Psychometric testing of a nursing intensity workload measurement instrument

Based on a desire to measure nursing workload for the purpose of better allocation of staffing and to apportion the cost of nursing care in the hospital bill, a study was designed to demonstrate the psychometric properties of a newly developed inpatient nursing intensity workload measurement instrument deployed in an academic tertiary care hospital setting across multiple specialty units. A review of nursing intensity instruments was conducted to examine approaches and adequacy of validity and reliability testing finding no fatal flaws and multi-method use of psychometric tests for seven tools. Three pilot studies were conducted over a six year period examining the new Medical University of South Carolina (MUSC) Nursing Intensity Database© instrument's validity and reliability, showing promising psychometrics and sensitivity to changes in nursing workload where staffing ratios do not.;The research study used a retrospective longitudinal design to examine the estimates of direct hours of nursing care resources expended to provide care for individual patients as reported by the assigned registered nurse. Data were collected in 32 hospital nursing units over eight months (January 2006–August 2006) producing 160,072 patient shift estimates. Estimates were averaged for monthly estimates and yielded a sample of 256 observations to test five study hypotheses.;Contrasted groups construct validity, predictive validity, internal consistency and inter-rater reliability were established for a majority of 32 units (60%). The tool is psychometrically sound; it is sensitive to differences among units; and exposes the variability of nursing resources expended for individual patients across different nursing care units. A novel approach to inter-rater reliability consistently demonstrated agreement between nurse's estimates for patients with the same selected All Payer Related–Diagnosis Related Groups (APR-DRGs) and for increasing higher levels of severity of illness.;These findings suggest the tool can be used in an academic tertiary care hospital setting to quantify nursing resources using direct care intensity hours and optimize staffing to meet patient care demands for nursing care. This tool may provide an independent variable that can be used in a revised DRG cost based system to quantify the nurse's contribution to care in a national nursing billing model.