What determines physical, mental and emotional workloads on nurses? A cross-sectional study.

AIM: This study aimed to identify determinants of physical, mental and emotional nursing workloads. BACKGROUND: Workload has a physical, mental and emotional dimension. It influences employees' well-being and quality of care. Nevertheless, studies of specific predictors for each dimension of nurses' workload are scarce. METHODS: We used a cross-sectional prospective design based on the Job Demand-Resources theory. We asked nurses to describe workload perceived at the end of every shift over three consecutive weeks. Data were gathered from two academic hospitals, in seven medical-surgical wards. We received 259 responses and tested 2 multivariate regression models. RESULTS: Physical workload was predicted from all variables tested; mental workload was determined by patient complexity or isolation, adequacy of nurse staffing and skill-mix, and unscheduled activities; and emotional workload was predicted by all variables except adequacy of staffing and other people's education. CONCLUSIONS: Patient, nurse and workflow aspects influenced nurse's shift workload differently for each specific dimension. IMPLICATIONS FOR NURSING MANAGEMENT: Measurement and definition of predictors of workload in the work environment are essential. Recognizing the determinants of specific dimensions of workload facilitates identification of the most appropriate interventions to improve nurses' well-being in health care settings.

Defining nursing workload predictors: A pilot study.

AIM: To explore predictors of perceived nursing workload in relation to patients, nurses and workflow. BACKGROUND: Nursing workload is important to health care organisations. It determines nurses' well-being and quality of care. Nevertheless, its predictors are barely studied. METHODS: A cross-sectional prospective design based on the complex adaptive systems theory was used. An online survey asked nurses to describe perceived workload at the end of every shift. Data were gathered from five medical-surgical wards over three consecutive weeks. We received 205 completed surveys and tested multivariate regression models. RESULTS: Patient acuity, staffing resources, patient transfers, documentation, patient isolation, unscheduled activities and patient specialties were significant in predicting perceived workload. Nurse-to-patient ratio proved not to be a predictor of workload. CONCLUSIONS: This study significantly contributed to literature by identifying some workload predictors. Complexity of patient care, staffing adequacy and some workflow aspects were prominent in determining the shift workload among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Our findings provide valuable information for top and middle hospital management, as well as for policymakers. Identification of predictors and measurement of workload are essential for optimizing staff resources, workflow processes and work environment. Future research should focus on the appraisal of more determinants.

The Role of the Leader on the nurses perception of work well-being.

BACKGROUND: Work well-being can affect performance and quality of care. Previous literature described the influence of leadership styles on nurse turnover, job satisfaction, attitudes and behaviours. There is a need to explore more nurses' perception of their leaders and related effects in the work environment. AIM: The aim of this study was to explore relationships between nurses' inspiration by the leader and nurses perceptions of work pleasure, work problems, and teamwork satisfaction. METHODS: This was a cross-sectional pilot study based on the theory of social exchange (Gouldner, 1960). We administered some of QEEW instrument scales to nurses working in five medical-surgical wards of a hospital. Simple linear regression analysis were performed. RESULTS: We received 81 completed questionnaires. The inspiration by the leader showed to be an antecedent of work pleasure (R2=26%), work problems (R2=30%), and teamwork satisfaction (R2=28%). CONCLUSIONS: An inspiring leadership was associated with nurse perceptions of reduced work problems, and increased teamwork satisfaction and work pleasure. The role of the leader and the use of an appropriate leadership style is therefore essential to increase levels of well-being in nurses. Future studies with a larger sample are needed to confirm our findings. NURSING IMPLICATIONS: Our results suggest that leadership style has a prediction effect on perceived nurse well-being. Moreover, leadership style has an impact on work climate and interdisciplinary teamwork. Therefore, chief executives should invest energies in leadership training and continuing education in order to develop among ward manager's effective leadership competencies.

Identification of nursing workload determinants for management of staffing resources: a cross-sectional pilot study.

BACKGROUND: Top managers and policy makers measure nursing workload (NW) based on nurse-to-patient ratios or on nursing hours per patient a day, as a standard. To offer patients care of quality and to prevent negative outcomes on staff, leaders should consider specific workflow aspects when determining staffing assets. AIM: The aim of this study was to identify some of NW deter-minants, particularly those linked to adequacy of staffing resources. METHODS: This was a cross-sectional prospective pilot study. Data were gathered in five medical-surgical wards of a University Hospital, through an online survey, asking nurses at the end of every shift, for three consecutive weeks, to describe the workload perceived. RESULTS: We collected 205 surveys. A multivariate regression model was tested. Adequacy of staffing resources was signifi-cantly related to NW ( =0.372), whether nurse-to-patient ratio was not. CONCLUSIONS: Our findings, although arising from a pilot study, are very important for organizations. These results put in discussion what was up to now used to take decisions on staffing resources, i.e., Nurse-to-Patient Ratios or Nursing Hours Per Patient a Day indicators. Further research is needed to confirm our results. NURSING IMPLICATIONS: Our findings can be useful to hospitals middle and top management for definition of staffing assets. Adequacy of staffing includes not only the number of nurses and nurse assistants present in the shift, but also their expertise and ability to organize the work of these resources. Therefore, staffing adequacy rather than nurse-to-patient ratio should be considered when planning staffing assets. Interventions to improve nurses and nurse assistants' expertise are essential.

