Development of a Labor and Delivery Nursing Patient Classification System: The Indirect Care Component. Executive Summary

The purpose of this study was to determine the Indirect Care time including Nonproductive time expressed as a proportion of Available time this eventually will be combined with Direct Care time and Unavailable for Care time to determine nursing requirements consistent with currently accepted nurse staffing standards methodology. To determine the Indirect Care and Nonproductive proportions for the Army L and D nursing units, a stratified work sampling design was used. Using weighted stratified sampling, the required sample size of 8 sites was selected from the low, medium, and high workload strata proportionate to the number of sites from the total universe that occurred within each stratum. Using 5 accuracy 95 confidence interval length and .65 as an approximation of the Indirect Care time proportion, it was estimated that at least 364 data point per site were required. Data collection was distributed over a work cycle for L and D defined as one week of the measured units hours of operation. A minimum of one observation session per hour and a maximum of six observation sessions per hour were scheduled to insure representative sampling of nursing activities throughout the day. Upon analysis of the collected data, the findings from this study recommend that a combined Indirect Care and Nonproductive proportion of 71.1 based upon Available time and with the head nurse, wardmaster, and ward clerk position considered as directed requirements be used to develop the L and D staffing standards.