To explore the status quo of workload in primary nurses at different levels and to provide a basis for hierarchical management over nursing staff.

Totally 45 wards of a Class Ⅲ Grade A hospital in Yantai City were selected by cluster sampling from February 20th to March 19th, 2017, including 23 from internal medicine departments and 22 from surgery departments. Nursing workers were divided into 5 levels ranging from N0 to N4 according to hierarchical management protocols. The self-designed workload questionnaire was used to investigate all primary nurses at different levels in terms of patients in charge, direct and indirect nursing items and walking distance during work. The workload of totally 7 113 nurses at different levels was investigated.

There was statistical difference in the number of patients in charge, critical patients, high-risk patients with pressure ulcers, high-risk patients with pressure falls and severely dependent patients between nurses at different levels (P<0.05) . The top 3 time-consuming nursing items in primary nurses at different levels were identical, which were drug therapy, severity assessment and observation and health education. Primary nurses at N0 and N1 levels needed more time for therapy-related preparation than primary nurses at N2 and N3 levels (P<0.05) . There was statistical difference in number of steps per shift during work between nurses at different levels (P<0.01) .

The number of patients in charge and the patients' severity correspond to the levels of primary nurses. The nursing work of these primary nurses at different levels are basically the same except for clinical teaching items. Nursing managers shall explore a hierarchical management model over nurses, properly configuring nurses at different levels, giving full play to the force of the nursing team, and managing the nursing team scientifically according to clinical practice in China.

Nurses; Nursing management research; Nursing workload; Hierarchical management