Leveraging nursing strengths, listening to nursing needs: A keynote paper from the 2022 Emory University Business Case for Nursing Summit.

This keynote paper is the first installment in the six-part Nursing Outlook special edition based on the 2022 Emory University Business Case for Nursing Summit. The summit, which took place in March 2022, was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises. Each of the summit's panels authored a paper in this special edition on their respective topic(s). Those topics included the growth, distribution, resilience, and value of the nursing workforce. As on the day of the event, the keynote frames the panelists' discussions by sharing nursing workforce trends, expert workforce insights, and data-informed questions to help promote dialogue in this series and beyond.

Stressors, coping strategies and intention to leave the nursing profession: A cross-sectional nationwide study in China.

AIMS: This study aims to investigate the association between stressors, coping strategies and intention to leave the nursing profession among nurses. BACKGROUND: Job stressors and coping strategies are believed to affect turnover intention among nurses, but no large-scale study has been conducted on these associations in China yet. METHOD: A cross-sectional secondary analysis was conducted among 51,406 nurses from 1858 hospitals. Univariable and multivariable logistic regression analyses were carried out, and odds ratios were reported. RESULTS: Overall, 49.58% nurses had an intention to leave the profession. It is found that stress from health condition, family, occupational injuries, nurse-patient tension, high job demands, strict leaders and colleague relationships were significantly associated with higher intention to leave. Coping strategies such as talking to family and friends, talking to leaders, doing outdoor activities, engaging in hobbies and attending on-the-job training were significantly associated with lower intention, but social gathering, psychological counselling and suffering in silence had an opposite effect. CONCLUSIONS: Our study provides new insights into the association between stressors, coping strategies and turnover intention among nurses in China. IMPLICATIONS FOR NURSING MANAGEMENT: Evidence from this study indicates that policies promoting a safe and supportive work environment should be developed to help nurses cope with stress.

Factors influencing nurses' intention to work in the oncology specialty: multi-institutional cross-sectional study.

BACKGROUND: Nursing care for terminally ill cancer patients is routinely provided by oncology nurses in Saudi Arabia. Shortages and retention of oncology nurses is an important concern for healthcare leaders. OBJECTIVES: To identify and describe predictors of nurses' intention toward working in the oncology specialty amongst three groups: undergraduate nursing students, oncology registered nurses and postgraduate oncology nursing students. In particular, the study sought to analyse association between individual characteristics, job-related factors, palliative care knowledge, attitude toward caring for dying patients, general self-efficacy, job satisfaction and intention to work in oncology. METHODS: A cross-sectional study was conducted involving 477 participants in five major hospitals in Saudi Arabia. The Palliative Care Quiz for Nursing, Frommelt Attitudes Toward Care of the Dying Scale, General Self-Efficacy Scale and Minnesota Satisfaction Questionnaire short form were used for data collection. Multilevel logistic regression analysis was used to identify predictors associated with intention to work in oncology. RESULTS: 43.9% (n = 208) of the sample reported an intention to work in oncology. Only one variable was a significant predictor of intention to work in oncology across all three groups studied: a more positive attitude toward caring for dying patients (Odds ratio (OR) = 1.09 [95% confidence interval (CI) 1.04-1.16]), (OR = 1.08 [95% CI 1.04-1.12]), (OR = 1.078 [95% CI 1.053-1.103] with P ≤ 0.001 for undergraduate, registered and postgraduate groups respectively. At post-graduate level, higher levels of palliative care knowledge and general self-efficacy were significantly associated with increased intention, whilst at undergraduate level, general self-efficacy was a significant predictor. Job satisfaction was a significant predictor of intention amongst registered nurses. CONCLUSIONS: Attitude toward caring for dying patients and general self-efficacy appear to be the most important predictors of intention to work in the oncology nursing specialty. However, the significance of influencing factors varied between the different groups of nurses studied. Perhaps surprisingly, palliative care knowledge was an influential factor amongst the postgraduate group only. The study results provide important insights for nursing leaders and policymakers in Saudi Arabia to inform the future planning of nursing workforce strategies to address shortages and retention of oncology nurses.

The economic case for meeting employees' needs.