Essential elements in determining patient's complexity of nursing care.

BACKGROUND: Nurses dedicate majority of working time to satisfy patients' needs, which are oftentimes complex. Although the concept of patient's complexity of care (PCC) has been extensively studied, it remains undefined in its essential characteristics. Various tools for assessing PCC have been developed, yet, there is no gold standard of reference. AIM: This study intends to explore the elements that determine PCC focusing on the patient's needs. METHODS: The bed management team of a University Hospital developed in 2010 a PCC measurement instrument, similar to a triage system, to classify rapidly patients into macro-levels of care complexity (low, medium, high, intensive). Descriptive analysis of prospectively collected data registered in nursing records during 2016-2017 are presented in this study. The incidence of individual metrics on the value assigned to the overall PCC level was calculated. RESULTS: 26593 patients' records were analyzed. The final level of PCC was equal to patient's level of autonomy in 92,2% of cases, to clinical stability in 74,4% and to cognitive status in 58,4%. CONCLUSIONS: Our finding indicate that essential elements to determine PCC are patient's autonomy and clinical stability. Therefore, nurses can use these metrics to classify quickly PCC in their work settings. NURSING IMPLICATIONS: Identifying and measuring PCC is very important for nurses. It can facilitate and support nurse decision-making in design, implementation and evaluation of activities aimed at improving patient care. Moreover, it can help in the distribution of care loads in the shift, and from an organizational point of view, it can allow defining staffing assets.

Decoding Nursing Job Demands: A Multicenter Cross-Sectional Descriptive Study Assessing Nursing Workload in Hospital Medical-Surgical Wards.

Background: Nursing workload is largely studied but poorly explored under physical, mental, and emotional dimensions. Currently, only a limited number of variables have been linked to nursing workload and work contexts. Purpose: The study aimed to investigate whether it is feasible to identify variables that consistently correlate with nursing workload and others that are specific to the context. Methods: We employed a descriptive correlational analysis and a cross-sectional design. Data were collected through a survey distributed to registered nurses working across Italy, at the conclusion of randomly assigned morning or afternoon shifts. Results: We received 456 surveys from 195 shifts, collected from nurses in four public and two private hospitals. Commonly associated variables with nursing workload dimensions included patient complexity of care, admission/discharge or transfer, informing patients/relatives, contacting physicians, and unscheduled activities. Variables categorized as setting-specific were patient isolation and specialties, nurse-to-patient ratio, adequacy of staff in the shift, peer collaboration, healthcare documentation, educating others, and medical urgency. Conclusions: In summary, certain variables consistently correlate with nursing workload across settings, while others are specific to the context of care. It is imperative for nurses and nurse managers to measure the nursing workload in various dimensions, enabling the prompt implementation of improvement actions.

Nurses' Organization of Work and Its Relation to Workload in Medical Surgical Units: A Cross-Sectional Observational Multi-Center Study.

INTRODUCTION: Work contexts can affect nurses' work and work outcomes. Work context factors of nurses, patients, or workflow can modulate nurses' organization of work and determine increased workloads. AIM: The aim of this research was to analyze relationships between factors regarding the patient, the nurse, workflow, and nurses' work organization, to investigate whether work organization is related to physical, mental, and emotional workloads, and to explore whether one dimension of workload influences the other dimensions. METHODS: We used a cross-sectional design based on the Job Demand-Resources theory. We asked registered nurses, working in nine medical-surgical wards across three hospitals in Italy, to self-report on work organization and workloads regarding randomized shifts over three consecutive weeks. Four scales from the QEEW 2.0 questionnaire were used on an online survey for data collection. multivariable linear regressions with structural equation modelling were tested. The study was approved by the three local Ethics Committees. RESULTS: We received 334 questionnaires regarding 125 shifts worked. Patient complexity (ß = 0.347), patient specialties (ß = 0.127), adequacy of staffing (ß = -0.204), collaboration with colleagues (ß = -0.155), unscheduled activities (ß = 0.213), supply search (ß = 0.141), and documentation (ß = 0.221) significantly influenced nurses' work organization. Nurses' work organization was significantly related to physical, mental, and emotional nursing workloads. CONCLUSIONS: the patient, the nurse, and workflow aspects influence nurses' work organization and workloads. Healthcare organizations, managers, and nurses should explore work settings to identify work turbulences early and implement strategies to improve nursing work conditions and workloads.

Self-Perceived Clinical Competence of Nurses in Different Working Experiences: A Cross-Sectional Study.

BACKGROUND: Competence is an essential concept for measuring nurses' performance in terms of effectiveness and quality. To this end, our analysis highlighted the process of acquiring competencies, their self-evaluation into clinical practice, and how their proficiency levels change throughout the nursing career. In detail, this research explored nurses' perceived level of competence and the factors that influence it in different contexts. METHODS: A cross-sectional survey using a structured questionnaire to assess the nursing participants' perception of their competencies in different clinical settings was accomplished. RESULTS: A descriptive and bivariate analysis was performed on 431 nurses. Most respondents assessed their level of competence to be higher than their roles required. The Kruskal-Wallis test confirmed that nursing experience was a relevant factor influencing nursing competencies. CONCLUSIONS: We suggest improving the competence of practicing nurses, using experience as a measurable effect of their development.