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Nursing Research and Practice
Volume 2014 (2014), Article ID 167674, 9 pages
Research Article

Nurses’ Experiences of Nonpatient Factors That Affect Nursing Workload: A Study of the PAONCIL Instrument’s Nonpatient Factors

1Nursing Science, Faculty of Health Sciences, Buskerud and Vestfold University College, Papirbredden, Grønland 58, 3045 Drammen, Norway
2Åbo Akademi University, Vaasa, Finland
3Department of Musculoskeletal Diseases, Turku University Hospital, Turku, Finland

Received 27 January 2014; Revised 8 April 2014; Accepted 19 May 2014; Published 18 June 2014

Academic Editor: Maria H. F. Grypdonck

Copyright © 2014 Lisbeth Fagerström and Paula Vainikainen. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In the RAFAELA patient classification system, the professional assessment of optimal nursing care intensity level (PAONCIL) instrument is used to assess the optimal nursing intensity level per unit. The PAONCIL instrument contains an overall assessment of the actual nursing intensity level and an additional list of central nonpatient factors that may increase or decrease the total nursing workload (NWL). The aim of this cross-sectional study was to assess and determine which nonpatient factors affect nurses’ experiences of their total NWL in both outpatient settings and hospitals, as captured through the PAONCIL instrument. The data material consisted of PAONCIL questionnaires from 38 units and 37 outpatient clinics at 11 strategically selected hospitals in Finland, and included nurses’ answers to the question of which factors, other than nursing intensity, affect total NWL. The methods for data analyses were qualitative content analyses. The nonpatient factors that affected nurses’ experiences of total NWL are “organization of work,” “working conditions,” “self-control,” and “cooperation.” The actual list of nonpatient factors in the PAONCIL instrument is to a reasonable extent relevant, but the list should be improved to include nurses’ actual working conditions and self-control.