AIM: The purpose of this article was to demonstrate that health care organisations stand to benefit financially by accommodating the needs of nursing staff. BACKGROUND: Nurse turnover results in major financial losses in health care, and inadequate staffing resulting from turnover negatively affects patient outcomes, which further drives up health care costs. Strategies to limit nurse turnover are available and crucial in the quest for health care sustainability. EVALUATION: Economic theory was presented to underpin evidence from business, education, and health disciplines literature, and from case studies of industry best practices in employee retention. This multidisciplinary analysis was applied to the retention of nurses in health care organisations. CONCLUSION: Significant reductions in nurse turnover lead to considerable financial benefit to employers. Reductions can be achieved when employers accommodate the needs of their staff. Further investigation of specific incentive models, and the transferability of those models, is needed. Incentive programmes may be matched to specific nurse needs to decrease turnover. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders have the opportunity to discover the unique need of their workforces and invest in incentive programmes to fulfil those needs.

Why do young nurses leave their organization? A qualitative descriptive study.

BACKGROUND: Nurse turnover is a major problem all over the world. It is known that young nurses who constitute the new nurse labour force are more likely to leave their organization, especially in their first year. However, qualitative studies that approach the problem from the perspective of young nurses and focus on the reasons for their decision to leave their organization are limited. AIM: To understand the reasons for young nurses' leaving their organization and determine their experiences, focusing on their point of view. METHODS: The study had a descriptive qualitative design and was conducted between January and February 2019. Purposeful sampling was used, and the sample included 15 nurses that voluntarily decided to leave a university hospital in Turkey and agreed to participate in the study. Data were collected with semi-structured interviews, and the interviews were audio-recorded. The data obtained from the interviews were evaluated by content analysis. FINDINGS: The young nurses' reasons for leaving their organization were found to be in three categories: the Negative work environment, Nursing shortage, and Unsatisfied individual expectations. The Negative work environment category included the subcategories of lack of professional solidarity, lack of support from managers, inadequacy of preceptorship process, and horizontal violence. The Nursing shortage category consisted of the subcategories of excessive workload and overtime. The category of Unsatisfied individual expectations comprised the subcategories of work-social life imbalance, availability of alternative options, and family-related reasons. CONCLUSION AND IMPLICATIONS FOR NURSING POLICY: It was determined that the young nurses left their organization because they did not receive sufficient support from their managers and colleagues during the transition period. This finding shows that nurse executives must have the managerial skills and understanding to regulate the work environment, increase peer support, and carefully plan each stage of the transition process for the retention of young nurses in their organization. In addition, nurse executives should encourage and be involved with policy making and policymakers and other managers in their organizations to develop institutional and national strategies to ensure that young nurses remain in nursing.

The Implementation of a Cultural Change Toolkit to Reduce Nursing Burnout and Mitigate Nurse Turnover in the Emergency Department.

PROBLEM: Nursing burnout and high levels of nursing turnover contribute to negative work environments, diminished patient care, and increased health care costs. There is a gap in literature regarding cost-effective, easily implemented interventions to address burnout and turnover. The purpose of this project was to determine if the implementation of evidence-based interventions would improve the perception of the practice environment, decrease the levels of nursing burnout, and decrease the voluntary nurse turnover rate in the emergency department. METHODS: The Cultural Change Toolkit was developed based on current recommendations in literature and implemented within an emergency department in southeast Texas. The toolkit included specific interventions related to meaningful recognition, shared decision making, and increased leadership involvement and support. Nursing burnout and anticipated turnover were measured using the Anticipated Turnover Scale and the Oldenburg Burnout Inventory both before and after implementation of the project. Participants (n = 30) included nursing staff employed in the emergency department. RESULTS: There was a reduction in both the anticipated turnover (mean anticipated turnover score, preimplementattion = 3.133, postimplementation = 2.989) and burnout scores among nursing staff (mean burnout score, preimplementation = 4.808, postimplementation = 4.463). The reduction in overall burnout scores were statistically significant following a paired t-test analysis (P = 0.004). There were no resignations among nursing staff throughout the project period. DISCUSSION: Nursing burnout and turnover are frequently discussed topics. The results support the use of cost-effective interventions outlined in the Cultural Change Toolkit to address nursing turnover and burnout.

