Presentation
Understanding Mental Workload in Nursing: A Task-Specific Approach
SessionPoster Session 1
DescriptionNurses comprise the largest hospital workforce and are critical for the safety and stability of the healthcare system. Current and future nursing workforce projections indicate a worsening registered nurse (RN) staffing crisis as the demand for nursing services continues to outpace supply, creating an ever-widening RN labor gap (Vozzella & Hehman, 2023). There is a strong correlation between nurse staffing, patient outcomes, and cost, with lower RN staffing levels associated with higher in-hospital mortality risk, higher frequency of missed nursing care events, and longer lengths of stay (Brennan et al., 2013; Griffiths et al., 2016, 2018; Kane et al., 2007; Shekelle, 2013). Staffing shortages also increase individual RN workload burden, leading to lower job satisfaction and higher intent to leave among direct care nurses, eventually increasing nurse turnover and exacerbating workforce instability (Lindqvist et al., 2014; Phillips, 2020).
It is essential to optimize staffing models to more effectively allocate RNs in a way that maintains high-quality patient care and safe work environments for staff. Staffing models rely on workload measurement systems, yet no commonly accepted definition or conceptual framework for nursing workload currently exists among the available published literature. The existing literature on nursing workload has primarily focused on measuring workload proxies such as the nurse-to-patient ratio (Carayon & Gurses, 2008) and patient classification systems (Griffiths et al., 2020). Environmental turbulence positively correlates with burnout and errors in patient care (Ebright et al., 2003). Environmental turbulence is defined as “a loss of control due to simultaneous demands; new, difficult, or unfamiliar work; heavy patient loads; and excessive responsibility,” resulting from factors such as time pressure and interruptions (Jennings et al., 2022). The effect of environmental turbulence on mental nursing workload has not been captured (Browne & Braden, 2020). We do so in this study.
We assessed whether variables such as age, race, years of experience as an RN, years of experience at the hospital where the study was conducted, certification status, and the assigned unit, affect perceived workload, NASA-TX, End-of-Shift survey including the MISSCARE survey, and the number of interruptions encountered when performing three specific tasks: Head-to-toe assessment, medication administration, and Central line dressing change.
Two observers collected ethnographic data on 14 nurses for a total of 210 hours. They recorded the number and types of interruptions faced by the nurses when they performed any of the three targeted tasks. After each task, nurses completed the unweighted NASA-TLX survey. At the end of each shadowing session, nurses completed the End of Shift survey, which included the Missed Nursing Care (MISSCARE) survey. The latter examines which nursing care was missed and the reasons for missing it, and five questions about their overall perception of the workday. A linear regression was performed to model age, years of experience as an RN, and years of experience at the hospital. A Poisson regression was used to model assigned unit and race. Certification status, which had two levels, was modeled by binary logistic regression. Pairwise comparisons were performed using Holm’s adjustment method for assigned unit, race, and certification status.
Most of the statistically significant regression models and pairwise comparisons were observed on the NASA-TLX scores, and not on the End of Shift Survey or the number of interruptions. Additionally, none of the variables were statistically significant for the Central Line Dressing Change task, possibly due to insufficient power, because the task was rarely observed during the duration of the study.
The effect of age on mean NASA-TLX rating was significant for the Head-to-Toe Assessment, such that the mean of the NASA-TLX subscales - Mental demand, Physical demand, Temporal demand, and Effort were positively correlated with age. In contrast, Frustration was negatively correlated with age. The effect of age on mean NASA-TLX ratings was similarly significant for Medication Administration: Age was positively correlated with Mental and Temporal demands, and negatively correlated with Physical demand, Effort and Frustration.
