Repeated assessments and predictors of nurses' shift-specific perceived workload.

BACKGROUND: Workload perception is of interest to researchers and policymakers as it captures subjective assessments of nurses' workload which has implications for staffing and patient outcomes. AIMS: We aimed to describe repeated assessments of nurses' perceived workload among registered nurses (RNs) in day and night shifts and to examine the association of perceived workload with workdays, units, and nurse-staffing. METHODS: Repeated data on the indictors of interest were collected from 90 RNs across 91 shifts in a Lebanese acute-care hospital. Perceived workload was assessed using the NASA-Task-Load Index (NASA-TLX). Linear mixed-effect models were used for analysis. RESULTS: Mean perceived workload was high reaching 6.63 (95% confidence interval [CI] = 6.34, 6.92) in day and 5.90 (95% CI = 5.43, 6.36) in night shifts. In mixed-effect models, perceived workload was lower on weekends/holidays as compared to weekdays in day (ß = -.32; 95% CI = -0.53, -0.12) and night (ß = -.46; 95% CI = -0.85, -0.07) shifts. Higher perceived workload (ß = .19; 95% CI = 0.04, 0.33) was associated with higher patient-to-nurse ratio in the day but not night shifts. CONCLUSION: Repeated workload assessments support the presence of elevated perceived workload among RNs which is related to weekdays and higher patient-to-nurse ratio. Future investigations would benefit from better characterization of workload particularities to address perceived burden and improve organizational and management decisions.

Variability, shift-specific workloads and rationed care predictors of work satisfaction among Registered nurses providing acute care: A longitudinal study.

AIMS: The aim of this study was to explore nurses' shift-work satisfaction variability across time and its shift-specific predictors: perceived workload, patient-to-nurse ratio and rationing of nursing care. DESIGN: Longitudinal study of 90 Registered nurses (N = 1,303 responses) in a Lebanese hospital over 91 days of data collection. METHODS: Intraclass correlation coefficients (ICCs) were computed to determine shift-work satisfaction variability between individual nurses and working-unit clusters. Generalized linear mixed models were used to explore the workloads and rationed care predictors of nurses' shift-work satisfaction separately for day and night shifts. RESULTS: Variability in shift-work satisfaction was noted between individual nurses in day (ICC = 0.43) and night shifts (ICC = 0.37), but not between medical/surgical units. Nurses satisfied with their shift-specific work were less probably to ration necessary nursing care (OR = 0.68; 95% CI = 0.60-0.77) in day shifts and to perceive high workload demands in both, day (OR = 0.29; 95% CI = 0.23-0.37) and night (OR = 0.29; 95% CI = 0.18-0.47) shifts. Monitoring and lowering workload demands while observing rationing of care is necessary to improve nurses' shift-work satisfaction.

Work environment-related factors and nurses' health outcomes: a cross-sectional study in Lebanese hospitals.

BACKGROUND: Worldwide, studies show a relationship between nurses' health and some work environment factors; however, data on nurses' health and self-perceived workload and nursing task allocation are lacking, particularly for Lebanese nurses. We assessed the relationship of several work environment factors: overall workload and specific temporal, physical, mental, effort, frustration, and performance demands (NASA Task Load Index), staffing resources and adequacy and leadership (Practice Environment Scale of Nursing Work Index), teamwork climate (Safety Attitudes Questionnaire), and nursing task allocation (Basel Extent of Rationing of Nursing Care)) with self-reported musculoskeletal, cardiovascular, skin, and mental health diseases (Work Ability Index) and emotional exhaustion (Maslach Burnout Inventory) among Lebanese nurses. METHODS: A cross-sectional self-report survey was distributed to all 289 registered nurses (RNs) in the medical, surgical, and pediatric units in two Lebanese university-affiliated hospitals; 170 RNs had complete data. Adjusted multivariable logistic regression models were used to estimate the association between work environment factors and health outcomes. RESULTS: The most prevalent outcomes were musculoskeletal disease (69%), emotional exhaustion (59%), and mental health problems (56%); 70% of RNs had ≥2 and 35.29% had ≥4 co-occurring health problems. Musculoskeletal disease was associated with higher overall (OR = 1.36 (95%CI = 1.03, 1.80)), temporal (OR = 1.30 (95%CI = 1.09, 1.55)), and physical demands (OR = 1.20 (95%CI = 1.03, 1.49)), higher task allocation to RNs (OR = 1.11 (95%CI = 1.01, 1.23)) and lower teamwork climate (OR = 0.60 (95%CI = 0.36, 0.98). Higher odds of mental/emotional problems were associated with higher overall, temporal, frustration, and effort demands, and lower teamwork climate, performance satisfaction, and resources adequacy (increased odds ranging from 18 to 88%). Work environment indicators were associated with higher co-occurrence of health problems. CONCLUSIONS: Results show elevated health burden and co-morbidity among Lebanese RNs and highlight the value of comprehensive approaches that can simultaneously improve several work environment factors (namely self-perceived workload, teamwork,, resources, and nursing task allocation) to reduce this burden.