How to keep registered nurses working in New Zealand even as economic conditions improve.

BACKGROUND: Many registered nurses (RNs) increased their participation in the New Zealand health workforce during the Global Financial Crisis (GFC), resulting in low vacancy rates. However, based on the documented impact of improving economies, a mean RN age of about 50, and just-agreed substantive increases in RN pay rates, it is likely that many will soon leave or reduce the hours they work. This study aims to investigate whether improved financial security will encourage RNs to leave or reduce their work commitment and to identify the factors that influence such intentions. METHODS: An exploratory study using a cross-sectional survey design. Data were collected in 2014-2015 via an e-survey of 2,910 RNs in New Zealand. Data were analysed by regression. RESULTS: We found that due to "burnout" and low "work engagement", both of which are strongly affected by workload and work-life interference, 22.6% of the RNs surveyed plan to leave work altogether and a further 32% plan to reduce their workforce participation when their financial situations improve. CONCLUSIONS: The findings justify the urgent cooperative development, implementation and evaluation of a comprehensive suite of RN 'retention' measures involving national nursing organisations, the RN regulator and health system employers and funders.

Factors predicting Registered Nurses' intentions to leave their organization and profession: A job demands-resources framework.

AIMS: To develop a comprehensive model of nursing turnover intention by examining the effects of job demands, job resources, personal demands and personal resources on burnout and work engagement and subsequently on the intention to leave the organization and profession. BACKGROUND: The ageing population and a growing prevalence of multimorbidity are placing increasing strain on an ageing nursing workforce. Solutions that address the anticipated nursing shortage should focus on reducing burnout and enhancing the engagement of Registered Nurses (RNs) to improve retention. DESIGN: A cross-sectional survey design. METHOD: Data were collected in 2014-2015 via an e-survey from 2,876 RNs working in New Zealand. Data were analysed with structural equation modelling. RESULTS: Higher engagement results in lower intention to leave the organization and profession. Burnout has significant effects on intentions to leave through lower engagement. While most of the demands and resources' variables (except professional development) have effects on intentions to leave, greater workload and greater work-life interference result in higher burnout and are the strongest predictors of intentions to leave. Greater emotional demands (challenges) and greater self-efficacy also have strong effects in lowering intentions to leave through higher engagement. CONCLUSIONS: Employee burnout and work engagement play an important role in transmitting the impacts of job demands, job resources, personal demands and personal resources into RN intention to leave the organization and profession. Work-life interference and high workloads are major threats to nursing retention while challenge demands and higher levels of self-efficacy support better retention.

The impact of nurse managers' leadership styles on ward staff.

AIM: to explore the nature of leadership styles used by the nursing management team, as perceived by nurses working at the bedside. BACKGROUND: leadership style is related to job satisfaction, staff retention, costs, and quality of care. The leadership styles of managers can be crucial in the healthcare setting, but very few studies have focused on them. METHOD: the study employed qualitative methodology, involving 35 nurses working in different specialties of a medical city in Saudi Arabia. Data collection consisted of completing demographic and professional information and a semi-structured interview using open-ended questions. ANALYSIS: a phenomenologic-hermeneutic approach was used to identify major themes. RESULTS: the findings showed that participants described four types of leadership styles: relational leadership, preferential leadership, communication chain leadership, and ineffectual leadership. CONCLUSION: the leadership style employed by nurse managers has a major impact on nurses' satisfaction, turnover, and the quality of patient care they deliver.

A multilevel investigation on nursing turnover intention: the cross-level role of leader-member exchange.

