Accuracy in workload measurement: a fact or fallacy?

As the drive within a market-led National Health Service is towards cost-efficiency and through-put, nurses are now more than ever having to 'prove their worth'. This has led to various workload measurement systems being used throughout nursing. Before examining the accuracy of these measurement tools this paper attempts to define workload and investigates how measurement is limited by an unclear definition of what 'nursing' actually is. There is little argument as to some of the beneficial effects of monitoring workload where changes in practice, rostering, skill mix and establishments have occurred. It is, however, necessary to examine the accuracy of workload measurement within the current framework of nursing to see if it is the promised panacea. The issues surrounding patient dependency and professional judgement are discussed and the seeming unacceptability of such 'soft data' to non-nursing personnel. Both the 'bottom-up' and 'top-down' approaches of workload measurement are explored within the context of equity, neutrality and bias. The conclusion is drawn that accuracy in nursing workload measurement is not possible in the current economic climate and that a compromise solution that uses patient dependency as an assessment tool is the best that can be hoped for without limiting nursing to inflexible and restrictive practices.