The health-care crisis won’t be solved without addressing the elephant in the room: Staff workload

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11 May 2024
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Excess workload has been identified as a root cause of the current health-care crisis in report, after report, after report. Excess workload for front-line staff like nurses contributes to fatigue, burnout, medical error and staff quitting.

After heroically working under decades of austerity policies, nurses are burned out and the health-care system is in collapse. If automakers took the same approach to workload management, not a single car would roll off the line with all five wheels properly connected (did you forget the steering wheel?). Excess workload lies at the root of the health-care crisis in Canada today and the wheels are flying off the cart.

So why then does our health-care system have no systematic approach to measuring workload? There is no objective measure of workload in use that can ensure staff have no more than eight hours of care work to complete in an eight-hour shift. There is a saying: “If you can’t measure it you can’t manage it” and by this standard, the Canadian health-care system is flying blind with regards to staff workloads.

It is no wonder our health-care system is in trouble: How can we set “safe staffing levels” with no measure of workload? Without evidence-based workload management, efforts to stave off the shortfall of nurses with increased hiring and “resiliency” training and other staff retention efforts are doomed to fail.

14 hours of work in a 12-hour shift
A collage of a clock and a calendar with a stethoscope
All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. (Shutterstock)
While the variability in care work can make measuring workload a challenge, new tools using computer simulation technologies are opening the door to objective workload measurement. Our computer modelling approaches have shown that nurses can have over 14 hours of work to complete in a 12-hour shift.

How are staff supposed to keep up with these demands? By rushing? By skipping non-essential tasks? All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. No wonder nurses are quitting in droves.

Read more: Canada’s health-care crisis is gendered: How the burden of care falls to women

These modelling tools allow us to create virtual care units based on actual unit conditions. These models have shown the impact on nurse workload goes well beyond nurse-patient ratios as is currently being discussed.

Making sure workload is balanced to the length of a nurse’s shift requires considering a number of factors, including:

the needs of the patient, including acuity and dependency levels,
the layout of the unit and positioning of medicines and materials,
the location of the beds assigned, and
the policies and practices that determine the time needed for between-shift hand-offs, safety huddles and data entry.
All of these factors can increase workload and contribute to missed care as tasks are left undone by the end of a nurse’s working shift.

If you consider the donning and doffing of personal protective equipment required for caring for those with COVID-19, for example, a nurse might spend half of their shift simply dealing with the PPE. Where is the time to deal with the extra needs of these pExcess workload has been identified as a root cause of the current health-care crisis in report, after report, after report. Excess workload for front-line staff like nurses contributes to fatigue, burnout, medical error and staff quitting.
After heroically working under decades of austerity policies, nurses are burned out and the health-care system is in collapse. If automakers took the same approach to workload management, not a single car would roll off the line with all five wheels properly connected (did you forget the steering wheel?). Excess workload lies at the root of the health-care crisis in Canada today and the wheels are flying off the cart.
So why then does our health-care system have no systematic approach to measuring workload? There is no objective measure of workload in use that can ensure staff have no more than eight hours of care work to complete in an eight-hour shift. There is a saying: “If you can’t measure it you can’t manage it” and by this standard, the Canadian health-care system is flying blind with regards to staff workloads.
It is no wonder our health-care system is in trouble: How can we set “safe staffing levels” with no measure of workload? Without evidence-based workload management, efforts to stave off the shortfall of nurses with increased hiring and “resiliency” training and other staff retention efforts are doomed to fail.

14 hours of work in a 12-hour shift

All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. (Shutterstock)
While the variability in care work can make measuring workload a challenge, new tools using computer simulation technologies are opening the door to objective workload measurement. Our computer modelling approaches have shown that nurses can have over 14 hours of work to complete in a 12-hour shift.
How are staff supposed to keep up with these demands? By rushing? By skipping non-essential tasks? All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. No wonder nurses are quitting in droves.
Read more: Canada’s health-care crisis is gendered: How the burden of care falls to women
These modelling tools allow us to create virtual care units based on actual unit conditions. These models have shown the impact on nurse workload goes well beyond nurse-patient ratios as is currently being discussed.
Making sure workload is balanced to the length of a nurse’s shift requires considering a number of factors, including:

  • the needs of the patient, including acuity and dependency levels,
  • the layout of the unit and positioning of medicines and materials,
  • the location of the beds assigned, and
  • the policies and practices that determine the time needed for between-shift hand-offs, safety huddles and data entry.

