“It's not just about the numbers”: Inside the black box of nurses' professional judgement in nurse staffing systems in England and Wales: Insights from a qualitative cross-case comparative study

• DOI: 10.1016/j.ijnurstu.2023.104586
• Publication Date: 2023-08-11T01:21:57Z
• Authors: Davina Allen; Nina Jacob; Heather Strange; Aled Jones; Chris Burton; Anne Marie Rafferty
• Keywords: Judgement; Staffing

Whether implicit or explicit, professional judgement is a central component of the many nurse staffing systems implemented in high-income countries to inform workforce planning and staff deployment. Whilst substantial body research has evaluated technical operational elements systems, no studies have systematically examined role its contribution decision-making.To explore nurses' use England Wales.A cross-case comparative design centred on adult in-patient services three University Health Boards Wales National Service Trusts England. Data generation was undertaken between January 2021 March 2023 through stakeholder interviews, observations meetings, analysis documents artefacts. Observations were clinical areas but limited cases by COVID-19 restrictions. Analysis informed translational mobilisation theory.Two kinds deployed systems: nurses senior managers. The highlighted reflexive relationship data, circumstances which organisations placed trust people when they numbers. Nurses' interpretation contextualisation. Healthcare relied judgements managers making decisions mitigate risk, where real-world understanding status organisation privileged over formal data. Professional had attenuated authority for purposes planning, data master actor. Nurses expressed concerns that strategic decision-making prioritised safety efficiency, measurement did not capture important aspects care quality wellbeing, made it difficult articulate their judgement.The implementation resource intensive. Given evidence recommend any specific methodology, priority future optimise existing systems. If are deploy proactively influence conditions care, as well responding challenges risk mitigation, there need robust nursing aligned with agreed standards vocabulary these can be articulated.Health depend decisions, planning.