Happy nurses

The biggest problem that Dutch hospitals face today is the lack of nursing staff. Therefore, hospital beds are closed to maintain safety levels for the already admitted patients. However, patients on the waiting list or those already planned for elective care experience longer waiting times. And sometimes emergency care beds have to be closed causing arriving patients to be transferred to other hospitals. If this trend goes on, we are losing the high quality of care and even emergency care, reducing the chance for a sick patient to recover quickly.

Patient stay shortened substantially in Dutch hospitals over the last decade. This is good for both patients, hospitals and society. However, due shorter stay the turnover of patients increased and also care acuity per patient per time unit in the hospital, the workload for nurses increases. Higher workload is associated with higher levels of burnout (sickness absence) and work dissatisfaction. Both could be predecessors for voluntarily stop of clinical nursing work by reschooling to a specialised nurse, nurse practioner or even leaving the job. The voluntary job leaves lead for the nurse behind to a higher workload if vacancies are not filled quickly with experienced nurses.

Scientific research shows an association between patient outcomes and nurse autonomy, sufficient numbers of nursing staff, a good relationship between nurses and doctors and the presence of nurses with a bachelor degree. This emerges by the influence of the nurses on the care process (surveillance, continuity of care, patient centredness and effective communication at discharged for the continuity of care at home or in a different location). Large studies over different departments and different hospitals show that facilitating these factors reduces mortality, improves patient satisfaction, provide less burnout among nurses and causes less safety issues for both patients and nurses. [Vahey, 2004]

In our hospital we need to close bed due to the lack of nursing staff that should take care of the patients more frequently. Until now this has not resulted in problems for hospital liquidity, but the amount of personnel will decrease further coming years. By the increase of elderly in the general population, nurse getting older and low increase of young nurses this will create a disbalance between demand and supply. In this project you will work on quantifying work load in daily clinical nursing care to provide insights for the management to guide better decision making in number of nursing staff per shift and help the hospital to understand patterns in workload evolvement over time.

Research questions

Nurses have several tasks that lead combined together to a certain workload.

  1. Is it possible to quantify changes in workload over time by using structured hospital data?
  2. Is it possible to predict workload on the next shift by the available structured data of the current shift?
  3. What is the best way to visualise workload from the available structured data for both nurses and departmental heads?
  4. Which hidden patterns are in the data that may inform care related process optimisation questions?

Data available

In preparation of this project nurses were interviewed, shifts were observed and relevant data from other institutions were taken into account. A combination of large datasets is already available in the hospital and were inspected and prepared for further analysis. This includes meta data from Hospital records, patient alarm data, wifi data, key pass data and admission data. All records are date and time stamped and could be combined via different keys.


These research questions are part of a larger project that uses Design Thinking to find the true problems that nurses experience in their daily working live. We are currently in the ‘ Define’ phase.

Details of this method can be find (amongst others) in: https://sites.google.com/site/moocmodules/research-for-entrepreneurs/design-thinking

Contact details:

Renata Medeiros de Carvalho – r.medeiros.de.carvalho@tue.nl

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