Rethinking Nursing Productivity

A Review of the Literature and Interviews With Thought Leaders

Joanne Disch, PhD, RN, FAAN; Nanne Finis, MS, RN


Nurs Econ. 2022;40(2):59-71. 

In This Article

Abstract and Introduction


Nursing productivity has been inadequately operationalized as the cost of producing nursing care. A literature review of nursing productivity and results from interviews of healthcare executives and thought leaders regarding challenges and recommendations for optimizing nursing productivity are presented. Key themes are identified.


For decades, nursing productivity has been operationalized simplistically in essentially quantifiable metrics, such as nursing hours/patient day (NHPPD), midnight census, number of patients/nurse or, in one early study, number of orders written by physicians/day for nurses to carry out (Artinian et al., 1984). NHPPD became a standard unit of measure during the 1980s and continues to be used today in many hospitals to match staffing levels with inpatient census. Historically, nurses have been viewed as labor costs, emphasizing quantifying nurses' work in hours or dollars spent. The goal of hospital leaders has been to increase efficiency by decreasing resources used (e.g., hours, salary dollars) to care for a given number of patients or increase nurses' ability to accomplish more with the same number of resources.

Hospital leaders eventually acknowledged (although nurses had known this for some time) patients are extraordinarily diverse and present with unique symptoms, needs, and issues. Thus, number of patients cared for is only a proxy for the actual work required by the nurse. The concept of workload needed to incorporate patient acuity and intensity of workload (extent of nursing work necessary for a particular patient) (Upenieks et al., 2021). This concept reflects the reality some patients are not acutely ill but still require a significant amount of nursing time, such as through complex treatments, emotional support, or education.