Search results for: staffing to workload

Authors: Kristin Thooft

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— Increasing pressure to manage healthcare costs has resulted in shifting care towards ambulatory settings and is driving a focus on cost transparency. There are few nurse staffing to workload models developed for ambulatory settings, less for multi-specialty clinics. Of the existing models, few have been evaluated against outcomes to understand any impact. This evaluation took place after the AWARD model for nurse staffing to workload was implemented in a multi-specialty clinic at a regional healthcare system in the Midwest. The multi-specialty clinic houses 26 medical and surgical specialty practices. The AWARD model was implemented in two specialty practices in October 2020. Donabedian’s Structure-Process-Outcome (SPO) model was used to evaluate outcomes based on changes to the structure and processes of care provided. The AWARD model defined and quantified the processes, recommended changes in the structure of day-to-day nurse staffing. Cost of care per patient visit, total visits, a total nurse performed visits used as structural and process measures, influencing the outcomes of cost of care and access to care. Independent t-tests were used to compare the difference in variables pre-and post-implementation. The SPO model was useful as an evaluation tool, providing a simple framework that is understood by a diverse care team. No statistically significant changes in the cost of care, total visits, or nurse visits were observed, but there were differences. Cost of care increased and access to care decreased. Two weeks into the post-implementation period, the multi-specialty clinic paused all non-critical patient visits due to a second surge of the COVID-19 pandemic. Clinic nursing staff was re-allocated to support the inpatient areas. This negatively impacted the ability of the Nurse Manager to utilize the AWARD model to plan daily staffing fully. The SPO framework could be used for the ongoing assessment of nurse staffing performance. Additional variables could be measured, giving a complete picture of the impact of nurse staffing. Going forward, there must be a continued focus on the outcomes of care and the value of nursing

Keywords: ambulatory, clinic, evaluation, outcomes, staffing, staffing model, staffing to workload

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Authors: Rebecca Oakes

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In the New Zealand public health system, work has been taking place to use electronic systems to convey data from the ‘floor to the board’ that makes patient needs, and therefore nursing work, visible. For nurses, these developments in health information technology puts us in a very new and exciting position of being able to articulate the work of nursing through a language understood at all levels of an organisation, the language of acuity. Nurses increasingly have a considerable stake-hold in patient acuity data. Patient acuity systems, when used well, can assist greatly in demonstrating how much work is required, the type of work, and when it will be required. The New Zealand Safe Staffing Unit is supporting New Zealand nurses to create a culture of shared governance, where nursing data is informing policies, staffing methodologies and forecasting within their organisations. Assisting organisations to understand their acuity data, strengthening user confidence in using electronic patient acuity systems, and ensuring nursing and midwifery workload is accurately reflected is critical to the success of the safe staffing programme. Nurses and midwives have the capacity via an acuity tool to become key informers of organisational planning. Quality patient care, best use of health resources and a quality work environment are essential components of a safe, resilient and well resourced organisation. Nurses are the key informers of this information. In New Zealand a national level approach is paving the way for significant changes to the understanding and use of patient acuity and nursing workload information.

Keywords: nursing workload, patient acuity, safe staffing, New Zealand

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Authors: Shonuga Olajumoke Adedoyinsola

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Staffing and Compensation are at the core of any employment exchange, and they serve as the defining characteristics of any employment relationship. Most organizations understand the benefits that a longer term approach to staff planning can bring and the answer to this problem lies not in trying to implement the traditional approach more effectively, but in implementing a completely different kind of process for strategic staffing. The study focuses on critical points of compensation, staffing and personnel management. The fundamentals of these programs include the elements of vision, potential, communication and motivation. The aim of the paper is to identify the most important attributes of compensation and incentives, staffing and personnel management. Research method is the analysis and synthesis of scientific literature, logical, comparative and graphic representation. On the basis of analysis, the author presents the models of these systems for positive employee attitudes and behaviors.

Keywords: compensation, employees, incentives, staffing, personnel management

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Authors: Ahmed Hamzi, Bryan Norman

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Having scribes help document patient records in electronic health record systems can improve hospitalists’ productivity. But hospitals need to determine the optimum number of scribes to hire to maximize scribe cost effectiveness. Scribe attendance uncertainty due to planned and unplanned absences is a primary challenge. This paper presents simulation and analytical models to determine the optimum number of scribes for a hospital to hire. Scribe staffing practices vary from one context to another; different staffing scenarios are considered where having extra attending scribes provides or does not provide additional value and utilizing on-call scribes to fill in for potentially absent scribes. These staffing scenarios are assessed for different scribe revenue ratios (ratio of the value of the scribe relative to scribe costs) ranging from 100% to 300%. The optimum solution depends on the absenteeism rate, revenue ratio, and desired service level. The analytical model obtains solutions easier and faster than the simulation model, but the simulation model is more accurate. Therefore, the analytical model’s solutions are compared with the simulation model’s solutions regarding both the number of scribes hired and cost-effectiveness. Additionally, an Excel tool has been developed to facilitate decision-makers in easily obtaining solutions using the analytical model.

Keywords: hospitalists, workload, optimization cost, economic analysis

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Authors: Maya Arlini Puspasari, Shafira Karamina Alifah, Hardianto Iridiastadi

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High mental workload can lead to fatigue and further result in decreased concentration and work performance. This study is conducted to see the effects of mental workload towards mental fatigue. Mental fatigue measurement was conducted at the first and the last 10 minutes of the working time using electroencephalogram, while mental workload measurement was conducted after the work is completed using the NASA-TLX questionnaire. The result shows that there is an increase in alpha band which indicates an increase in mental fatigue. This study also shows absolute alpha is more sensitive compared to the relative alpha. This study proves that there is a relationship between mental workload and mental fatigue although not relatively strong.

