Nurse staffing and workload drivers in small rural hospitals: An imperative for evidence

Document Type

Journal Article


Binghamton University – Decker School of Nursing


School of Nursing and Midwifery




Originally published as: Twigg, D. E., Cramer, J. H., & Pugh, J. D. (2016). Nurse staffing and workload drivers in small rural hospitals: An imperative for evidence. Online Journal of Rural Nursing and Health Care, 16(1), 97-121. Original article available here


Purpose: The aim of this study was to explore staffing issues and the workload drivers influencing nursing activities in designated small rural hospitals of Western Australia. A problem for small rural hospitals is an imbalance between nurse staffing resources and work activity. Sample: A purposive sample of 17 nurse leaders employed at designated small rural hospitals in Western Australia. Method: A qualitative research design was used. Data were collected by focus group and semi-structured interviews and review of Western Australian Country Health Service records. Thematic analysis was used to interpret data. Findings: A minimum nurse staffing model is in use. Staff workload is generated from multiple activities involving 24-hour emergency services, inpatient care, and other duties associated with a lack of clinical and administrative services. These factors together impact on nursing staff resources and the skill mix required to ensure the safety and quality of patient care. Conclusion: Nurse staffing for small rural hospitals needs site-specific recording techniques for workload measurement, staff utilisation and patient outcomes. It is imperative that evidence guide nurse staffing decisions and that the workload driving nursing activity is reviewed.