Trends and variability of implicit rationing of care across time and shifts in an acute care hospital: A longitudinal study.

BACKGROUND: Implicit rationing of nursing care is associated with work environment factors. Yet a deeper understanding of trends and variability is needed. AIMS: To explore the trends and variability of rationing of care per shift between individual nurses, services over time, and its relationship with work environment factors. METHODS: Longitudinal study including 1,329 responses from 90 nurses. Intraclass correlation coefficients (ICC) were computed to examine variability of rationing per shift between individual nurses, services, and data collection time; generalized linear mixed models were used to explore the relationship with work environment factors. RESULTS: Percentage of rationing of nursing activities exceeded 10% during day and night shifts. Significant variability in rationing items was observed between nurses, with ICCs ranging between 0.20 and 0.59 in day shifts, and between 0.35 and 0.85 in night shifts. Rationing of care was positively associated with nurses' self-perceived workload in both shifts, but not with patient-to-nurse ratios. CONCLUSION: Most variability in rationing over time was explained by the individual. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and leaders need to develop and implement educational programs on implicit rationing of nursing care to strengthening nurses' skills related to decision-making, prioritization and time management.

Perspectives of Registered Nurses on refugee healthcare in Lebanon and Jordan (PROfILE): A multi-site cross-sectional study protocol.

AIM: This is a study protocol to investigate nurses' perspectives on refugee health care in two countries. The aims are to: (a) explore self-reported work environment factors, including work stressors, self-rated leadership, staffing and resources adequacy, and teamwork among Jordanian and Lebanese nurses caring for refugees; (b) investigate the relationship between nurse related outcomes (physical health; emotional exhaustion) and their psychosocial work environment; and (c) assess the association between nurses' perceived work environment factors and implicit rationing of care and quality of patient care. BACKGROUND: Globally, the care of refugees is achieving increased attention. Over 6.3 million people are internally displaced and 4.8 million recorded Syrian expatriates are residing in and receiving healthcare services in the neighbouring host countries. DESIGN: This is a cross-sectional, comparative study using a survey design. METHOD: The study setting involves both private and public hospitals and primary healthcare centres that provide care to refugees on regular basis in Lebanon and Jordan. The estimated sample size includes 3,000 Registered Nurses from Lebanon and 2,500 nurses and midwives from Jordan. DISCUSSION: Workplace factors affecting quality of nursing care and psychosocial status of nurses caring for refugees will be identified. Potential findings will help leaders design interventions to support nurses who are serving refugees for safer care and better patient outcomes. Findings will assist in more efficient resource allocation and management. IMPACT: New knowledge on the impact of providing health care for refugees will be generated based on the structure of nursing care (e.g., work environment), on the nursing process (e.g., implicit rationing of care), and nurse outcomes (health) in two hosting communities. Moreover, factors enabling resilience in patients, providers, and systems will be identified and be of potential use in addressing the growing global problem of caring for displaced persons.

A longitudinal study on implicit rationing of nursing care among Lebanese patients - Study protocol.

AIM: To gain an in-depth understanding of the variations and trends of implicit rationing of nursing care, of its associated factors and of its relation to with nurse and patient outcomes. BACKGROUND: Maintaining and improving the quality of nursing care and patient safety have been the focus of health services researchers over the last decade. Cross-sectional studies have showed the magnitude of implicit rationing of nursing care and its associations with negative patient and nurse outcomes. DESIGN: Observational longitudinal study. METHOD: Two-year funded study (between 2018-2020), including a sample of 317 Registered Nurses working on 19 units in two large Lebanese urban hospitals. The study included a cross-sectional baseline survey followed by multiple follow-up assessments over 90 days. The repeated measurements on each of the units include repeated surveys on nurses' rationing of care, hospital administration reported nurse-sensitive indicators, nurse staffing levels, and patient mortality data. DISCUSSION: The study results will describe variations and trends of implicit rationing of nursing care in hospital units over time and whether and which elements of the nurses' work environment are associated with these variations. Data will inform on the impact of implicit rationing of care on patient and nurse outcomes. These data are needed to advance future planning and interventional research to efficiently reduce rationing of nursing care and improve the quality of care. IMPACT: Generating new knowledge (variations and trends) on the association between rationing of care and other element of nurses' work environment and nurse and patient outcomes.