Keywords: mental workload, electroencephalogram, customer care agents, NASA-TLX

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Authors: Jessica Hemberg, Mikaela Miller

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Unreasonable workload and work-related stress can reduce nurse leaders’ job satisfaction and productivity and can increase absence and burnout. Nurse leaders’ workload in public healthcare settings is relatively unresearched. The aim of this study was to investigate nurse leaders’ perceptions of workload and task distribution with relation to leading work tasks in public healthcare. A qualitative explorative design was used. The data material consisted of texts from interviews with nurse leaders in public healthcare (N=8). The method was inspired by content analysis. The COREQ checklist was used. Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Six main themes were found: Increased and unreasonable workload, Length of work experience as nurse leader affects perception of workload, Number of staff and staff characteristics affect perception of workload, Versatile and flexible task distribution, Working overtime as a way of managing high workload, and Insufficient time for leadership mission. The workload for nurse leaders in a public healthcare setting was perceived to be unreasonable. Common measures for managing high workload included working overtime, delegating work tasks and organizing more staff resources in the form of additional staff. How nurse leaders perceive their workload was linked to both the number of staff and staff characteristics. These should both be considered equally important when determining staff levels and measuring nurse leaders’ workload. Future research should focus on investigating workload and task distribution from nurses’ perspectives.

Keywords: nurse leaders, workload, task distribution, public healthcare, qualitative

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Authors: Naveed Tahir, Adnan Maqsood

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Cognitive workload is a significant factor affecting user performance, and it has been broadly investigated for its application in ergonomics as well as in designing and optimizing effective human-machine interactions. It is mentally challenging to maneuver an aircraft, and pilots must control the aircraft and adequately communicate to the verbal-auditory stimuli. Several physiological measures have long been researched and used to demonstrate the cognitive workload. In our current study, we have summarized recent findings of the effectiveness, accuracy, and applicability of commonly used physiological measures in evaluating cognitive workload. We have also highlighted on the advancements in physiological measures. The strength and limitations of physiological measures have also been discussed to assess the cognitive workload of people, especially the aircrews in laboratory settings and real-time situations. We have presented the research findings of the physiological measures to base suggestions on the proper applications of the measures and settings demanding the use of single measure or their combinations.

Keywords: aircrew, cognitive workload, subjective measure, physiological measure, performance measure

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Authors: Ron Bishop, Jim Mitchell, Talitha Best

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The increase in air travel worldwide has resulted in a pilot shortage. To increase student pilot capacity and lower costs, flight schools have increased the use of recreational aircraft (RA) with technological advanced cockpits in flight schools. The impact of RA based training compared to general aviation (GA) aircraft training on student mental workload is not well understood. This research investigated student pilot (N = 17) awareness of mental workload between technologically advanced cockpit equipped RA training with analogue gauge equipped GA training. The results showed a significantly higher rating of mental workload across subscales of mental and physical demand on the NASA-TLX in recreational aviation aircraft training compared to GA aircraft. Similarly, thematic content analysis of follow-up questions identified that mental workload of the student pilots flying the RA was perceived to be more than the GA aircraft.

Keywords: mental workload, recreational aircraft, student pilot, training

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Authors: Peregrine James Dalziel, Philip Vu Tran

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Objective / Introduction: Demand for radiology services from Emergency Departments (ED) continues to increase with greater demands placed on radiology staff providing reports for the management of complex cases. Queuing theory indicates that wide variability of process time with the random nature of request arrival increases the probability of significant queues. This can lead to delays in the time-to-availability of radiology reports (TTA-RR) and potentially impaired ED patient flow. In addition, greater “cognitive workload” of greater volume may lead to reduced productivity and increased errors. We sought to quantify the potential ED flow improvements obtainable from increased radiology providers serving 3 public hospitals in Melbourne Australia. We sought to assess the potential productivity gains, quality improvement and the cost-effectiveness of increased labor inputs. Methods & Materials: The Western Health Medical Imaging Department moved from single resident coverage on weekend days 8:30 am-10:30 pm to a limited period of 2 resident coverage 1 pm-6 pm on both weekend days. The TTA-RR for weekend CT scans was calculated from the PACs database for the 8 month period symmetrically around the date of staffing change. A multivariate linear regression model was developed to isolate the improvement in TTA-RR, between the two 4-months periods. Daily and hourly scan volume at the time of each CT scan was calculated to assess the impact of varying department workload. To assess any improvement in report quality/errors a random sample of 200 studies was assessed to compare the average number of clinically significant over-read addendums to reports between the 2 periods. Cost-effectiveness was assessed by comparing the marginal cost of additional staffing against a conservative estimate of the economic benefit of improved ED patient throughput using the Australian national insurance rebate for private ED attendance as a revenue proxy. Results: The primary resident on call and the type of scan accounted for most of the explained variability in time to report availability (R2=0.29). Increasing daily volume and hourly volume was associated with increased TTA-RR (1.5m (p<0.01) and 4.8m (p<0.01) respectively per additional scan ordered within each time frame. Reports were available 25.9 minutes sooner on average in the 4 months post-implementation of double coverage (p<0.01) with additional 23.6 minutes improvement when 2 residents were on-site concomitantly (p<0.01). The aggregate average improvement in TTA-RR was 24.8 hours per weekend day This represents the increased decision-making time available to ED physicians and potential improvement in ED bed utilisation. 5% of reports from the intervention period contained clinically significant addendums vs 7% in the single resident period but this was not statistically significant (p=0.7). The marginal cost was less than the anticipated economic benefit based assuming a 50% capture of improved TTA-RR inpatient disposition and using the lowest available national insurance rebate as a proxy for economic benefit. Conclusion: TTA-RR improved significantly during the period of increased staff availability, both during the specific period of increased staffing and throughout the day. Increased labor utilisation is cost-effective compared with the potential improved productivity for ED cases requiring CT imaging.

