Estimation of Working Hours of Nursing Staff in Neonatal Intensive Care Units: A Work Sampling

Document Type : Original Article


1 Department of Nursing, Tehran Medical Sciences Branch, Islamic Azad University, Tehran,

2 Department of Pediatrics and Neonatal Intensive Care Nursing, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Department of Management, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: Human resources are considered the most valuable capital of every healthcare system, and the quality of care is closely related to the quantity and skill of this group. Therefore, the proper estimation of the required nursing staff in different wards can help improve the quality of nursing care. The purpose of this study was to determine the hours of provided care by nursing staff in neonatal care units.
Methods: In this descriptive study, the research samples consisted of all nursing activities done by the nursing staff including head nurses, nurses, and nurse assistants working in the neonatal intensive care units of the chosen educational hospitals affiliated with Shahid Beheshti University of Medical Sciences in Tehran, Iran. Data collection tool was a nursing checklist with four categories, including direct care, indirect care, managerial activities, and personal activities. Calculating their activity duration was done using a stopwatch. Data analysis was performed by SPSS software (version 21).
Results: The obtained findings showed that the time allocated to direct care by head nurses and nurses in morning and evening shifts was always less than the time allocated to indirect care and the nurses spent most of their time doing indirect activities.
Conclusion: According to the obtained results of the present, it is essential that nursing managers provide the possibility of reducing some nursing activities’ time by applying more accurate supervision and time management and thus increase the quality of care by providing purposeful healthcare.


