Nurse Staffing and Workload Drivers in Small Rural Hospitals: An imperative for Evidence


  • Diane E Twigg Edith Cowan University
  • Jennifer H Cramer Edith Cowan University
  • Judith D Pugh Edith Cowan University Murdoch University



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. 

Keywords: rural health nursing; nursing staff; skill mix; workload; workload measurement; hospitals, rural; rural health services


Author Biographies

Diane E Twigg, Edith Cowan University

School of Nursing and Midwifery

Professor of Nursing
Head of School

Jennifer H Cramer, Edith Cowan University

School of Nursing and Midwifery

Centre for Nursing, Midwifery and Health Services Research

Senior Research Assistant

Judith D Pugh, Edith Cowan University Murdoch University

School of Nursing and Midwifery

Adjunct Senior Lecturer

School of Health Professions 

Senior Research Fellow