Table 1
General information of the selected hospitals
Year of research
|
Provincial general hospital
|
Bac Giang
|
Thanh Hoa
|
Can Tho
|
Dong Thap
|
2015
|
2015
|
2017
|
2018
|
Number of faculty in research
Surgery
Internal medicine
|
7
3
4
|
6
3
3
|
5
3
2
|
4
2
2
|
Available working time (AWT) (hours)
|
1,856 -1,988
|
1,976 -2,008
|
1,633 -1,989
|
1,958 -2,021
|
Number of inpatients in each faculty/year
|
1,545–5,773
|
2,012 − 5,845
|
3,478 -7,777
|
1,633 -7,003
|
Number of nurses in each faculty
|
11–21
|
15–21
|
16–23
|
11–16
|
Total number of inpatient treatment days
|
18,923 − 44,739
|
18,139 − 49,963
|
15,625–35,455
|
13,560 − 63,805
|
Table 1 described general information of 04 selected hospitals. The research collected data at Bac Giang and Thanh Hoa general hospitals in 2015–2016, at Can Tho central hospital and Dong Thap general hospital in 2017–2018. There were 22 clinical faculties studied, including 11 faculties of surgery and 11 faculties of internal medicine. In general, the available working time (AWT) of hospitals ranged from 1,850 hours to 2,000 hours per year, varied by hospital due to the difference in number of days off of faculties. In Can Tho central hospital for instance, the AWT of nuses working in Neurology faculty was 1,633 hours because the nurses in this faculty are required to work 7 hours per day.
The number of patients hospitalized annually at each faculty varied from hospital to hospital. In particular, the highest number of inpatients per year was recorded at Can Tho central hospital (from 3,478 to 7,777 inpatients) and at Dong Thap general hospitals (from 1,633 to 7,003 inpatients). In comparison, the range of inpatient number per year was lower than in Thanh Hoa hospital and Bac Giang hospital from 2,012 to 5,845 inpatients and from 1,545 to 5,773, respectively. The number of nurses in each department also varied among hospitals. Can Tho central hospital has a largest number of nurses from 16 to 23 nurses, followed by Thanh Hoa hospital (15 to 21 nurses in each faculty) and Bac Giang hospital (11 to 21 nurses in each faculty). Otherwise, Dong Thap general hospital had a small number of nurses, from 11 to 16 nurses in each faculty. According to hospital statistics, the total number of inpatient treatment days in each faculty was highest in Dong Thap general hospital (from 13,560 to 63,805 days), meanwhile it reported only from 15,625 to 35,455 days for inpatient treatment in Can Tho central hospital.
Table 2
Comparison of common standard activities of nurses for performing specialized services by hospitals
Activities
|
Unit
|
Provincial general hospital
|
Bac Giang
|
Thanh Hoa
|
Can Tho
|
Dong Thap
|
Monitoring patient with ICU levels
|
Mins/patient
|
15/30
|
15/20/30
|
15/30
|
15/30
|
Medical procedures
|
Mins/patient
|
30–100
|
15/30
|
5/30/ 120
|
10/30/60
|
Preparation of patients before and after surgery
|
Mins/patient
|
30
|
25/30
|
10/15/ 20
|
10,15
|
Measuring survival indicators
|
Mins/ time
|
5
|
5
|
3
|
3
|
Taking additional blood
|
Mins/ time
|
5
|
3
|
5
|
5
|
Infusion/Transfusion
|
Mins/ time
|
5
|
5
|
6,7
|
7
|
Intravenous injection
|
Mins/ time
|
5
|
5
|
3–4
|
3–4
|
Intramuscular injection
|
Mins/ time
|
3
|
3
|
2
|
2
|
Subcutaneously injection
|
Mins/ time
|
3
|
2
|
2
|
2
|
Blood transfusion
|
Mins/ time
|
15
|
30
|
30
|
30/40
|
Sonde fastrique
|
Mins/ time
|
5
|
5
|
5/6
|
8–10
|
Sonde Urinaire
|
Mins/ time
|
7
|
5
|
5–7
|
8–10
|
Dressing
|
Mins/ time
|
10
|
10
|
6–9
|
8
|
Table 2 described the standards for nursing activities. The findings showed that the time allotted to the normal activity of each faculty in hospitals varied. For example, measuring survival indicators by a nurses working in Bac Giang and Thanh Hoa general hospitals was reported to take 5 minutes, however in Can Tho and Dong Thap general hospitals, this activity was completed in only 3 minutes. Similarly in terms of standard time to perform intravenous injection, in Bac Giang and Thanh Hoa general hospitals nurses need 5 minutes, more than those reported in Can Tho and Dong Thap general hospitals. Meanwhile, standard time of several activities in Can Tho, Dong Thap took longer than those in Bac Giang and Thanh Hoa general hospitals. For example, a standard time for blood transfusion by nurses in Bac Giang general hospital was 15 minutes, in Thanh Hoa and Can Tho general hospitals was 30 minutes; and from 30–40 minutes in Dong Thap general hospital. Even within a hospital, the standard time for performing an activity within the faculties was variable.