1. Spilsbury K, Hewitt C, Stirk L, Bowman C. The relationship between nurse staffing and quality of care in nursing homes: a systematic review. Int J Nurs Stud. 2011; 48(6):732-50.
 2. Twigg D, Duffield C. A review of workload measures: a context for a new staffing methodology in Western Australia. Int J Nurs Stud. 2009; 46(1):131-9.
 3. Williams H, Harris R, Turner-Stokes L. Work sampling: a quantitative analysis of nursing activity in a neuro-rehabilitation setting. J Adv Nurs. 2009; 65(10):2097-107.
4. Badini Pourazar S, Shirinabadi Farahani A, Ghahri Sarabi A, Pourhoseingholi MA, Dehghan K. The effect of abdominal touch on nutritional tolerance in preterm infants. Int J Pediatr. 2018; 6(8):8119-28.
5. Bradley S, Kamwendo F, Chipeta E, Chimwaza W, de Pinho H, McAuliffe E. Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi. BMC Pregnancy Childbirth. 2015; 15(1):65-6.
 6. West E, Barron DN, Harrison D, Rafferty AM, Rowan K, Sanderson C. Nurse staffing, medical staffing and mortality in Intensive Care: an observational study. Int J Nurs Stud. 2014; 51(5):781-94. 7. Rogowski JA, Staiger D, Patrick T, Horbar J, Kenny M, Lake ET. Nurse staffing and NICU infection rates. JAMA Pediatr. 2013; 167(5):444-50.
8. Garcia PC, Fugulin FM. Nursing care time and quality indicators for the ICU: correlation analysis. Crit Care. 2013; 17(3):13-7.
9. Padilha KG, de Sousa RM, Garcia PC, Bento ST, Finardi EM, Hatarashi RH. Nursing workload and staff allocation in an intensive care unit: a pilot study according to Nursing Activities Score (NAS). Intensive Crit Care Nurs. 2010; 26(2):108-13.
10. de Magalhaes AM, Dall'Agnol CM, Marck PB. Nursing workload and patient safety--a mixed method study with an ecological restorative approach. Rev Lat Am Enfermagem. 2013; 21:146-54. 11. Lawn JE, Davidge R, Paul VK, Xylander SV, de Graft Johnson J, Costello A, et al. Born too soon: care for the preterm baby. Reprod Health. 2013; 10(Suppl 1):S56.
12. Ndelema B, Van den Bergh R, Manzi M, van den Boogaard W, Kosgei RJ, Zuniga I, et al. Low-tech, high impact: care for premature neonates in a district hospital in Burundi. A way forward to decrease neonatal mortality. BMC Res Notes. 2016; 9:28.
13. Namnabati M, Taleghani F. Nursing satisfaction with medication care by using neonatal electronic medication management systems. Iran J Neonatol. 2017; 8(4):43-56.
 14. Rogowski JA, Staiger DO, Patrick TE, Horbar JD, Kenny MJ, Lake ET. Nurse staffing in neonatal Intensive Care Units in the United States. Res Nurs Health. 2015; 38(5):333-41.
15. Bray K, Wren I, Baldwin A, St Ledger U, Gibson V, Goodman S, et al. Standards for nurse staffing in critical care units determined by: the British Association of Critical Care Nurses, The Critical Care Networks National Nurse Leads, Royal College of Nursing Critical Care and In-flight Forum. Nurs Crit Care. 2010; 15(3):109-11.
 16. Mark W, Stanton MA. Hospital nurse staffing and quality of care. Prof Inferm. 2005; 58(2):67-74. 17. Abbey M, Chaboyer W, Mitchell M. Understanding the work of intensive care nurses: a time and motion study. Aust Crit Care. 2012; 25(1):13-22.
18. Kakushi LE, Evora YD. Direct and indirect nursing care time in an intensive care unit. Rev Lat Am Enfermagem. 2014; 22(1):150-7.
19. Harrison L, Nixon G. Nursing activity in general intensive care. J Clin Nurs. 2002; 11(2):158-67.
20. Swansburg RC, Swansburg RJ. Introduction to management and leadership for nurse managers. Massachusetts: Jones & Bartlett Learning; 2002.
21. Norrie P. Nurses' time management in intensive care. Nurs Crit Care. 1997; 2(3):121-5.
 22. Gardner GE, Gardner A, Middleton S, Gibb M, Della P, Duffield C. Development and validation of a novel approach to work sampling : a study of nurse practitioner work patterns. Aust J Adv Nurs. 2010; 27(4):4-12.
 23. Westbrook JI, Duffield C, Li L, Creswick NJ. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals. BMC Health Serv Res. 2011; 11:319.
24. Heydari F, Tabari R. Identify direct and indirect nursing care time in a medical and surgical ward. J Holist Nurs Midwifery. 2015; 25(1):1-9.
 25. Kiekkas P, Poulopoulou M, Papahatzi A, Androutsopoulou C, Maliouki M, Prinou A. Nursing activities and use of time in the postanesthesia care unit. J Perianesth Nurs. 2005; 20(5):311-22.
26. Desjardins F, Cardinal L, Belzile E, McCusker J. Reorganizing nursing work on surgical units: a time-and-motion study. Nurs Leadership. 2008; 21(3):26-38.
27. Gholizadeh M, Janati A, Nadimi B, Kabiri N, Abri S. How do nurses spend their time in the hospital? J Clin Res Govern. 2014; 3(1):27-33.
28. Bosman RJ, Rood E, Oudemans-van Straaten HM, Van der Spoel JI, Wester JP, Zandstra DF. Intensive care information system reduces documentation time of the nurses after cardiothoracic surgery. Intensive Care Med. 2003; 29(1):83-90.
29. Marasovic C, Kenney C, Elliott D, Sindhusake D. Attitudes of Australian nurses toward the implementation of a clinical information system. Comput Nurs. 1997; 15(2):91-8.
30. Padilha KG, Stafseth S, Solms D, Hoogendoom M, Monge FJ, Gomaa OH, et al. Nursing activities score: an updated guideline for its application in the Intensive Care Unit. Rev Esc Enferm USP. 2015; 49:131-7.
31. Nomura AT, Silva MB, Almeida MA. Quality of nursing documentation before and after the Hospital Accreditation in a university hospital. Rev Lat Am Enfermagem. 2016; 24:e2813.
32. Bazi A, Sharafi S. Evaluation time nurses for nonnursing tasks and text services in nursing shifts: a cross-sectional study. Navid Now J. 2016; 19(62):24-32.
 33. Jiang H, Li H, Ma L, Gu Y. Nurses' roles in direct nursing care delivery in China. Appl Nurs Res. 2015; 28(2):132-6.
 34. Momennasab M, Karimi F, Dehghanrad F, Zarshenas L. Evaluation of nursing workload and efficiency of staff allocation in a trauma Intensive Care Unit. Trauma Mon. 2018; 23(1):e58161.