The effect of certification status and years of experience (both as an RN and time at the hospital) on NASA-TLX scores was significant. The mean rating for nurses who were certified, and for nurses who had more experience, was lower on all subscales, except Performance. Additionally, the effect of certification status on mean Global NASA-TLX was statistically significant for Head-to-Toe Assessment, such that the certified individuals had lower ratings than those not certified. The effect of experience on mean Global NASA-TLX was significant for both Head-to-Toe Assessment and Medication Administration, such that there was a negative correlation between experience and NASA-TLX ratings. These results indicate that having more experience and being certified results in lower perceived workload. Finally, the mean Global NASA-TLX rating was higher for the stroke unit for the medication administration and head-to-toe assessment tasks when compared to the Intermediary Care Unit, the Surgical Liver Intensive Care Unit, and the Neurology/Neurosurgery Unit. The implication is that patient characteristics contribute to perceived workload.
It is essential to optimize staffing models to more effectively allocate RNs in a way that maintains high-quality patient care and safe work environments for staff. Staffing models rely on workload measurement systems, yet no commonly accepted definition or conceptual framework for nursing workload currently exists among the available published literature. The existing literature on nursing workload has primarily focused on measuring workload proxies such as the nurse-to-patient ratio (Carayon & Gurses, 2008) and patient classification systems (Griffiths et al., 2020). Environmental turbulence positively correlates with burnout and errors in patient care (Ebright et al., 2003). Environmental turbulence is defined as “a loss of control due to simultaneous demands; new, difficult, or unfamiliar work; heavy patient loads; and excessive responsibility,” resulting from factors such as time pressure and interruptions (Jennings et al., 2022). The effect of environmental turbulence on mental nursing workload has not been captured (Browne & Braden, 2020). We do so in this study.
We assessed whether variables such as age, race, years of experience as an RN, years of experience at the hospital where the study was conducted, certification status, and the assigned unit, affect perceived workload, NASA-TX, End-of-Shift survey including the MISSCARE survey, and the number of interruptions encountered when performing three specific tasks: Head-to-toe assessment, medication administration, and Central line dressing change.
Two observers collected ethnographic data on 14 nurses for a total of 210 hours. They recorded the number and types of interruptions faced by the nurses when they performed any of the three targeted tasks. After each task, nurses completed the unweighted NASA-TLX survey. At the end of each shadowing session, nurses completed the End of Shift survey, which included the Missed Nursing Care (MISSCARE) survey. The latter examines which nursing care was missed and the reasons for missing it, and five questions about their overall perception of the workday. A linear regression was performed to model age, years of experience as an RN, and years of experience at the hospital. A Poisson regression was used to model assigned unit and race. Certification status, which had two levels, was modeled by binary logistic regression. Pairwise comparisons were performed using Holm’s adjustment method for assigned unit, race, and certification status.
Most of the statistically significant regression models and pairwise comparisons were observed on the NASA-TLX scores, and not on the End of Shift Survey or the number of interruptions. Additionally, none of the variables were statistically significant for the Central Line Dressing Change task, possibly due to insufficient power, because the task was rarely observed during the duration of the study.
The effect of age on mean NASA-TLX rating was significant for the Head-to-Toe Assessment, such that the mean of the NASA-TLX subscales - Mental demand, Physical demand, Temporal demand, and Effort were positively correlated with age. In contrast, Frustration was negatively correlated with age. The effect of age on mean NASA-TLX ratings was similarly significant for Medication Administration: Age was positively correlated with Mental and Temporal demands, and negatively correlated with Physical demand, Effort and Frustration.
The effect of certification status and years of experience (both as an RN and time at the hospital) on NASA-TLX scores was significant. The mean rating for nurses who were certified, and for nurses who had more experience, was lower on all subscales, except Performance. Additionally, the effect of certification status on mean Global NASA-TLX was statistically significant for Head-to-Toe Assessment, such that the certified individuals had lower ratings than those not certified. The effect of experience on mean Global NASA-TLX was significant for both Head-to-Toe Assessment and Medication Administration, such that there was a negative correlation between experience and NASA-TLX ratings. These results indicate that having more experience and being certified results in lower perceived workload. Finally, the mean Global NASA-TLX rating was higher for the stroke unit for the medication administration and head-to-toe assessment tasks when compared to the Intermediary Care Unit, the Surgical Liver Intensive Care Unit, and the Neurology/Neurosurgery Unit. The implication is that patient characteristics contribute to perceived workload.
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments