Workload and nursing care: A case study in some selected Hospitals in the Brong-Ahafo region of Ghana

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Nurses since time immemorial have often cited workload as one of the main reasons for their inability to provide holistic care to their patients. The nurse-patient ratio has often been the most frequently used measure of workload at the unit- level. Not much has been studied into the effect of the unfavourable nurse-patient ratio in Ghana as a whole and the Brong-Ahafo Region in particular. This study investigated workload and nursing care in some selected hospitals in the Brong-Ahafo Region of Ghana by determining the daily nursing workload, the factors that contributed to workload, the effects of workload on nurses and the quality of care delivered. The study used mixed sampling techniques -0in selecting the respondents. A cross sectional survey was then employed by administering questionnaire to 375 bedside nurses with 350 of them responding giving it a retrieval rate of 93%. Interviews with five nurse managers (hospital matrons) were recorded and transcribed. The results from the questionnaire were analyzed using SPSS (version16) which were subsequently triangulated with that of the in depth interview. The findings of the study revealed that, the nurse- patient ratio was 1:9 as compared with the ideal of 1:4; an indication that there was increased workload in the study area. In general, nursing care was either delayed or not done an indication that quality of care was not the best.”Borrowed” procedures carried out by nurses were more pronounced in the government owned hospitals as compared with the Christian Health Association of Ghana (CHAG) hospitals with taking of patient samples showing appreciable level of significance(P=0.049). Some of the nurse factors which were found to have an association with increased workload included: staff absenteeism (p=0.0279), colleagues resting at nurses‟ station (p=0.0235), reporting to work late (p=0.009), clarifying doctors‟ orders (p=0.051) and unavailability of keys to open logistics room (p=0.000). vii Doctors‟ response to calls however was statistically insignificant to increasing workload (p=0.239). The commonest reason why nurses missed work was found to be physical illness. This research recommends that, ward in-charges should conduct effective daily supervision to ensure nurses deliver quality of care to their patients. The Ministry of Health (MOH) in collaboration with the Nurses and Midwifery Council (NMC) could also establish more nurses‟ training Colleges to reduce the nurse- patient ratio.
A thesis submitted to the Department of Community Health, College of Health Sciences in partial fulfilment of the requirements for the degree of Master of Public Health in Health Services Planning and Management