Building a nursing productivity measure based on the Synergy Model: First steps

Abstract

Background: The Synergy Model describes nurses' work on the basis of the individual needs of patients and their families. Objective: To generate data necessary to develop a nursing productivity system by using the Synergy Model as a conceptual framework. Methods: Nurses from 3 different intensive care units participated. In phase 1, charge nurses in focus groups described patient and family indicators considered when making nursepatient assignments. In phase 2, charge nurse data were used to construct a survey for experienced staff nurses, asking them to link the indicators to 3 levels of nursing workload. Results: Thirty charge nurses considered all 8 patient dimensions of the Synergy Model when making nurse-patient assignments. Thirty-two experienced staff nurses completed 79 surveys ranking patients' stability as the most important dimension in patient care followed by complexity and predictability. Respondents linked a common set of unique indicators to each of the patient dimensions of the Synergy Model: fluctuation in vital signs was linked to stability, number and severity of diagnoses, to complexity, trajectory of illness, to predictability, lack of reserve, to resiliency, invasiveness of procedures, to vulnerability, family educational level and participation style, to family participation in decision making/care; and home environment, to resources. Sets of indicators were common across units and clustered around level of workload. Conclusion: The Synergy Model shows promise as a conceptual framework for a nursing productivity system. Using a model that centers nursing work on patients' needs may better capture what nurses do and enhance our capacity to quantify nursing resource allocation.