Reflections on the meaning of nursing work loads and responsibility to establish safe staffing

: The methods for establishing nursing staff requirements , based on the caring needs of patients , take into consideration two parameters: the determination of the overall care requirements fundamental for programming nursing care; the quantification of the requirements as the time needed for care, classifying patients according to their degree of dependence, by the analysis of the pre-established parameters. Consequently, the approach to the evaluation of nursing staff requirements varies: in fact, when the focus is placed on the care necessary for different types of patients, the nursing practice is based on planning of care and the resulting criteria are more objective. On the other hand, when the approach focuses on an analysis of the division of available resources among the different types of patients, it is influenced by local factors and is less objective. The DRG system introduced in Italy in 1995 classifies patients on a medical basis and allocates resources accordingly. However, since this system does not take into account a nursing classification, it cannot extrapolate the true requirements of nursing resources: this means that financing does not adequately evaluate the costs of nursing care. The non-assessable aspects of nursing care and their significance are also taken into consideration.