AIM: To analyse nursing turnover intention from the unit by using multilevel approach, examining at the individual level, the relationships between job characteristics, job satisfaction and turnover intention, and at the group level the role of leader-member exchange. BACKGROUND: Research on nursing turnover has given little attention to the effects of multilevel factors. METHOD: Aggregated data of 935 nurses nested within 74 teams of four Italian hospitals were collected in 2009 via a self-administered questionnaire. RESULTS: Hierarchical linear modelling showed that job satisfaction mediated the relationship between job characteristics and intention to leave at the individual level. At the unit level, leader-member exchange was directly linked to intention to leave. Furthermore, cross-level interaction revealed that leader-member exchange moderated the relationship between job characteristics and job satisfaction. CONCLUSION: This study supported previous research in single-level turnover studies concerning the key role of job satisfaction, providing evidence that job characteristics are important in creating motivating and satisfying jobs. At the unit-level, leader-member exchange offers an approach to understand the role of unit-specific conditions created by leaders on nurses' workplace wellbeing. IMPLICATIONS FOR NURSING MANAGEMENT: This study showed that it is important for nursing managers to recognise the relevance of implementing management practices that foster healthy workplaces centred on high-quality nurse-supervisor relationships.

A comparative review of nurse turnover rates and costs across countries.

AIMS: To compare nurse turnover rates and costs from four studies in four countries (US, Canada, Australia, New Zealand) that have used the same costing methodology; the original Nursing Turnover Cost Calculation Methodology. BACKGROUND: Measuring and comparing the costs and rates of turnover is difficult because of differences in definitions and methodologies. DESIGN: Comparative review. DATA SOURCES: Searches were carried out within CINAHL, Business Source Complete and Medline for studies that used the original Nursing Turnover Cost Calculation Methodology and reported on both costs and rates of nurse turnover, published from 2014 and prior. METHODS: A comparative review of turnover data was conducted using four studies that employed the original Nursing Turnover Cost Calculation Methodology. Costing data items were converted to percentages, while total turnover costs were converted to US 2014 dollars and adjusted according to inflation rates, to permit cross-country comparisons. RESULTS: Despite using the same methodology, Australia reported significantly higher turnover costs ($48,790) due to higher termination (~50% of indirect costs) and temporary replacement costs (~90% of direct costs). Costs were almost 50% lower in the US ($20,561), Canada ($26,652) and New Zealand ($23,711). Turnover rates also varied significantly across countries with the highest rate reported in New Zealand (44·3%) followed by the US (26·8%), Canada (19·9%) and Australia (15·1%). CONCLUSION: A significant proportion of turnover costs are attributed to temporary replacement, highlighting the importance of nurse retention. The authors suggest a minimum dataset is also required to eliminate potential variability across countries, states, hospitals and departments.

Turnover of regulated nurses in long-term care facilities.

AIMS: To describe the relationship between nursing staff turnover in long-term care (LTC) homes and organisational factors consisting of leadership practices and behaviours, supervisory support, burnout, job satisfaction and work environment satisfaction. BACKGROUND: The turnover of regulated nursing staff [Registered Nurses (RNs) and Registered Practical Nurses (RPNs)] in LTC facilities is a pervasive problem, but there is a scarcity of research examining this issue in Canada. METHODS: The study was conceptualized using a Stress Process model. Distinct surveys were distributed to administrators to measure organisational factors and to regulated nurses to measure personal and job-related sources of stress and workplace support. In total, 324 surveys were used in the linear regression analysis to examine factors associated with high turnover rates. RESULTS: Higher leadership practice scores were associated with lower nursing turnover; a one score increase in leadership correlated with a 49% decrease in nursing turnover. A significant inverse relationship between leadership turnover and nurse turnover was found: the higher the administrator turnover the lower the nurse turnover rate. CONCLUSION: Leadership practices and administrator turnover are significant in influencing regulated nurse turnover in LTC. IMPLICATIONS FOR NURSING MANAGEMENT: Long-term care facilities may want to focus on building good leadership and communication as an upstream method to minimize nurse turnover.

Nursing turnover in a large, rural health system.

PURPOSE: Nursing turnover is a leading cause of inefficiency in health care delivery. Few studies have examined turnover among nurses who work in rural areas. METHODS: We accessed human resources data that tracked hiring and terminations from a large health system operating in South Dakota, North Dakota, and Minnesota between January 2016 and December 2017. Our study sample included 7,634 registered nurses, 1,765 of whom worked in a rural community. Within the health system, there were 27 affiliated hospitals, 17 of which were designated critical access hospitals. We estimated nursing turnover rates overall and stratified turnover rates by available demographic and occupational characteristics, including whether the nurse worked in a community with an affiliated acute care hospital or critical access hospital. FINDINGS: Overall, 19% of nurses left their position between January 2016 and December 2017. Turnover rates were associated with state, nurse gender and age, and occupational tenure, but were similar in urban and rural areas. Of note, turnover rates were significantly higher in communities without an affiliated acute care hospital or critical access hospital. CONCLUSION: Between 2016 and 2017, nearly 1 in 5 nurses working in this health system left their position. Turnover rates differed based on nurse demographics and selected occupational characteristics, including tenure. We also found higher turnover rates among nurses who worked in communities without an affiliated hospital, which points to a potential but unexplored benefit of hospitals in rural areas.

