Can the Northwick Park Care Needs Assessment be used to estimate nursing staff requirements in an inpatient rehabilitation setting?

Abstract

Aim : To determine whether the Northwick Park Care Needs Assessment (NPCNA) could be used to estimate nursing staff requirements in an inpatient rehabilitation setting. Design : Retrospective analysis of NPCNA data in comparison with nursing staff provision over a six-month period from 1 April 2003 to 30 September 2003. Setting : A specialist neurorehabilitation unit. Methods : Daily care requirements for the ward were calculated at two-week intervals by summing the NPCNA care-hour estimates for all inpatients. Nursing staff hours provided were identified from the unit's duty rota and agency records for each corresponding period. Results : In total, 271 care-hour recordings were extracted from 59 patients. There was a poor relationship between the calculated total ward care-hour requirements and nursing staff hours provided (Pearson's r = 0.31, P = 0.29); but staff hours provided fell significantly short of estimated daily care requirements (mean shortfall 6.2 hours/day, SD 8.6 (95% confidence interval (CI) 0.73, 11.1), P = 0.03)). The shortfall was most obvious during peak care periods in the morning and at bedtime, which resonates with experience reported by nursing staff that they are overstretched at these times. A marked discrepancy between qualified nursing staff hours provided and NPCNA-estimated `special nursing' care requirements highlights a failure to address important facets of the rehabilitation nursing role. Conclusions : The NPCNA, which was designed to assess only direct care needs in a community setting, requires the further development of a new algorithm before it could be used to estimate nursing staff requirements in a rehabilitation ward setting.