More work has been done looking at staffing in ambulatory care settings. This work has focused on nursing workload models and adequate staffing based upon these measures. In 2005, Gaits identified four categories of questions that can be used to guide staff allocation decisions. The questions focus on
- Patients and intensity
- Staff availability
- Expertise of staff
- Unit architecture/resource availability (e.g., documentation system).
Several authors have addressed measurement of intensity and nursing workload in the ambulatory setting.
- An Ambulatory Intensity System developed at the Warren G. Magnuson Clinical Center at the National Institutes of Health (NIH) to reflect both direct and indirect care needs in oncology ambulatory settings is described in a series of articles by Cusack, Jones, and Chisholm (2004) (Article 1, Article 2, and Article 3).
- The Ambulatory Intensity System was expanded to address day hospital settings and encompass a greater diversity of patient populations with adapted versions evaluated for the pediatric, medical-surgical, and hematology-oncology populations (Moore & Hastings, 2006).
- Building upon the work done at NIH, a Medical Oncology Acuity of Care Rating System was developed by the Cleveland Clinic Cancer Center at Hillcrest Hospital (Hawley & Carter, 2009).
Cusack, G., Jones, A., & Chisholm, L. (2004). Patient intensity in an ambulatory oncology research center: Step forward for the field of ambulatory care—Part III. Nursing Economics, 22, 193–195, 175.
Cusack G., Jones-Wells, A., Chisholm, L., & Warren, G. (2004). Patient intensity in an ambulatory oncology research center: A step forward for the field of ambulatory care. Nursing Economics, 22, 58–63.
Gaits, V.A. (2005). Nurse resource allocation in ambulatory cancer centers: Guidelines for clinicians and executives. Oncology Issues, 20(5). Retrieved from http://www.accc-cancer.org/oncology_issues/articles/sepoc05/gaits.pdf
Hawley, E., & Carter, N.G. (2009, November/December). An acuity rating system for infusion cancer nurse staffing. Oncology Issues, 24(6). Retrieved from http://accc-cancer.org/oncology_issues/articles/novdec09/ND09-Hawley.pdf
Jones, A., Cusack, G., & Chisholm, L. (2004). Patient intensity in an ambulatory oncology research center: A step forward for the field of ambulatory care—Part II. Nursing Economics, 22, 120–123.
Moore, M., & Hastings, C. (2006). The evolution of an ambulatory nursing intensity system: Measuring nursing workload in a day hospital setting. Journal of Nursing Administration, 36, 241–248. doi: 10.1097/00005110-200605000-00017