Paper
Friday, July 13, 2007
Changes in nurses' work during introduction of the DRG-system in German hospitals
Sabine U. Bartholomeyczik, RN, PhD, Elke Donath, PhD, Michael Galatsch, RN, student, Caecilia Krueger, RN, student, Tina Quasdorf, RN, student, and Markus Schroller, RN, student. Institute of Nursing Science, University of Witten/Herdecke, Witten, Germany
| Learning Objective #1: estimate the advantages of the work-sampling method for illuminating the work structure of the nursing staff |
| Learning Objective #2: discuss some aspects of nurses' work changes in German hospitals and compare them with his/her own experience |
In 2004 the DRG based financing system was introduced into German hospitals with the purpose to reduce hospital stay and the number of hospital beds. Both indicators are the highest in Germany in comparison to other European countries. Nurses are afraid that in the new system their work will not be visible, since DRG are built upon medical diagnoses and nursing diagnoses are not used. The project aimed to describe potential structure changes in nursing in hospitals during DRG introduction and the nurses' perspectives. An explorative descriptive longitudinal design with three measure points was used: October 2003(t1), 2004(t2), 2005(t3). Convenience sample of three large hospitals with a surgical and an internal ward each. Methods were a self-administered questionnaire for nurses and a computer-assisted work-sampling method, measuring tasks of the whole nursing staff every 5 minutes during 7 days in morning and afternoon shifts on these 6 wards. 156 questionnaires and 62 006 observations by the work-sampling method were analyzed. Results show, that close-to-patient activities were reduced, especially nurses' communication with patients. From the nurses' perspective training and counselling tasks were diminished. "Paper work" rose only in the year of the DRG introduction. Kitchen and cleaning work comprises as much time as direct nursing care. The utilization of a national guideline for discharge management has become common in 2005, however, the discharge work is rarely visible in the work-sampling data. Some results suggest that the patient during the short stay in hospital is more often left alone. Changes in nurses' work don't seem to be oriented towards patients needs. Work distribution among physicians and nurses should be reconsidered.