers in employment and distribution of human resources in treatment and administrative chancellors of Medical Universities, and 12 nursing managers in hospitals). The data were analyzed by Atlas.ti software version 6.0.15.
Results: The following 14 subthemes emerged from data analysis: Lack of specific steward, weakness in attracting stakeholder contributions, lack of authorities trust to the models, lack of mutual interests between stakeholders, shortage of nurses, financial deficit, non-native models, designing models by people unfamiliar with nursing process, lack of attention to the nature of work in each ward, lack of attention to hospital classification, lack of transparency in defining models, reduced nurses available time, increased indirect activity of nurses, and outdated norms. The main themes were inappropriate planning and policymaking in high levels, resource constraints, and poor design of models and lack of updating the model.
Conclusion: The results of present study indicate that many barriers exist in applying models for estimating the size of a hospital’s nursing team. Therefore, for designing an appropriate nursing staff estimation model and implementing it, in addition to considering the present barriers, identifying the norm required features may positively impact on norm acceptance and implementation.
References
Dreesch N, Dolea C, Dal Poz MR, Goubarev A, Adams O, Aregawi M, et al. An approach to estimating
human resource requirements to achieve the Millennium Development Goals. Health Policy Plan. 2005;
(5): 267-76. doi: 10.1093/heapol/czi036. PMID: 16076934.
Fakhri A, Aryankhesal A. The Effect of Mutual Task Sharing on the Number of Needed Health Workers at
the Iranian Health Posts; Does Task Sharing Increase Efficiency? Int J Health Policy Manag. 2015; 4(8):
-6. doi: 10.15171/ijhpm.2015.22. PMID: 26340390, PMCID: PMC4529040.
Daviaud E, Chopra M. How much is not enough? Human resources requirements for primary health care: a
case study from South Africa. Bull World Health Organ. 2008; 86(1): 46-51. PMID: 18235889, PMCID:
PMC2647342.
Ministry of Health (Kenya). Norms and Standards for Health Service Delivery. Nairobi: Ministry of Health.
Bahadori M, Arab M, Sadeghifar J, Ahmadi B, Salimi M, Yghoubi M. Estimation of nursing staff in
selected hospitals of Ilam and Ahvaz Provinces, Western Iran. Nurs Midwifery Stud. 2013; 2(2): 21725-. PMID: 25414862, PMCID: PMC4228553.
Farahbakhsh M, Mostafaei M, Sadeghifar J, Estebsari F. Structure Design and Estimation of Needed
Manpower for Hospital. Tehran: kamal-e-danesh. 2011.
Zandiyan H, GHiasvand H, Nasimi DR. Measuring inequality of distribution of health resources: A case
study. Payesh. 2012; 11(6): 799-805.
Sadeghifar J, Pourreza A, Ahmadi B, Zeraati H, Arab M. Assessment of necessary staff for hospitals of
Ilam university of medical sciences in accordance with personnel criteria and standards of Iranian health
ministry. JIUM. 2011; 19(1): 24-31.
Ghazi Mirsaeid J, Mirzaie M, Haghshenas E, Dargahi H. Human resources distribution among tehran
university of medical sciences hospitals. Payavard Salamat. 2014; 7(5): 432-46.
Sherman RO, Chiang¬-Hanisko L, Koszalinski R. The ageing nursing workforce: a global challenge. J
Nurs Manag. 2013; 21(7): 899-902. doi: 10.1111/jonm.12188.
Dehghan-Nayeri N, Ghaffari F, Shali M. Exploring Iranian nurses’ experiences of missed nursing care: a
qualitative study: a threat to patient and nurses’ health. Med J Islam Repub Iran. 2015; 29: 276. PMID:
, PMCID: PMC4715394.
Hendrich A, Chow MP, Skierczynski BA, Lu Z. A 36-hospital time and motion study: how do medical- surgical nurses spend their time? Perm J. 2008; 12(3): 25-34. PMID: 21331207, PMCID: PMC3037121.
Hassmiller SB, Cozine M. Addressing the nurse shortage to improve the quality of patient care. Health Aff
(Millwood). 2006; 25(1): 268-74. doi: 10.1377/hlthaff.25.1.268. PMID: 16403763.
Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient
hospital mortality. N Engl J Med. 2011; 364(11): 1037-45. doi: 10.1056/NEJMsa1001025. PMID:
Farsi Z, Dehghan-nayeri N, Negarandeh R, Broomand S. Nursing profession in Iran: an overview of
opportunities and challenges. Jpn J Nurs Sci. 2010; 7(1): 9-18. doi:10.1111/j.1742-7924.2010.00137.x.
PMID: 20618672.