Keywords: workflow, quality, administration, CT, staffing

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Authors: Wynne De Jong, Robert Miller, Ross Riggs

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Beyond the number of nurses providing care for patients, having nurses with the right skills, experience and education is essential to ensure the best possible outcomes for patients. Research studies continue to link nurse staffing and skill mix with nurse-sensitive patient outcomes; numerous studies clearly show that superior patient outcomes are associated with higher levels of regulated staff. Due to the limited number of tools and processes available to assist nurse leaders with staffing models of care, nurse leaders are constantly faced with the ongoing challenge to ensure their staffing models of care best suit their patient population. In 2009, several hospitals in Ontario, Canada participated in a research study to develop and evaluate an RN/RPN utilization toolkit. The purpose of this study was to develop and evaluate a toolkit for Registered Nurses/Registered Practical Nurses Staff mix decision-making based on the College of Nurses of Ontario, Canada practice standards for the utilization of RNs and RPNs. This paper will highlight how an organization has further developed the Patient Care Needs Assessment (PCNA) questionnaire, a major component of the toolkit. Moreover, it will demonstrate how it has utilized the information from PCNA to clearly identify patient and family care needs, thus providing evidence-based results to assist leaders with matching the best staffing skill mix to their patients.

Keywords: nurse staffing models of care, skill mix, nursing health human resources, patient safety

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Authors: Jennifer Loar, Jason Montefalcon, Kissy Mae Alimpangog, Miriam Bongo

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The demanding, professional roles that air traffic controllers (ATC) play in air transport operation provided the main motivation of this paper. As the controllers’ workload stress becomes more complex due to various stressors, the challenge to overcome these in the pursuit of improving the efficiency of controllers and safety level of aircrafts has been relevant. Therefore, in order to determine the main stressors and surface the best alternative, two widely-known multi-criteria decision-making (MCDM) methods, DANP and PROMETHEE II, are applied. The proposed method is demonstrated in a case study at Mactan Civil Aviation Authority of the Philippines (CAAP). The results showed that the main stressors are high air traffic volume, extraneous traffic, unforeseen events, limitations and reliability of equipment, noise/distracter, micro climate, bad posture, relations with supervisors and colleagues, private life conditions/relationships, and emotional conditions. In the outranking of alternatives, compartmentalization is believed to be the most preferred alternative to overcome controllers’ workload stress. This implies that compartmentalization can best be applied to reduce controller workload stress.

Keywords: air traffic controller, DANP, MCDM, PROMETHEE II, workload stress

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Authors: Pan Lee Ching, Chua Bee Seok

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The experience of negative work-life interaction often confronted with work related stress includes workload. The appraisal of challenge and hindrance jobs depend on the type of workload to stimulate stress response. Nevertheless, the effects of challenge and hindrance jobs on distress and negative work-life interaction are scarcely explored. Thus, research objective was to examine the relationship among challenge appraisal job (qualitative workload), hindrance appraisal job (quantitative workload), and negative work-life interaction with the mediating role of distress. A survey with random sampling method was performed on current serving public secondary school teachers in Sabah. Collected data showed 447 respondents completed three questionnaires, namely Challenge-hindrance Appraisal Scale, Stress Professional Positive and Negative Questionnaire, and Survey Work-home Interaction-Nijmegan. Partial Least Square-Structural Equation Modeling (PLS-SEM) was used to analyse mediation effect. Results showed distress fully mediates the relationship between challenge appraisal job (qualitative workload) and negative work-life interaction. The indirect effect was significant and negative. While distress partially mediates the relationship between hindrance appraisal job (quantitative workload) and negative work-life interaction. The indirect effect was significant and positive. The study implied that challenge appraisal job could be a positive resource for teacher to facilitate work and life, whereas hindrance appraisal job could disengage the facilitation. Hence, strengthen challenge appraisal job and control hindrance appraisal job could curb distress at work and underpin life interaction among the teachers.

Keywords: challenge-hindrance job, distress, work-life, workload

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Authors: Sarah Werner, Michael J. Pritchard

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From pilots to engineers, the skills development within the aerospace industry is exceptionally broad. Employers often struggle with finding the right mixture of qualified skills to fill their organizational demands. This effort to find qualified talent is further complicated by the industrial delineation between two key areas: aviation and aerospace. In a broad sense, the aerospace industry overlaps with the aviation industry. In turn, the aviation industry is a smaller sector segment within the context of the broader definition of the aerospace industry. Furthermore, it could be conceptually argued that -in practice- there is little distinction between these two sectors (i.e., aviation and aerospace). However, through our unstructured text analysis of over 6,000 job listings captured, our team found a clear delineation between aviation-related jobs and aerospace-related jobs. Using techniques in natural language processing, our research identifies an integrated workforce skill pattern that clearly breaks between these two sectors. While the aviation sector has largely maintained its need for pilots, mechanics, and associated support personnel, the staffing needs of the aerospace industry are being progressively driven by integrative engineering needs. Increasingly, this is leading many aerospace-based organizations towards the acquisition of 'system level' staffing requirements. This research helps to better align higher educational institutions with the current industrial staffing complexities within the broader aerospace sector.