Table 3
The time spent to perform clinical services and administrative-management activities
|
Proportion of time allocated for clinical services and administrative/management activities
|
Bac Giang
(%)
|
Thanh Hoa
(%)
|
Can Tho
(%)
|
Dong Thap
(%)
|
Clinical services
|
63.2–74.4
|
66.8–79.1
|
61.3–75.5
|
67.2–75.6
|
Administrative/ management activities, other activities
|
25.6–36.8
|
20.9–33.2
|
24.5–41.7
|
24.4–32.8
|
Table 3 describes the time spent on clinical services and administrative activities. The results showed that the time of administrative /management activities accounts for 20–40% of the total working time of a nurse. The faculties have different proportions of time for these activities. In comparion to other selected hospitals, nurses in Can Tho hospital spent the most time on administrative/management activities, from 24.5–41.7% of their working time. Nurses in Thanh Hoa spent between 21–33% of their working time on administrative/management activities, including daily professional meetings in faculty, meeting of hospital, patient record completion, writing reports, etc.
Table 4
Required number of nursing staff based on WISN and WISN ratio
|
Provincial general hospital
|
Bac Giang
|
Thanh Hoa
|
Can Tho
|
Dong Thap
|
Number of understaffed faculties
Internal medicine
Surgery
|
3
3
0
|
2
2
0
|
2
1
1
|
3
2
1
|
Shortage in understaffed faculties
|
1–2
|
0
|
2/5
|
1
|
WISN ratio in understaffed faculties
|
0.88–0.95
|
0.88–0.95
|
0.78–0.92
|
0.91–0.92
|
Number of adequate staffed faculties
Internal medicine
Surgery
|
1
0
1
|
0
0
0
|
1
1
0
|
1
0
1
|
Number of overstaffed faculties
Internal medicine
Surgery
|
3
1
2
|
4
1
3
|
2
0
2
|
0
0
0
|
Excess in overstaffed faculties
|
1/3
|
2/3
|
2
|
-
|
Table 4 described the staff needs of the faculties following calculation using the WISN tool. The results showed that out of 22 clinical faculties in 04 general hospitals surveyed, 10 faculties had a shortage of nurses. The shortage of nurses was mainly occurred in the Internal Medicine faculties (7 faculties including 3 faculties at Bac Giang hospital (General medical, Cardiology, Gastroenterology), 2 faculties at Thanh Hoa hospital (General medical, Respiratory), 1 faculty at Can Tho hospital (General medical) and 2 faculties at Dong Thap hospital (General medical, Respiratory) whereas there were only 2 Surgical faculties (2 General Surgery faculties at Can Tho and Dong Thap hospital) did not have enough nurses. These understaffed faculties should be completed between 01 and 02 nurses each. Workload pressures in these faculties were not significant, with WISN ratios ranging from 0.88 to 0.95.
A single clinical faculty at Can Tho general hospital lacked 05 nurses, facing a high workload with a WISN ratio of 0.78. Three of the 22 faculties had enough staff, including 01 in internal medicine and 2 in surgery. The number of overstaffed faculties was 09 faculties, including 07 Surgical faculties and 2 Internal medicine faculties, with the excess number of nurses ranging from 01 to 03, depending on the faculties. Thus, we could see that if the shortage of nurses occurred mainly in the faculties of internal medicine, the excess of nurses often ended up in the faculties of surgery. Dong Thap general hospital did not have adequate number of staffs in almost clinical faculties, while at Thanh Hoa Hospital general hosptial, 2/3 of the clinical faculties (equivalent to 4 faculties) had excess human resources.