The Impact of Heavy Perceived Nurse Workloads on Patient and Nurse Outcomes

This study investigated the relationships between seven workload factors and patient and nurse outcomes. (1) Background: Health systems researchers are beginning to address nurses’ workload demands at different unit, job and task levels; and the types of administrative interventions needed for specific workload demands. (2) Methods: This was a cross-sectional correlational study of 472 acute care nurses from British Columbia, Canada. The workload factors included nurse reports of unit-level RN staffing levels and patient acuity and patient dependency; job-level nurse perceptions of heavy workloads, nursing tasks left undone and compromised standards; and task-level interruptions to work flow. Patient outcomes were nurse-reported frequencies of medication errors, patient falls and urinary tract infections; and nurse outcomes were emotional exhaustion and job satisfaction. (3) Results: Job-level perceptions of heavy workloads and task-level interruptions had significant direct effects on patient and nurse outcomes. Tasks left undone mediated the relationships between heavy workloads and nurse and patient outcomes; and between interruptions and nurse and patient outcomes. Compromised professional nursing standards mediated the relationships between heavy workloads and nurse outcomes; and between interruptions and nurse outcomes. (4) Conclusion: Administrators should work collaboratively with nurses to identify work environment strategies that ameliorate workload demands at different levels.

[1]  D. A. Kenny,et al.  Mediation with Dichotomous Outcomes , 2013 .

[2]  M. Leiter,et al.  The Impact of Nursing Work Environments on Patient Safety Outcomes: The Mediating Role of Burnout Engagement , 2006, The Journal of nursing administration.

[3]  C. Maslach,et al.  Nurse turnover: the mediating role of burnout. , 2009, Journal of nursing management.

[4]  Peter Griffiths,et al.  ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care , 2013, BMJ quality & safety.

[5]  B. Karsh,et al.  A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life , 2011, Quality and Safety in Health Care.

[6]  B. Kalisch,et al.  It Takes a Team , 2012, The American journal of nursing.

[7]  Brian P. Bailey,et al.  On the need for attention-aware systems: Measuring effects of interruption on task performance, error rate, and affective state , 2006, Comput. Hum. Behav..

[8]  Jennifer Dziuba-Ellis,et al.  Float Pools and Resource Teams: A Review of the Literature , 2006, Journal of nursing care quality.

[9]  OiSaeng Hong,et al.  The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events. , 2016, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[10]  Ann Van Hecke,et al.  Determining a set of measurable and relevant factors affecting nursing workload in the acute care hospital setting: a cross-sectional study. , 2012, International journal of nursing studies.

[11]  Trevor A Sheldon,et al.  Nurse Staffing and Healthcare Outcomes: A Systematic Review of the International Research Evidence , 2005, ANS. Advances in nursing science.

[12]  Caitlin W Brennan,et al.  Patient acuity: a concept analysis. , 2009, Journal of advanced nursing.

[13]  C. Duffield,et al.  Nursing staffing, nursing workload, the work environment and patient outcomes. , 2011, Applied nursing research : ANR.

[14]  Michelle Aebersold,et al.  Interruptions and multitasking in nursing care. , 2010, Joint Commission journal on quality and patient safety.

[15]  A. Hamric,et al.  Moral Distress, Moral Residue, and the Crescendo Effect , 2009, The Journal of Clinical Ethics.

[16]  B. Jennings Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions , 2008 .

[17]  Jeannie P. Cimiotti,et al.  Nurse staffing, burnout, and health care-associated infection. , 2012, American journal of infection control.

[18]  Paul Cornell,et al.  Transforming Nursing Workflow, Part 1: The Chaotic Nature of Nurse Activities , 2010, The Journal of nursing administration.

[19]  Thomas Höge When work strain transcends psychological boundaries: an inquiry into the relationship between time pressure, irritation, work–family conflict and psychosomatic complaints , 2009 .

[20]  Catherine Pope,et al.  Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development. , 2016, International Journal of Nursing Studies.

[21]  Patricia Pendry Moral distress: recognizing it to retain nurses. , 2007, Nursing economic$.

[22]  C. Varcoe,et al.  Registered Nurses’ Perceptions of Moral Distress and Ethical Climate , 2009, Nursing ethics.

[23]  Alison M. Hutchinson,et al.  The Effects of Time Pressure and Experience on Nurses' Risk Assessment Decisions: A Signal Detection Analysis , 2008, Nursing research.