Work schedule flexibility is associated with emotional exhaustion among registered nurses in Swiss hospitals: A cross-sectional study.

BACKGROUND: Emotional exhaustion among healthcare workers is a widely investigated, well-recognized problem, the incidence of which has recently been linked to work environment factors, particularly work/family conflict. However, another environmental feature that may be equally influential, but that is more amenable to nurse manager action, remains less recognized: shift schedule flexibility. OBJECTIVES: This study's main purposes were to assess variations in work schedule flexibility between Swiss acute care hospital units, and to investigate associations between psychosocial work environment (e.g. work schedule flexibility) and self-reported emotional exhaustion among registered nurses. METHODS: This is a secondary analysis of data collected for the multi-center observational cross-sectional MatchRN study, which included a national sample of 23 hospitals and 1833 registered nurses across Switzerland. RESULTS: Overall, self-reported work schedule flexibility among registered nurses was limited: 32% of participants reported little or no influence in planning their own shifts. Work schedule flexibility (ß -0.11; CI -0.16; -0.06) and perceived nurse manager ability (ß -0.30; CI -0.49; -0.10) were negatively related to self-reported emotional exhaustion. Work-family conflict (ß 0.39; CI 0.33; 0.45) was positively correlated to emotional exhaustion. CONCLUSIONS: The study results indicate that managerial efforts to improve working environments, including special efforts to improve work schedule flexibility, might play an important role in promoting nurses' emotional health.

Are nursing home care workers' health and presenteeism associated with implicit rationing of care? A cross-sectional multi-site study.

To explore associations between care workers' health and implicit rationing of care. Diverse studies have linked impaired health to reduced work performance - a factor measured through omission of required tasks. This cross-sectional study gathered data from 3239 care workers in 162 Swiss nursing homes. Data were analyzed via a linear logistic regression model using general estimating equations. Overall, rationing of care occurred "never" to "seldom." Rationing of activities of daily living was positively associated with care workers' joint pain (ß 0.04, CI 0.001-0.07), emotional exhaustion (ß 0.11, CI 0.07-0.15), and presenteeism (ß 0.05, CI 0.004-0.09). Rationing of caring, rehabilitation, and monitoring was positively associated with care workers' joint pain (ß 0.05, CI 0.01-0.09) and emotional exhaustion (ß 0.2, CI 1.16-0.24). Care workers health complaints are strongly associated with rationing of tasks directly related to resident care.

Care workers health in Swiss nursing homes and its association with psychosocial work environment: A cross-sectional study.

BACKGROUND: Previous studies have demonstrated poor health of care workers in nursing homes. Yet, little is known about the prevalence of physical and mental health outcomes, and their associations with the psychosocial work environment in nursing homes. OBJECTIVES: (1) To explore the prevalence of physical and mental health outcomes of care workers in Swiss nursing homes, (2) their association with psychosocial work environment. METHODS: This is a secondary data analysis of the cross-sectional Swiss Nursing Home Human Resources Project (SHURP). We used survey data on socio-demographic characteristics and work environment factors from care workers (N=3471) working in Swiss nursing homes (N=155), collected between May 2012 and April 2013. GEE logistic regression models were used to estimate the relationship between psychosocial work environment and physical and mental health outcomes, taking into account care workers' age. RESULTS: Back pain (19.0%) and emotional exhaustion (24.2%) were the most frequent self-reported physical and mental health. Back pain was associated with increased workload (odds ratios (OR) 1.52, confidence interval (CI) 1.29-1.79), conflict with other health professionals and lack of recognition (OR 1.72, CI 1.40-2.11), and frequent verbal aggression by residents (OR 1.36, CI 1.06-1.74), and inversely associated with staffing adequacy (OR 0.69, CI 0.56-0.84); emotional exhaustion was associated with increased workload (OR 1.96, CI 1.65-2.34), lack of job preparation (OR 1.41, CI 1.14-1.73), and conflict with other health professionals and lack of recognition (OR 1.68, CI 1.37-2.06), and inversely associated with leadership (OR 0.70, CI 0.56-0.87). CONCLUSIONS: Physical and mental health among care workers in Swiss nursing homes is of concern. Modifying psychosocial work environment factors offer promising strategies to improve health. Longitudinal studies are needed to conduct targeted assessments of care workers health status, taking into account their age, along with the exposure to all four domains of the proposed WHO model.