Keywords: aerospace industry, job demand, text mining, workforce development

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Authors: Julien Romieux, Fabio Verdicchio

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Wireless Sensor Networks (WSNs), which sense environmental data with battery-powered nodes, require multi-hop communication. This power-demanding task adds an extra workload that is unfairly distributed across the network. As a result, nodes run out of battery at different times: this requires an impractical individual node maintenance scheme. Therefore we investigate a new Cooperative Sensing approach that extends the WSN operational life and allows a more practical network maintenance scheme (where all nodes deplete their batteries almost at the same time). We propose a novel cooperative algorithm that derives a piecewise representation of the sensed signal while controlling approximation accuracy. Simulations show that our algorithm increases WSN operational life and spreads communication workload evenly. Results convey a counterintuitive conclusion: distributing workload fairly amongst nodes may not decrease the network power consumption and yet extend the WSN operational life. This is achieved as our cooperative approach decreases the workload of the most burdened cluster in the network.

Keywords: cooperative signal processing, signal representation and approximation, power management, wireless sensor networks

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Authors: Abhinay Puvvala, Veerendra Kumar Rai

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A bottleneck situation arises when the outflow is lesser than the inflow in a pipe-like setup. A more practical interpretation of bottlenecks emphasizes on the realization of Service Level Objectives (SLOs) at given workloads. Our approach detects two key aspects of bottlenecks – when and where. To identify ‘when’ we continuously poll on certain key metrics such as resource utilization, processing time, request backlog and throughput at a system level. Further, when the slope of the expected sojourn time at a workload is greater than ‘K’ times the slope of expected sojourn time at the previous step of the workload while the workload is being gradually increased in discrete steps, a bottleneck situation arises. ‘K’ defines the threshold condition and is computed based on the system’s service level objectives. The second aspect of our approach is to identify the location of the bottleneck. In multi-tier systems with a complex network of layers, it is a challenging problem to locate bottleneck that affects the overall system performance. We stage the system by varying workload incrementally to draw a correlation between load increase and system performance to the point where Service Level Objectives are violated. During the staging process, multiple metrics are monitored at hardware and application levels. The correlations are drawn between metrics and the overall system performance. These correlations along with the Service Level Objectives are used to arrive at the threshold conditions for each of these metrics. Subsequently, the same method used to identify when a bottleneck occurs is used on metrics data with threshold conditions to locate bottlenecks.

Keywords: bottleneck, workload, service level objectives (SLOs), throughput, system performance

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Authors: Olga C. Rodrigue

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Long-term care and skilled nursing facilities experience ebbs and flows of nursing staffing, a problem compounded by the perception of the facilities as undesirable workplaces and competition for staff from other healthcare entities. Travel nurses are contracted to fill staffing needs due to increased admissions, increased and unexpected attrition of nurses, or facility expansion of services. Prior to beginning the contracted assignment, the travel nurse must meet industry, company, and regulatory requirements (The Joint Commission and CMS) for skills and knowledge. Travel nurses, however, inconsistently receive the pre-assignment orientation needed to work at the contracted facility, if any information is given at all. When performance expectations are not met, travel nurses may subsequently choose to leave the position without completing the terms of the contract, and some facilities may choose to terminate the contract prior to the expected end date. The overarching goal of the Doctor of Nursing Practice evidence-based practice improvement project is to provide travel nurses with the basic and necessary information to prepare them to begin a long-term and skilled nursing assignment. The project involves the identification of travel nurse learning needs through a survey and the development and provision of web-based learning modules to address those needs prior to arrival for a long-term and skilled nursing assignment.

Keywords: nurse staffing, travel nurse, travel staff, contract staff, contracted assignment, long-term care, skilled nursing, onboarding, orientation, staff development, supplemental staff

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Authors: Tamer E. Yared

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The use of driving simulators has made laboratory testing easier. It has been proven to be valid for testing driving ability by many researchers. One benefit of using driving simulators is keeping the human subjects away from traffic hazards, which drivers usually face in a real driving environment while performing a driving experiment. In this study, a driving simulator was developed with a navigation system using a game development software (Unity 3D) and C-sharp codes to measure and evaluate driving performance, safety, and workload for different driving tasks. The driving simulator hardware included a gaming steering wheel and pedals as well as a monitor to view the driving tasks. Moreover, driver distraction was evaluated by utilizing an eye-tracking system working in conjunction with the driving simulator. Twenty subjects were recruited to evaluate driver distraction, workload, driving safety, and performance, as well as provide their feedback about the driving simulator. The subjects’ feedback was obtained by filling a survey after conducting several driving tasks. The main question of that survey was asking the subjects to compare driving on the driving simulator with real driving. Furthermore, other aspects of the driving simulator were evaluated by the subjects in the survey. The survey revealed that the recruited subjects gave an average score of 7.5 out of 10 to the driving simulator when compared to real driving, where the scores ranged between 6 and 8.5. This study is a preliminary effort that opens the door for more improvements to the driving simulator in terms of hardware and software development, which will contribute significantly to driving ability testing.

Keywords: driver distraction, driving performance, driving safety, driving simulator, driving workload, navigation system

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Authors: Özlem Canbolat, Sevgisun Kapucu

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The aim of this study was to determine the effect of a computer-assisted glycemic surveillance protocol on nursing workload in intensive care unit. The study is completed in an Education and Research Hospital in Ankara with the attendance of volunteered 19 nurse who had been worked in reanimation unit. Nurses used the written protocol and computer-assisted glycemic surveillance protocol for glycemic follow-up approach of the intensive care patients. Nurses used the written protocol first in the glycemic follow-up of the patient, then used the computer-assisted protocol. (Nurses used the written protocol first, then the computer-assisted protocol in the glycemic follow-up of the patient). Less time was spent in glycemic control with computerized protocol than written protocol and this difference is statistically significant (p < 0.001). It was determined that the computerized protocol application was completed in about 10 seconds (25% shorter) than the written protocol implementation. The computer-assisted glycemic surveillance protocol was found to be more easy and appropriate by nurses and the satisfaction level of the users was higher than with written protocol. While 79% of the nurses find it confusing to implement the written protocol, 79% were satisfied with the use of computerized protocol.