All of these factors can increase workload and contribute to missed care as tasks are left undone by the end of a nurse’s working shift.
If you consider the donning and doffing of personal protective equipment required for caring for those with COVID-19, for example, a nurse might spend half of their shift simply dealing with the PPE. Where is the time to deal with the extra needs of these patients?
Excess workloads 
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Excess workloads Excess workload has been identified as a root cause of the current health-care crisis in report, after report, after report. Excess workload for front-line staff like nurses contributes to fatigue, burnout, medical error and staff quitting.
After heroically working under decades of austerity policies, nurses are burned out and the health-care system is in collapse. If automakers took the same approach to workload management, not a single car would roll off the line with all five wheels properly connected (did you forget the steering wheel?). Excess workload lies at the root of the health-care crisis in Canada today and the wheels are flying off the cart.
So why then does our health-care system have no systematic approach to measuring workload? There is no objective measure of workload in use that can ensure staff have no more than eight hours of care work to complete in an eight-hour shift. There is a saying: “If you can’t measure it you can’t manage it” and by this standard, the Canadian health-care system is flying blind with regards to staff workloads.
It is no wonder our health-care system is in trouble: How can we set “safe staffing levels” with no measure of workload? Without evidence-based workload management, efforts to stave off the shortfall of nurses with increased hiring and “resiliency” training and other staff retention efforts are doomed to fail.

14 hours of work in a 12-hour shift

All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. (Shutterstock)
While the variability in care work can make measuring workload a challenge, new tools using computer simulation technologies are opening the door to objective workload measurement. Our computer modelling approaches have shown that nurses can have over 14 hours of work to complete in a 12-hour shift.
How are staff supposed to keep up with these demands? By rushing? By skipping non-essential tasks? All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. No wonder nurses are quitting in droves.
Read more: Canada’s health-care crisis is gendered: How the burden of care falls to women
These modelling tools allow us to create virtual care units based on actual unit conditions. These models have shown the impact on nurse workload goes well beyond nurse-patient ratios as is currently being discussed.
Making sure workload is balanced to the length of a nurse’s shift requires considering a number of factors, including:

  • the needs of the patient, including acuity and dependency levels,
  • the layout of the unit and positioning of medicines and materials,
  • the location of the beds assigned, and
  • the policies and practices that determine the time needed for between-shift hand-offs, safety huddles and data entry.

All of these factors can increase workload and contribute to missed care as tasks are left undone by the end of a nurse’s working shift.
If you consider the donning and doffing of personal protective equipment required for caring for those with COVID-19, for example, a nurse might spend half of their shift simply dealing with the PPE. Where is the time to deal with the extra needs of these patients?
Excess workloads Excess workload has been identified as a root cause of the current health-care crisis in report, after report, after report. Excess workload for front-line staff like nurses contributes to fatigue, burnout, medical error and staff quitting.
After heroically working under decades of austerity policies, nurses are burned out and the health-care system is in collapse. If automakers took the same approach to workload management, not a single car would roll off the line with all five wheels properly connected (did you forget the steering wheel?). Excess workload lies at the root of the health-care crisis in Canada today and the wheels are flying off the cart.
So why then does our health-care system have no systematic approach to measuring workload? There is no objective measure of workload in use that can ensure staff have no more than eight hours of care work to complete in an eight-hour shift. There is a saying: “If you can’t measure it you can’t manage it” and by this standard, the Canadian health-care system is flying blind with regards to staff workloads.
It is no wonder our health-care system is in trouble: How can we set “safe staffing levels” with no measure of workload? Without evidence-based workload management, efforts to stave off the shortfall of nurses with increased hiring and “resiliency” training and other staff retention efforts are doomed to fail.

14 hours of work in a 12-hour shift

All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. (Shutterstock)
While the variability in care work can make measuring workload a challenge, new tools using computer simulation technologies are opening the door to objective workload measurement. Our computer modelling approaches have shown that nurses can have over 14 hours of work to complete in a 12-hour shift.
How are staff supposed to keep up with these demands? By rushing? By skipping non-essential tasks? All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. No wonder nurses are quitting in droves.
Read more: Canada’s health-care crisis is gendered: How the burden of care falls to women
These modelling tools allow us to create virtual care units based on actual unit conditions. These models have shown the impact on nurse workload goes well beyond nurse-patient ratios as is currently being discussed.
Making sure workload is balanced to the length of a nurse’s shift requires considering a number of factors, including:

  • the needs of the patient, including acuity and dependency levels,
  • the layout of the unit and positioning of medicines and materials,
  • the location of the beds assigned, and
  • the policies and practices that determine the time needed for between-shift hand-offs, safety huddles and data entry.