Zarea K, Negarandeh R, Dehghan-Nayeri N, Rezaei-Adaryani M. Nursing staff shortages and job
satisfaction in Iran: Issues and challenges. Nurs Health Sci. 2009; 11(3): 326-31. doi: 10.1111/j.1442- 2018.2009.00466.x. PMID: 19689643.
Rossetti AC, Gaidzinski RR. Estimating the nursing staff required in a new hospital. Rev Lat Am
Enfermagem. 2011; 19(4): 1011-7. doi:10.1590/S0104-11692011000400021. PMID: 21876955.
Sigarodi A D-NN, Rahnavard Z, Norisaeed A. Qualitative research methodology: phenomenology. Holist
Nurs Midwifery. 2012; 22(2): 56-63.
Adib hajbagheri M, Parvizi S, Salsali S. Qualitative Research Methods. Boshry Pubilshing. 2011.
Ghada Abu Shosha. Employment of colaizzi's strategy in descriptive phenomenology: a reflection of a
researcher. Euro Sci J. 2012; 8(27): 31-43
Anderson C. Presenting and evaluating qualitative research. Am J Pharm Educ. 2010; 74(8): 141. PMID:
, PMCID: PMC2987281.
Morse JM, Barrett M, Mayan M, Olson K, Spiers J. Verification strategies for establishing reliability and
validity in qualitative research. IJQM. 2002; 1(2): 13-22.
Biglar M, Bastani P, Soudabeh Vatan khah. The Challenges Of Stewardship In Medical Education System:
A Qualitative Approach. Payavard Salamat. 2013; 7(4): 299-311.
Lunenburg FC. The Decision-Making Process in an Organization. IJBAM. 2011; 15(1): 1-9
Buchan J. A certain ratio? The policy implications of minimum staffing ratios in nursing. J Health Serv Res
Policy. 2005; 10(4): 239-44. doi: 10.1258/135581905774414204. PMID: 16259691.
Mugisha JG, Namaganda G. Using the Workload Indicator of Staffing Needs (WISN) methodology to
assess work pressure among the nursing staff of Lacor Hospital. Health Pol Dev. 2008; 6(1): 1-15.
Sadeghifar J, Tofighi Sh, Hasani M, RekabEslami S, Raadabadi M, Moosavi SM. Estimation of the
Necessary Nursing Manpower in Selected Hospital Affiliated with Jundishapur University of Medical
Sciences. Sci Med J Ahwaz Jundishapur Univ Med Sci. 2013; 5(1): 1-8.
Reiter KL, Harless DW, Pink GH, Mark BA. Minimum nurse staffing legislation and the financial
performance of California hospitals. Health Serv Res. 2012; 47(3pt1): 1030-50. doi: 10.1111/j.1475- 6773.2011.01356.x. PMID: 22150627, PMCID: PMC3337946.
The sixth draft development plan, [online]. [Cited 2016 April 24]. Available from: http://www.
budget.farhang.gov.ir/fa/peshnvesbrnameh6/peshnvesbrnameh63
Jajarmizadeh M, Forozandeh-Dehkord L, Abasi N, Tadauon A. Native Model of Human Resource
Management with on Emphasis on Contextual Factor of the Administrative System. Management
Research. 2015; 7(26): 45-62.
Ignjatović M, Svetlik I. European HRM clusters. EBS review. 2003; 17(3): 25-39.
Twigg D, Duffield C. A review of workload measures: a context for a new staffing methodology in
Western Australia. Int J Nurs Stud. 2009; 46(1): 131-9. doi:10.1016/j.ijnurstu.2008.08.005. PMID:
Shivam S, Roy RN, Dasgupta S, Das Bhattacharyya K, Misra RN, Roy S, et al. Nursing Personnel Planning
for Rural Hospitals in Burdwan District, West Bengal, India, Using Workload Indicators of Staffing Needs.
J Health Popul Nutr. 2014; 32(4): 658-64. PMID: 25895199, PMCID: PMC4438696.
Vali L, Tabatabaee SS, Kalhor R, Amini S, Kiaei MZ. Analysis of Productivity Improvement Act for
Clinical Staff Working in the Health System: A Qualitative Study. Glob J Health Sci. 2015; 8(2): 106-16.
doi:10.5539/gjhs.v8n2p106. PMID: 26383203, PMCID: PMC4803926.
McQuide PA, Kolehmainen-Aitken RL, Forster N. Applying the workload indicators of staffing need
(WISN) method in Namibia: challenges and implications for human resources for health policy. Hum
Resour Health. 2013; 11(1): 64. doi: 10.1186/1478-4491-11-64. PMID: 24325763, PMCID: PMC4028865.
Hoi SY, Ismail N, Ong LC, Kang J. Determining nurse staffing needs: The workload intensity
measurement system. J Nurs Manag. 2010; 18(1): 44-53. doi: 10.1111/j.1365-2834.2009.01045.x. PMID:
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