Keywords: computer-assisted protocol, glycemic control, insulin infusion protocol, intensive care, nursing workload

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Authors: Christina Kirsch, Adam Hatzigiannis

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Rail operators and maintainers worldwide are increasingly replacing walking patrols in the rail corridor with mechanized track patrols -essentially data capture on trains- and on-screen reviews of track infrastructure in centralized review facilities. The benefit is that infrastructure workers are less exposed to the dangers of the rail corridor. The impact is a significant change in work design from walking track sections and direct observation in the real world to sedentary jobs in the review facility reviewing captured data on screens. Defects in rail infrastructure can have catastrophic consequences. Reviewer performance regarding accuracy and efficiency of reviews within the available time frame is essential to ensure safety and operational performance. Rail operators must optimize workload and resource loading to transition to on-screen reviews successfully. Therefore, they need to know what workload assessment methodologies will provide reliable and valid data to optimize resourcing for on-screen reviews. This paper compares objective workload measures, including track difficulty ratings and review distance covered per hour, and subjective workload assessments (NASA TLX) and analyses the link between workload and reviewer performance, including sensitivity, precision, and overall accuracy. An experimental study was completed with eight on-screen reviewers, including infrastructure workers and engineers, reviewing track sections with different levels of track difficulty over nine days. Each day the reviewers completed four 90-minute sessions of on-screen inspection of the track infrastructure. Data regarding the speed of review (km/ hour), detected defects, false negatives, and false positives were collected. Additionally, all reviewers completed a subjective workload assessment (NASA TLX) after each 90-minute session and a short employee engagement survey at the end of the study period that captured impacts on job satisfaction and motivation. The results showed that objective measures for tracking difficulty align with subjective mental demand, temporal demand, effort, and frustration in the NASA TLX. Interestingly, review speed correlated with subjective assessments of physical and temporal demand, but to mental demand. Subjective performance ratings correlated with all accuracy measures and review speed. The results showed that subjective NASA TLX workload assessments accurately reflect objective workload. The analysis of the impact of workload on performance showed that subjective mental demand correlated with high precision -accurately detected defects, not false positives. Conversely, high temporal demand was negatively correlated with sensitivity and the percentage of detected existing defects. Review speed was significantly correlated with false negatives. With an increase in review speed, accuracy declined. On the other hand, review speed correlated with subjective performance assessments. Reviewers thought their performance was higher when they reviewed the track sections faster, despite the decline in accuracy. The study results were used to optimize resourcing and ensure that reviewers had enough time to review the allocated track sections to improve defect detection rates in accordance with the efficiency-thoroughness trade-off. Overall, the study showed the importance of a multi-method approach to workload assessment and optimization, combining subjective workload assessments with objective workload and performance measures to ensure that recommendations for work system optimization are evidence-based and reliable.

Keywords: automation, efficiency-thoroughness trade-off, human factors, job design, NASA TLX, performance optimization, subjective workload assessment, workload analysis

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Authors: Chisom N. Nwaigwe, Blessing N. Egbulefu, Angela Uwakwem

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A study on Stress and its’ effect on the health of workers in Federal Medical Centres in Nigeria is presented. The aim is to evaluate how much stress related hazards health workers in our tertiary health institutions are exposed to and to create awareness and reduce the rate at which stress affect the health of the working population in Nigeria, using workers in Federal Medical Centre, Umuahia as a case study. The descriptive survey design was adopted with the aid of 100 questionnaires delivered to the respondents in order to obtain first-hand information. From the findings, the major causes of stress were identified as inadequate staffing, unresolved family problems and psychological/cultural factors like the return of a lactating mother to work after three months post-delivery. The effects of stress on the workers were identified as hypertension, poor job performances, depression, asthma, and peptic ulcers. The study recommended instituting counseling units for stress management, holding seminars on stress management and increasing the salary scale (remuneration) and proper roster planning as solutions to stress reduction in our hospitals. This study is important to management in planning staffing, roaster, and a rehabilitation programme for her staff.

Keywords: stress, causes, effects, workers

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Authors: S. Aneeka, S.M. Phyoe, R. Guo, Z.W. Zhong

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Arrival flights tend to spend long waiting times at holding stacks if the arrival airport is congested. However, the waiting time spent in the air in the vicinity of the arrival airport may be reduced if the delays are distributed to the cruising phase of the arrival flights by means of speed control. Here, a case study was conducted for the flights arriving at Changi Airport. The flights that were assigned holdings were simulated to fly at a reduced speed during the cruising phase. As the study involves a single airport and is limited to imposing speed constraints to arrivals within 200 NM from its location, the simulation setup in this study could be considered as an application of the Extended Arrival Management (E-AMAN) technique, which is proven to result in considerable fuel savings and more efficient management of delays. The objective of this experiment was to quantify the benefits of imposing cruise speed constraints to arrivals at Changi Airport and to assess the effects on controllers’ workload. The simulation results indicated considerable fuel savings, reduced aircraft emissions and reduced controller workload.