All of these factors can increase workload and contribute to missed care as tasks are left undone by the end of a nurse’s working shift.
If you consider the donning and doffing of personal protective equipment required for caring for those with COVID-19, for example, a nurse might spend half of their shift simply dealing with the PPE. Where is the time to deal with the extra needs of these patients?
Excess workloadExcess workload has been identified as a root cause of the current health-care crisis in report, after report, after report. Excess workload for front-line staff like nurses contributes to fatigue, burnout, medical error and staff quitting.
After heroically working under decades of austerity policies, nurses are burned out and the health-care system is in collapse. If automakers took the same approach to workload management, not a single car would roll off the line with all five wheels properly connected (did you forget the steering wheel?). Excess workload lies at the root of the health-care crisis in Canada today and the wheels are flying off the cart.
So why then does our health-care system have no systematic approach to measuring workload? There is no objective measure of workload in use that can ensure staff have no more than eight hours of care work to complete in an eight-hour shift. There is a saying: “If you can’t measure it you can’t manage it” and by this standard, the Canadian health-care system is flying blind with regards to staff workloads.
It is no wonder our health-care system is in trouble: How can we set “safe staffing levels” with no measure of workload? Without evidence-based workload management, efforts to stave off the shortfall of nurses with increased hiring and “resiliency” training and other staff retention efforts are doomed to fail.

14 hours of work in a 12-hour shift

All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. (Shutterstock)
While the variability in care work can make measuring workload a challenge, new tools using computer simulation technologies are opening the door to objective workload measurement. Our computer modelling approaches have shown that nurses can have over 14 hours of work to complete in a 12-hour shift.
How are staff supposed to keep up with these demands? By rushing? By skipping non-essential tasks? All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. No wonder nurses are quitting in droves.
Read more: Canada’s health-care crisis is gendered: How the burden of care falls to women
These modelling tools allow us to create virtual care units based on actual unit conditions. These models have shown the impact on nurse workload goes well beyond nurse-patient ratios as is currently being discussed.
Making sure workload is balanced to the length of a nurse’s shift requires considering a number of factors, including:

  • the needs of the patient, including acuity and dependency levels,
  • the layout of the unit and positioning of medicines and materials,
  • the location of the beds assigned, and
  • the policies and practices that determine the time needed for between-shift hand-offs, safety huddles and data entry.

All of these factors can increase workload and contribute to missed care as tasks are left undone by the end of a nurse’s working shift.
If you consider the donning and doffing of personal protective equipment required for caring for those with COVID-19, for example, a nurse might spend half of their shift simply dealing with the PPE. Where is the time to deal with the extra needs of these patients?
Excess workloads 
s Excess workload has been identified as a root cause of the current health-care crisis in report, after report, after report. Excess workload for front-line staff like nurses contributes to fatigue, burnout, medical error and staff quitting.
After heroically working under decades of austerity policies, nurses are burned out and the health-care system is in collapse. If automakers took the same approach to workload management, not a single car would roll off the line with all five wheels properly connected (did you forget the steering wheel?). Excess workload lies at the root of the health-care crisis in Canada today and the wheels are flying off the cart.
So why then does our health-care system have no systematic approach to measuring workload? There is no objective measure of workload in use that can ensure staff have no more than eight hours of care work to complete in an eight-hour shift. There is a saying: “If you can’t measure it you can’t manage it” and by this standard, the Canadian health-care system is flying blind with regards to staff workloads.
It is no wonder our health-care system is in trouble: How can we set “safe staffing levels” with no measure of workload? Without evidence-based workload management, efforts to stave off the shortfall of nurses with increased hiring and “resiliency” training and other staff retention efforts are doomed to fail.

14 hours of work in a 12-hour shift

All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. (Shutterstock)
While the variability in care work can make measuring workload a challenge, new tools using computer simulation technologies are opening the door to objective workload measurement. Our computer modelling approaches have shown that nurses can have over 14 hours of work to complete in a 12-hour shift.
How are staff supposed to keep up with these demands? By rushing? By skipping non-essential tasks? All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. No wonder nurses are quitting in droves.
Read more: Canada’s health-care crisis is gendered: How the burden of care falls to women
These modelling tools allow us to create virtual care units based on actual unit conditions. These models have shown the impact on nurse workload goes well beyond nurse-patient ratios as is currently being discussed.
Making sure workload is balanced to the length of a nurse’s shift requires considering a number of factors, including:

  • the needs of the patient, including acuity and dependency levels,
  • the layout of the unit and positioning of medicines and materials,
  • the location of the beds assigned, and
  • the policies and practices that determine the time needed for between-shift hand-offs, safety huddles and data entry.

