Are nurses? assessments of their workload affected by non-patient factors? An analysis of the RAFAELA system

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Abstract
To identify (1) the contribution of non-patient factors to patient classification systems and (2) the explanatory power of nursing care intensity and non-patient factors to Professional Assessment of Optimal Nursing Care Intensity Level workload. In the Rainio, Fagerström and Rauhala (RAFAELA) patient classification system, nursing care intensity per nurse is measured daily by the Oulu Patient Classification/Qualisan instrument. The optimal nursing care intensity is determined using Professional Assessment of Optimal Nursing Care Intensity Level instrument. However, nurses' workload may be affected by factors other than nursing care intensity. Therefore, RAFAELA contains 12 non-patient questions. A retrospective study of all 22 somatic wards of a secondary healthcare hospital in Finland. Non-patient questions were answered in 26% of 4870 questionnaires. They added to workload in 62%. Eight questions were grouped into four factors: administration; staff resources and mental stress; co-operation within and between units. The explanatory value between Oulu Patient Classification/Qualisan and Professional Assessment of Optimal Nursing Care Intensity Level had a median of 0.45. Including the non-patient questions raised it to 0.55. Non-patient factors affect the nurses' assessments of their workload, but less than nursing care intensity. They contribute valuable information on the functioning and problems of wards.

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