Keywords: aircraft emissions, air traffic flow management, controller workload, fuel consumption

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Authors: Al Asyary, Meita Veruswati, Dian Ayyubi

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Sukabumi municipal has highest rank for maternal mortality in Indonesia with 102 by 100,000 live birth with almost 80% of birth were not attended by skilled birth attendant (SBA). Although universal health coverage has been implemented, availability and sufficiency of SBA, such as midwife in this developing country, are problematic agenda for the quality of public healthcare as well as decreasing maternal mortality rate. This study aims to describe the equal distribution of midwives in Sukabumi municipal as support of government’s program named Millennium Development Goals (MDGs) that suppressed maternal mortality rate in Indonesia. We conducted an observational study with Workload Indicator of Staffing Need (WISN) analysis to present the dispersion of midwives by their activities and workloads in 37 Puskesmas. We also generated in-depth interview with several executive chief of health sections, including chief of health offices in Sukabumi municipal. It resulted inferentially that several activities in midwives’ program were differed at once of existing than needed condition ideally (ρ value = 0.002 < 0.05). Meanwhile, decision for midwives’ procurement and placement were held by un-systematically procedure such as based on where the midwife was staying, and it also progressed by neighborhood issue priorities. The absence of formal regulation in local government is a serious problem that indicated poor political commitment, while access to SBA shall be focused carefully.

Keywords: developing country, health professional resources, health policy, need assessment

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Authors: Melissa Dorsey

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Moral distress and compassion fatigue plague nurses in the Cardiothoracic Intensive Care Unit (CTICU) and cause an unnecessary level of turnover. Dueling Burnout describes an initiative that was implemented in the CTICU to reduce the level of burnout the nurses endure by encouraging dual roles with collaborating departments. Purpose: Critical care nurses are plagued by burnout, moral distress, and compassion fatigue due to the intensity of care provided. The purpose of the dual role program was to decrease these issues by providing relief from the intensity of the critical care environment while maintaining full-time employment. Relevance/Significance: Burnout, moral distress, and compassion fatigue are leading causes of Cardiothoracic Critical Care (CTCU) turnover. A contributing factor to burnout is the workload related to serving as a preceptor for a constant influx of new nurses (RN). As a result of these factors, the CTICU averages 17% nursing turnover/year. The cost, unit disruption, and, most importantly, distress of the clinical nurses required an innovative approach to create an improved work environment and experience. Strategies/Implementation/Methods: In May 2018, a dual role pilot was initiated for nurses. The dual role constitutes .6 full-time equivalent hours (FTE) worked in CTICU in combination with .3 FTE worked in the Emergency Department (ED). ED nurses who expressed an interest in cross-training to CTICU were also offered the dual role opportunity. The initial hypothesis was that full-time employees would benefit from a change in clinical setting leading to increased engagement and job satisfaction. The dual role also presents an opportunity for professional development through the expansion of clinical skills in another specialty. Success of the pilot led to extending the dual role to areas beyond the ED. Evaluation/Outcomes/Results: The number of dual role clinical nurses has grown to 22. From the dual role cohort, only one has transferred out of CTICU. This is a 5% turnover rate for this group of nurses as compared to the average turnover rate of 17%. A role satisfaction survey conducted with the dual role cohort found that because of working in a dual role, 76.5% decreased their intent to leave, 100% decreased their level of burnout, and 100% reported an increase in overall job satisfaction. Nurses reported the ability to develop skills that are transferable between departments. Respondents emphasized the appreciation gained from working in multiple environments; the dual role served to transform their care. Conclusions/Implications: Dual role is an effective strategy to retain experienced nurses, decrease burnout and turnover, improve collaboration, and provide flexibility to meet staffing needs. The dual role offers RNs an expansion of skills, relief from high acuity and orientee demands, while improving job satisfaction.

Keywords: nursing retention, burnout, pandemic, strategic staffing, leadership

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Authors: Hsien Hwa Kuo, Lin Wen Chun, Lin Wen Chun, Hsien Wen Kuo

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Objective: Nurses represent an important occupational group frequently affected by wrist musculoskeletal disorders (WMSDs) due to a heavy workload, working shifts, poor posture, giving shots, making beds, lifting patients, bending their waist and insufficient rest time every day. However, lack of research reported nurses whether workload in household correlated with the severity of WMSDs. Methods: 550 nurses from a hospital in Taoyuan were interviewed using a modified standardized Nordic Musculoskeletal (NMQ) questionnaire including the demographic information, workplace condition and nine body parts of musculoskeletal disorders. Results: 17.9% and 23.9% of severity and symptoms in WMSDs among nurses with children were significant higher than among nurses without children (1​2.4% and 15.9%). Based on multiple logistic regression models adjusted for age, work duration, job title and body mass index (BMI), we found that heavy workload in hospital had higher odds ratio (OR) of the severity and symptoms of WMSD among nurses with children (OR= 8.67 and OR= 4.30, p<0.05) compared to nurses without children (OR= 1.94 and OR= 1.70). Conclusion: The severity and symptoms of WMSDs among nurses significantly correlated with workload in hospital among nurses with children. If women are at greater risk because of the combination of their work and family demands, synergistic effect of WMSDs was found among nurses. Comment: Women's domestic work, especially once they become mothers, they invest more time and energy caring for children, helping others, and doing housework. Thus domestic work, per se, may be a risk factor for wrist musculoskeletal problems, and, more importantly, it may constrain women's ability to protect themselves from the effects of their paid work. If nurses with more domestic work periodically make efforts to physical activity or modify inappropriate posture, their WMSDs symptoms will be alleviated.

