Implementation of Work Sampling in an Acute Rehabilitation Unit: Assessing Nursing Efficiency

To establish appropriate staffing guidelines, roles, reduced labor costs and reduced cost per unit of service, i) identification of work with appropriate staff members, and ii) development and utilization of a patient acuity system were studied in an acute rehabilitation unit of a hospital in central Illinois. Acuity of patients (n = 127) was categoried by using assisting levels of minimal, moderate and maximal based on the Functional Independence Measure (FIM) score. The FIM score was reevaluated each week. In the 1st month, volume and time studies were done on all rehabilitation patients. In the 2nd month, roles of the registered nurse (RN) and the unlicensed assistive personnel (UPA) were clarified; and in the 3rd month, patients' acuity levels were reestablished and staffing management was adjusted. This system also clearly identified patients' acuity and the role of RNs and UPAs. Hours per unit of RN service was cut from 8.85 to 7.49 per 8 h shift. Cost per unit of service was decreased from $163.6 to $105.2. A total annual savings of $268,410 indicated a big financial impact on the unit with almost the same level of patient satisfaction as before. The results of the study suggest that the work sampling method for a management and organizational development program can be used to objectively assess work load of RNs as a first step.