All of these factors can increase workload and contribute to missed care as tasks are left undone by the end of a nurse’s working shift.
If you consider the donning and doffing of personal protective equipment required for caring for those with COVID-19, for example, a nurse might spend half of their shift simply dealing with the PPE. Where is the time to deal with the extra needs of these patients?
Excess workloads Excess workload has been identified as a root cause of the current health-care crisis in report, after report, after report. Excess workload for front-line staff like nurses contributes to fatigue, burnout, medical error and staff quitting.
After heroically working under decades of austerity policies, nurses are burned out and the health-care system is in collapse. If automakers took the same approach to workload management, not a single car would roll off the line with all five wheels properly connected (did you forget the steering wheel?). Excess workload lies at the root of the health-care crisis in Canada today and the wheels are flying off the cart.
So why then does our health-care system have no systematic approach to measuring workload? There is no objective measure of workload in use that can ensure staff have no more than eight hours of care work to complete in an eight-hour shift. There is a saying: “If you can’t measure it you can’t manage it” and by this standard, the Canadian health-care system is flying blind with regards to staff workloads.
It is no wonder our health-care system is in trouble: How can we set “safe staffing levels” with no measure of workload? Without evidence-based workload management, efforts to stave off the shortfall of nurses with increased hiring and “resiliency” training and other staff retention efforts are doomed to fail.

14 hours of work in a 12-hour shift

All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. (Shutterstock)
While the variability in care work can make measuring workload a challenge, new tools using computer simulation technologies are opening the door to objective workload measurement. Our computer modelling approaches have shown that nurses can have over 14 hours of work to complete in a 12-hour shift.
How are staff supposed to keep up with these demands? By rushing? By skipping non-essential tasks? All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. No wonder nurses are quitting in droves.
Read more: Canada’s health-care crisis is gendered: How the burden of care falls to women
These modelling tools allow us to create virtual care units based on actual unit conditions. These models have shown the impact on nurse workload goes well beyond nurse-patient ratios as is currently being discussed.
Making sure workload is balanced to the length of a nurse’s shift requires considering a number of factors, including:

  • the needs of the patient, including acuity and dependency levels,
  • the layout of the unit and positioning of medicines and materials,
  • the location of the beds assigned, and
  • the policies and practices that determine the time needed for between-shift hand-offs, safety huddles and data entry.

All of these factors can increase workload and contribute to missed care as tasks are left undone by the end of a nurse’s working shift.
If you consider the donning and doffing of personal protective equipment required for caring for those with COVID-19, for example, a nurse might spend half of their shift simply dealing with the PPE. Where is the time to deal with the extra needs of these patients?
Excess workloads Excess workload has been identified as a root cause of the current health-care crisis in report, after report, after report. Excess workload for front-line staff like nurses contributes to fatigue, burnout, medical error and staff quitting.
After heroically working under decades of austerity policies, nurses are burned out and the health-care system is in collapse. If automakers took the same approach to workload management, not a single car would roll off the line with all five wheels properly connected (did you forget the steering wheel?). Excess workload lies at the root of the health-care crisis in Canada today and the wheels are flying off the cart.
So why then does our health-care system have no systematic approach to measuring workload? There is no objective measure of workload in use that can ensure staff have no more than eight hours of care work to complete in an eight-hour shift. There is a saying: “If you can’t measure it you can’t manage it” and by this standard, the Canadian health-care system is flying blind with regards to staff workloads.
It is no wonder our health-care system is in trouble: How can we set “safe staffing levels” with no measure of workload? Without evidence-based workload management, efforts to stave off the shortfall of nurses with increased hiring and “resiliency” training and other staff retention efforts are doomed to fail.

14 hours of work in a 12-hour shift

All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. (Shutterstock)
While the variability in care work can make measuring workload a challenge, new tools using computer simulation technologies are opening the door to objective workload measurement. Our computer modelling approaches have shown that nurses can have over 14 hours of work to complete in a 12-hour shift.
How are staff supposed to keep up with these demands? By rushing? By skipping non-essential tasks? All too often nurses are working overtime or skipping breaks in an effort to deliver the quality of care they were trained for. No wonder nurses are quitting in droves.
Read more: Canada’s health-care crisis is gendered: How the burden of care falls to women
These modelling tools allow us to create virtual care units based on actual unit conditions. These models have shown the impact on nurse workload goes well beyond nurse-patient ratios as is currently being discussed.
Making sure workload is balanced to the length of a nurse’s shift requires considering a number of factors, including:

  • the needs of the patient, including acuity and dependency levels,
  • the layout of the unit and positioning of medicines and materials,
  • the location of the beds assigned, and
  • the policies and practices that determine the time needed for between-shift hand-offs, safety huddles and data entry.

All of these factors can increase workload and contribute to missed care as tasks are left undone by the end of a nurse’s working shift.
If you consider the donning and doffing of personal protective equipment required for caring for those with COVID-19, for example, a nurse might spend half of their shift simply dealing with the PPE. Where is the time to deal with the extra needs of these patients?
Excess workloads 





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