Keywords: musculoskeletal disorders, nurse, NMQ, WMSDs

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Authors: Euan Donley

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Emergency Departments (EDs) are heavily burdened as presentation rates continue to rise. To improve patient flow National Emergency Access Targets (NEAT) were introduced. NEAT implements timelines for ED presentations, such as discharging patients within four hours of arrival. Mental health patients use EDs more than the general population and are generally more complex in their presentations. The aim of this study is to examine the impact of NEAT on psychiatric risk assessment of mental health patients in the ED. Seventy-eight mental health clinicians from 7 Victoria, Australia, hospital EDs participated in a mixed method analysis via anonymous online survey. NEAT was considered helpful as mental health patients were seen quicker, were less likely to abscond, could improve teamwork amongst ED staff, and in some cases administrative processes were better streamlined. However, clinicians felt that NEAT was also responsible for less time with patients and relatives’, resulted in rushed assessments, placed undue pressure on mental health clinicians, was not conducive to training, and the emphasis on time was the wrong focus for patient treatment. The profile of a patient typically likely to be treated within NEAT timelines showed a perfect storm of luck and compliance. If a patient was sober, medically stable, referred early, did not require much collateral information and did not have distressed relatives, NEAT was more likely to be met. Organisationally participants reported no organisational change or training to meet NEAT. Poor mental health staffing, multiple ED presentations and a shortage of mental health beds also hamper meeting NEAT. Findings suggest participants were supportive of NEAT in principle, but a demanding workload and organisational barriers meant NEAT had an overall negative effect on psychiatric risk assessment of mental health patients in ED.

Keywords: assessment, emergency, risk, psychiatric

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Authors: Mansir Abubakar, Hazlina Hamdan, Norwati Mustapha, Teh Noranis Mohd Aris

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In order to build a matching pattern for each class correspondences of ontology, it is required to specify a set of attribute correspondences across two corresponding classes by clustering. Clustering reduces the size of potential attribute correspondences considered in the matching activity, which will significantly reduce the computation workload; otherwise, all attributes of a class should be compared with all attributes of the corresponding class. Most existing ontology matching approaches lack scalable attributes discovery methods, such as cluster-based attribute searching. This problem makes ontology matching activity computationally expensive. It is therefore vital in ontology matching to design a scalable element or attribute correspondence discovery method that would reduce the size of potential elements correspondences during mapping thereby reduce the computational workload in a matching process as a whole. The objective of this work is 1) to design a clustering method for discovering similar attributes correspondences and relationships between ontologies, 2) to discover element correspondences by classifying elements of each class based on element’s value features using K-medoids clustering technique. Discovering attribute correspondence is highly required for comparing instances when matching two ontologies. During the matching process, any two instances across two different data sets should be compared to their attribute values, so that they can be regarded to be the same or not. Intuitively, any two instances that come from classes across which there is a class correspondence are likely to be identical to each other. Besides, any two instances that hold more similar attribute values are more likely to be matched than the ones with less similar attribute values. Most of the time, similar attribute values exist in the two instances across which there is an attribute correspondence. This work will present how to classify attributes of each class with K-medoids clustering, then, clustered groups to be mapped by their statistical value features. We will also show how to map attributes of a clustered group to attributes of the mapped clustered group, generating a set of potential attribute correspondences that would be applied to generate a matching pattern. The K-medoids clustering phase would largely reduce the number of attribute pairs that are not corresponding for comparing instances as only the coverage probability of attributes pairs that reaches 100% and attributes above the specified threshold can be considered as potential attributes for a matching. Using clustering will reduce the size of potential elements correspondences to be considered during mapping activity, which will in turn reduce the computational workload significantly. Otherwise, all element of the class in source ontology have to be compared with all elements of the corresponding classes in target ontology. K-medoids can ably cluster attributes of each class, so that a proportion of attribute pairs that are not corresponding would not be considered when constructing the matching pattern.

Keywords: attribute correspondence, clustering, computational workload, k-medoids clustering, ontology matching

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Authors: Jae Young Park, Hwansu Jung, Jong Tae Kim

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Whether the data has been well parallelized is an important factor in the Solid-State-Drive (SSD) performance. SSD parallelization is affected by allocation scheme and it is directly connected to SSD performance. There are dynamic allocation and static allocation in representative allocation schemes. Dynamic allocation is more adaptive in exploiting write operation parallelism, while static allocation is better in read operation parallelism. Therefore, it is hard to select the appropriate allocation scheme when the workload is mixed read and write operations. We simulated conditions on a few mixed data patterns and analyzed the results to help the right choice for better performance. As the results, if data arrival interval is long enough prior operations to be finished and continuous read intensive data environment static allocation is more suitable. Dynamic allocation performs the best on write performance and random data patterns.

Keywords: dynamic allocation, NAND flash based SSD, SSD parallelism, static allocation

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Authors: Damien Mouratille, Antonio R. Hidalgo-Muñoz, Nadine Matton, Yves Rouillard, Mickael Causse, Radouane El Yagoubi

