Reliability of the nursing care hour measure: a descriptive study.

Background: The nursing care hour has become an international standard unit of measure in research where nurse staffing is a key variable. Until now, there have been no studies verifying whether nursing care hours obtained from hospital data sources can be collected reliably.

Objectives: To examine the processes used by hospitals to generate nursing care hour data and to evaluate inter-rater reliability and guideline compliance with standards of the National Database of Nursing Quality Indicators(®) (NDNQI(®)) and the National Quality Forum.

Design And Setting: Two-phase descriptive study of all NDNQI hospitals that submitted data in third quarter of 2007.

Methods: Data for phase I came from an online survey created by the authors to ascertain the processes used by hospitals to collect nursing care hours and their compliance with standardized data collection guidelines. In phase II, inter-rater reliability was measured using intra-class correlations between nursing care hours generated from clock hour files submitted to the study team by participants' payroll/accounting departments and aggregated data submitted previously.

Results: Phase I data were obtained from a total of 714 respondents. Nearly half (48%) of all sites use payroll records to obtain nursing care hour data and 70% use one of the standardized methods for converting the bi-weekly hours into months. Unit secretaries were reportedly included in NCH by 17.4% of respondents and only 26.2% of sites could accurately identify the point at which newly hired nurses should be included. The phase II findings (n=11) support the ability of two independent raters to obtain similar results when calculating total nursing care hours according to standard guidelines (ICC=0.76-0.99).

Conclusions: Although barriers exist, this study found support for hospitals' abilities to collect reliable nursing care hour data.