[24]  F. Tschan,et al.  The Assessment of Psychological Strain in Work Contexts: Concerning the Structural Equivalency of Ni , 2006 .

[25]  T. Wilt,et al.  The Association of Registered Nurse Staffing Levels and Patient Outcomes: Systematic Review and Meta-Analysis , 2007, Medical care.

[26]  M. Curley,et al.  Synergy : the unique relationship between nurses and patients, the AACN Synergy Model for Patient Care , 2007 .

[27]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[28]  S. Clarke,et al.  The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey. , 2013, International journal of nursing studies.

[29]  L. McGillis Hall,et al.  Losing the Moment: Understanding Interruptions to Nurses' Work , 2010, The Journal of nursing administration.

[30]  Martin McKee,et al.  Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States , 2012, BMJ : British Medical Journal.

[31]  Ann Van Hecke,et al.  Non-direct patient care factors influencing nursing workload: a review of the literature. , 2011, Journal of advanced nursing.

[32]  B. I. Van der Heijden,et al.  Longitudinal Analysis of Personal and Work-Related Factors Associated With Turnover Among Nurses , 2010, Recherche en soins infirmiers.

[33]  K. Patrick,et al.  Burnout in nursing. , 2007, The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation.

[34]  A. Kitson,et al.  Anything but basic: Nursing's challenge in meeting patients' fundamental care needs. , 2014, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[35]  L. Aiken,et al.  Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology , 2011, BMC nursing.

[36]  Hong Lu,et al.  Job satisfaction among hospital nurses revisited: a systematic review. , 2012, International journal of nursing studies.

[37]  Sarah A. Delgado,et al.  Understanding and Addressing Moral Distress , 2010, OJIN: The Online Journal of Issues in Nursing.

[38]  S. Jackson,et al.  Maslach burnout inventory manual , 1996 .

[39]  R. Hughes Patient Safety and Quality: An Evidence-Based Handbook for Nurses , 2008 .

[40]  B. Aust,et al.  Comprehensive health promotion interventions at the workplace: experiences with health circles in Germany. , 2004, Journal of occupational health psychology.

[41]  J. Lönnqvist,et al.  Occupational burnout and medically certified sickness absence: a population-based study of Finnish employees. , 2008, Journal of psychosomatic research.

[42]  R. Schwendimann,et al.  Frequencies of falls in Swiss hospitals: concordance between nurses' estimates and fall incident reports. , 2009, International journal of nursing studies.

[43]  Lisbeth Fagerström,et al.  Determining optimal nursing intensity: the RAFAELA method. , 2004, Journal of Advanced Nursing.

[44]  Walter Sermeus,et al.  Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe , 2015, Medical care research and review : MCRR.

[45]  M. Blegen,et al.  Medication-Related Errors: A Literature Review of Incidence and Antecedents , 2006, Annual Review of Nursing Research.

[46]  T. Rigotti,et al.  Interruptions to workflow: Their relationship with irritation and satisfaction with performance, and the mediating roles of time pressure and mental demands , 2013 .

[47]  M. Wirtz,et al.  Burnout in nurses - the relationship between social capital in hospitals and emotional exhaustion. , 2010, Journal of clinical nursing.

[48]  M. MacPhee,et al.  RNs and LPNs: emotional exhaustion and intention to leave. , 2016, Journal of nursing management.

[49]  N. North,et al.  Nurse turnover: a literature review - an update. , 2012, International journal of nursing studies.

[50]  Matthew D. McHugh,et al.  Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. , 2011, Health affairs.

[51]  Abbey Hyde,et al.  Reconsidering the conceptualization of nursing workload: literature review. , 2007, Journal of advanced nursing.

[52]  Dieter Zapf,et al.  Social stressors at work, irritation, and depressive symptoms: Accounting for unmeasured third variables in a multi‐wave study , 2002 .

[53]  L. Aiken,et al.  Nursing workforce a global priority area for health policy and health services research: a special issue. , 2013, International journal of nursing studies.

[54]  L. Aiken,et al.  Nurses' reports of working conditions and hospital quality of care in 12 countries in Europe. , 2013, International journal of nursing studies.

[55]  Donald Schopflocher,et al.  Addressing nonresponse bias in postal surveys. , 2009, Public health nursing.

[56]  Paul G Shekelle,et al.  Nurse–Patient Ratios as a Patient Safety Strategy , 2013, Annals of Internal Medicine.