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Background: The monitoring of the physiological activity related to mental workload (MW) on pilots will be useful to improve aviation safety by anticipating human performance degradation. The electrocardiogram (ECG) can reveal MW fluctuations due to either cognitive workload or/and emotional state since this measure exhibits autonomic nervous system modulations. Arguably, heart rate (HR) is one of its most intuitive and reliable parameters. It would be particularly interesting to analyze the interaction between cognitive requirements and emotion in ecologic sets such as a flight simulator. This study aims to explore by means of HR the relation between cognitive demands and emotional activation. Presumably, the effects of cognition and emotion overloads are not necessarily cumulative. Methodology: Eight healthy volunteers in possession of the Private Pilot License were recruited (male; 20.8±3.2 years). ECG signal was recorded along the whole experiment by placing two electrodes on the clavicle and left pectoral of the participants. The HR was computed within 4 minutes segments. NASA-TLX and Big Five inventories were used to assess subjective workload and to consider the influence of individual personality differences. The experiment consisted in completing two dual-tasks of approximately 30 minutes of duration into a flight simulator AL50. Each dual-task required the simultaneous accomplishment of both a pre-established flight plan and an additional task based on target stimulus discrimination inserted between Air Traffic Control instructions. This secondary task allowed us to vary the cognitive workload from low (LC) to high (HC) levels, by combining auditory and visual numerical stimuli to respond to meeting specific criteria. Regarding emotional condition, the two dual-tasks were designed to assure analogous difficulty in terms of solicited cognitive demands. The former was realized by the pilot alone, i.e. Low Arousal (LA) condition. In contrast, the latter generates a high arousal (HA), since the pilot was supervised by two evaluators, filmed and involved into a mock competition with the rest of the participants. Results: Performance for the secondary task showed significant faster reaction times (RT) for HA compared to LA condition (p=.003). Moreover, faster RT was found for LC compared to HC (p < .001) condition. No interaction was found. Concerning HR measure, despite the lack of main effects an interaction between emotion and cognition is evidenced (p=.028). Post hoc analysis showed smaller HR for HA compared to LA condition only for LC (p=.049). Conclusion. The control of an aircraft is a very complex task including strong cognitive demands and depends on the emotional state of pilots. According to the behavioral data, the experimental set has permitted to generate satisfactorily different emotional and cognitive levels. As suggested by the interaction found in HR measure, these two factors do not seem to have a cumulative impact on the sympathetic nervous system. Apparently, low cognitive workload makes pilots more sensitive to emotional variations. These results hint the independency between data processing and emotional regulation. Further physiological data are necessary to confirm and disentangle this relation. This procedure may be useful for monitoring objectively pilot’s mental workload.

Keywords: cognitive demands, emotion, flight simulator, heart rate, mental workload

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Authors: Renata Hrecska

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This research seeks to fully examine the internal employment law of international organizations by comparing it with the characteristics of the national civil service. The aim of the research is to compare the legal system that has developed over many centuries and the relatively new internal staffing regulations to find out what solution schemes can help each other through mutual legal development in order to respond effectively to the social challenges of everyday life. Generally, the rules of civil service of any country or international entity have in common that they have, in their pragmatics inherently, the characteristic that makes them serving public interests. Though behind the common base there are many differences: there is the clear fragmentation of state regulation and the unity of organizational regulation. On the other hand, however, this difference disappears to some extent: the public service regulation of international organizations can be considered uniform until we examine it within, but not outside an organization. As soon as we compare the different organizations we may find many different solutions for staffing regulations. It is clear that the national civil service is a strong model for international organizations, but the question may be whether the staffing policy of international organizations can serve the national civil service as an example, too. In this respect, the easiest way to imagine a legislative environment would be to have a single comprehensive code, the general part of which is the Civil Service Act itself, and the specific part containing specific, necessarily differentiating rules for each layer of the civil service. Would it be advantageous to follow the footsteps of the leading international organizations, or is there any speciality in national level civil service that we cannot avoid during regulating processes? In addition to the above, the personal competencies of officials working in international organizations and public administrations also show a high degree of similarity, regardless of the type of employment. Thus, the whole public service system is characterized by the fundamental and special values that a person capable of holding a public office must be able to demonstrate, in some cases, even without special qualifications. It is also interesting how we can compare the two spheres of employment in light of the theory of Lawyer Louis Brandeis, a judge at the US Supreme Court, who formulated a complex theory of profession as distinguished from other occupations. From this point of view we can examine the continuous development of research and specialized knowledge at work; the community recognition and social status; that to what extent we can see a close-knit professional organization of altruistic philosophy; that how stability grows in the working conditions due to the stability of the profession; and that how the autonomy of the profession can prevail.

Keywords: civil service, comparative law, international organizations, regulatory systems

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Authors: Hsien Hua Kuo, Wen Chun Lin, Chia Chi Hsu, Hsien Wen Kuo

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Objective: Despite the high prevalence of musculoskeletal disorders (MSDs) among nurses, which has been consistently observed in the studies of Western countries, very little information regarding intensity of workload and work-related quality of life (WRQOL) related to MSDs among nurses is available in Taiwan. The objective of this study is to investigate the factors affecting musculoskeletal disorders in nurses from a hospital. Methods: 550 nurses from a hospital in Taoyuan were interviewed using a modified standardized Nordic Musculoskeletal (NMQ) questionnaire which contained the demographic information, workplace condition and musculoskeletal disorders. Results: Response rate of nurses were 92.5% from a teaching hospital. Based on medical diagnosis by physician, neck of musculoskeletal disorders had the highest percentage in nine body portions. The higher percentage of musculoskeletal disorders in nurses found from wards of internal and surgery. Severity and symptoms of musculoskeletal disorders diagnosed by self-reported questionnaire significantly correlated with WRQOL, job satisfaction and intensity of workload among nurses based on the logistic regression model. Conclusion: The severity and symptoms of musculoskeletal disorders among nurses showed a dose-dependent with WRQOL and workload. When work characteristics in hospital were modified, the severity of musculoskeletal disorders among nurses will be decreased and alleviated. Comment: Multifaceted ergonomic intervention programme to reduce the prevalence of MSDs among nurses was by encouraging nurses to do more physical activity which will make them more flexible and increase their strength. Therefore, the head nurse should encourage nurses to regularly physical activity and to modify unfitting ergonomic environment in order to reduce the prevalence of MSDs.

Keywords: musculoskeletal disorders, nurse, WRQOL, job satisfaction

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