Building a nursing productivity measure based on the synergy model: first steps

The Synergy Model describes nurses' work on the basis of the individual needs of patients and their families. To generate data necessary to develop a nursing productivity system by using the Synergy Model as a conceptual framework. Nurses from 3 different intensive care units participated. In phase 1, charge nurses in focus groups described patient and family indicators considered when making nurse-patient assignments. In phase 2, charge nurse data were used to construct a survey for experienced staff nurses, asking them to link the indicators to 3 levels of nursing workload. Thirty charge nurses considered all 8 patient dimensions of the Synergy Model when making nurse-patient assignments. Thirty-two experienced staff nurses completed 79 surveys ranking patients' stability as the most important dimension in patient care followed by complexity and predictability. Respondents linked a common set of unique indicators to each of the patient dimensions of the Synergy Model: fluctuation in vital signs was linked to stability; number and severity of diagnoses, to complexity; trajectory of illness, to predictability; lack of reserve, to resiliency; invasiveness of procedures, to vulnerability; family educational level and participation style, to family participation in decision making/care; and home environment, to resources. Sets of indicators were common across units and clustered around level of workload. The Synergy Model shows promise as a conceptual framework for a nursing productivity system. Using a model that centers nursing work on patients' needs may better capture what nurses do and enhance our capacity to quantify nursing resource allocation.