Abstract：
BACKGROUND: 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 a substantial body of research has evaluated the technical and operational elements of nurse staffing systems, no studies have systematically examined the role of professional judgement and its contribution to decision-making.
OBJECTIVE: To explore nurses\' use of professional judgement in nurse staffing systems in England and Wales.
METHODS: A cross-case comparative design centred on adult in-patient services in three University Health Boards in Wales and three National Health Service Trusts in England. Data generation was undertaken between January 2021 and March 2023 through stakeholder interviews, observations of staffing meetings, and analysis of documents and artefacts. Observations were undertaken in clinical areas but limited to three cases by COVID-19 restrictions. Analysis was informed by translational mobilisation theory.
RESULTS: Two kinds of professional judgement were deployed in the nurse staffing systems: the judgement of clinical nurses and the judgement of senior nurse managers. The research highlighted the reflexive relationship between professional judgement and data, and the circumstances in which organisations placed trust in people and when they placed trust in numbers. Nurses\' professional judgement was central to the generation of data, its interpretation and contextualisation. Healthcare organisations relied on the professional judgements of clinical nurses and senior nurse managers in making operational decisions to mitigate risk, where real-world understanding of the status of the organisation was privileged over formal data. Professional judgement had attenuated authority for the purposes of workforce planning, where data was a master actor. Nurses expressed concerns that strategic decision-making prioritised safety and efficiency, and formal measurement systems did not capture important aspects of care quality or staff wellbeing, which made it difficult to articulate their professional judgement.
CONCLUSIONS: The implementation of staffing systems is resource intensive. Given limited evidence on which to recommend any specific methodology, the priority for future research is to optimise existing systems. If nurses are to deploy their professional judgement to proactively influence the conditions for care, as well as responding to the challenges of risk mitigation, there is a need for robust systems of nursing measurement aligned with agreed standards of care and a vocabulary through which these judgements can be articulated.
CONCLUSIONS: Health systems depend on nurses\' professional judgement for operational staffing decisions, but data is privileged over professional judgement for workforce planning.
OBJECTIVE: To explore nurses\' use of professional judgement in nurse staffing systems in England and Wales.
METHODS: A cross-case comparative design centred on adult in-patient services in three University Health Boards in Wales and three National Health Service Trusts in England. Data generation was undertaken between January 2021 and March 2023 through stakeholder interviews, observations of staffing meetings, and analysis of documents and artefacts. Observations were undertaken in clinical areas but limited to three cases by COVID-19 restrictions. Analysis was informed by translational mobilisation theory.
RESULTS: Two kinds of professional judgement were deployed in the nurse staffing systems: the judgement of clinical nurses and the judgement of senior nurse managers. The research highlighted the reflexive relationship between professional judgement and data, and the circumstances in which organisations placed trust in people and when they placed trust in numbers. Nurses\' professional judgement was central to the generation of data, its interpretation and contextualisation. Healthcare organisations relied on the professional judgements of clinical nurses and senior nurse managers in making operational decisions to mitigate risk, where real-world understanding of the status of the organisation was privileged over formal data. Professional judgement had attenuated authority for the purposes of workforce planning, where data was a master actor. Nurses expressed concerns that strategic decision-making prioritised safety and efficiency, and formal measurement systems did not capture important aspects of care quality or staff wellbeing, which made it difficult to articulate their professional judgement.
CONCLUSIONS: The implementation of staffing systems is resource intensive. Given limited evidence on which to recommend any specific methodology, the priority for future research is to optimise existing systems. If nurses are to deploy their professional judgement to proactively influence the conditions for care, as well as responding to the challenges of risk mitigation, there is a need for robust systems of nursing measurement aligned with agreed standards of care and a vocabulary through which these judgements can be articulated.
CONCLUSIONS: Health systems depend on nurses\' professional judgement for operational staffing decisions, but data is privileged over professional judgement for workforce planning.
摘要：
背景：无论是隐式还是显式，专业判断是高收入国家实施的许多护士人员配备系统的核心组成部分，用于为员工队伍规划和员工部署提供信息。虽然大量研究已经评估了护士人员配备系统的技术和操作要素，没有研究系统地研究了专业判断的作用及其对决策的贡献。
目的：探讨在英格兰和威尔士的护士配置系统中护士职业判断的运用。
方法：跨病例比较设计集中于威尔士的三个大学健康委员会和英格兰的三个国家健康服务信托基金的成人住院服务。数据生成是在2021年1月至2023年3月之间通过利益相关者访谈进行的，人员配置会议的意见，以及文件和文物的分析。观察是在临床领域进行的，但根据COVID-19的限制，仅限于3例。分析是由翻译动员理论提供的。
结果：在护士配置系统中部署了两种职业判断：临床护士的判断和高级护士管理者的判断。研究强调了专业判断与数据之间的反身关系，以及组织对人的信任以及对人数的信任的情况。护士的专业判断是数据生成的核心，它的解释和语境化。医疗机构依靠临床护士和高级护士经理的专业判断来做出降低风险的运营决策。在现实世界中，对组织地位的理解优先于正式数据。专业判断削弱了劳动力规划的权威，数据是一个主要的演员。护士表示担心战略决策优先考虑安全和效率，正式的测量系统没有捕捉到护理质量或员工福祉的重要方面，这使得很难表达他们的专业判断。
结论：人员配置系统的实施是资源密集型的。鉴于推荐任何具体方法的证据有限，未来研究的重点是优化现有系统。如果护士要运用他们的专业判断来主动影响护理条件，以及应对风险缓解的挑战，需要与商定的护理标准和词汇相一致的稳健的护理测量系统，通过该词汇可以阐明这些判断。
结论：卫生系统依赖于护士的专业判断来决定运营人员配置，但是对于劳动力规划，数据优先于专业判断。
目的：探讨在英格兰和威尔士的护士配置系统中护士职业判断的运用。
方法：跨病例比较设计集中于威尔士的三个大学健康委员会和英格兰的三个国家健康服务信托基金的成人住院服务。数据生成是在2021年1月至2023年3月之间通过利益相关者访谈进行的，人员配置会议的意见，以及文件和文物的分析。观察是在临床领域进行的，但根据COVID-19的限制，仅限于3例。分析是由翻译动员理论提供的。
结果：在护士配置系统中部署了两种职业判断：临床护士的判断和高级护士管理者的判断。研究强调了专业判断与数据之间的反身关系，以及组织对人的信任以及对人数的信任的情况。护士的专业判断是数据生成的核心，它的解释和语境化。医疗机构依靠临床护士和高级护士经理的专业判断来做出降低风险的运营决策。在现实世界中，对组织地位的理解优先于正式数据。专业判断削弱了劳动力规划的权威，数据是一个主要的演员。护士表示担心战略决策优先考虑安全和效率，正式的测量系统没有捕捉到护理质量或员工福祉的重要方面，这使得很难表达他们的专业判断。
结论：人员配置系统的实施是资源密集型的。鉴于推荐任何具体方法的证据有限，未来研究的重点是优化现有系统。如果护士要运用他们的专业判断来主动影响护理条件，以及应对风险缓解的挑战，需要与商定的护理标准和词汇相一致的稳健的护理测量系统，通过该词汇可以阐明这些判断。
结论：卫生系统依赖于护士的专业判断来决定运营人员配置，但是对于劳动力规划，数据优先于专业判断。