Exploring the Factors behind Nurses' Decision to Leave Clinical Practice: Revealing Causes for Leaving and Approaches for Enhanced Retention.

Nursing turnover has emerged as an urgent concern with a substantial influence on the financial efficiency and quality of care in healthcare frameworks worldwide. This study determined important factors associated with nurses' intentions to leave and what would bring them back. This was a cross-sectional, multisite study of nurses in three public hospitals. Convenience sampling was used to recruit 205 nurses from the selected hospitals. A questionnaire was used to measure demographic and professional background information, current job satisfaction, and the intention to leave work and return. Bivariate and multivariate analyses were run using SPSS. This study revealed that both job satisfaction (M = 47.26, SD = 11.59, range: 19-76) and intent to leave a current job (M = 14.18, SD = 4.36, range: 4-20) were reported at moderate levels. There were significant differences reported between the scores of nationality and job satisfaction (p < 0.05) and between the means of income level and intention to leave (p < 0.05). There was also a significant, negative association between satisfaction and intention to leave (r = -0.551, p < 0.05). In regression, income level (ß = 0.159, p = 0.021), incentives (ß = 0.186, p = 0.002), hospital type (ß = 0.189, p = 0.005), and intention to leave (ß = -0.454, p < 0.001) significantly influenced satisfaction. Gender (ß = -0.122, p = 0.037) and nationality (ß = -0.210, p = 0.007) were found to influence the intention to leave among participants significantly. In conclusion, this study indicated that job satisfaction and intention to leave are important factors affecting nurses' enthusiasm. Incentives also had a positive impact on increasing nurses' satisfaction levels. Future research studies should investigate what factors might lead to improved monthly salaries and provide more incentives among nurses.

Newly qualified graduate nurses' experiences of workplace incivility in healthcare settings: An integrative review.

AIM: To explore, identify and integrate the existing knowledge to categorise the characteristics, likelihood, and consequences of workplace incivility among newly qualified graduate registered nurses. A particular focus of this review is on the experiences of new nurses related to these negative workplace behaviours and the strategies employed by these nurses and their organisations to manage workplace incivility. BACKGROUND: Workplace incivility has been widely recognised as a global problem in healthcare settings and is known to affect nurses in all facets of their professional and personal life. This might be particularly harmful for newly qualified graduate nurses, as they are unprepared to deal with this uncivil culture. DESIGN: An integrative review of the global literature, conducted according to the Whittemore and Knafl framework. METHODS: Database searches (CINAHL, OVID Medline, PubMed, Scopus, Ovid Emcare and PsycINFO), and manual searching generated an aggregate of 1904 articles, which were further screened based on inclusion criteria and eligibility using the Mixed Methods Appraisal Tool (MMAT). Peer-reviewed empirical studies that explored the workplace incivility experiences of new graduate nurses were included in this review. Extracted data were grouped to develop themes and sub-themes. RESULTS: This review included 14 studies in total with seven quantitative and seven qualitative studies. The data collected from these studies were categorised according to the research questions into a) expectations of civility, b) experiences and exposure to workplace incivility, c) forms and characteristics of incivility, d) sources of incivility, e) consequences of incivility, and f) managing and coping with incivility. Across studies, graduate nurses' views about the prestige and power of the nursing profession are conflicted due to experiences of incivility in clinical practice. New graduate nurses experienced a high but variable prevalence of incivility from their co-workers (25.6-87 %), with manifestations of incivility varying greatly, including eye rolling, yelling, exclusion and sexual harassment. Included studies primarily focused on professional and organisational effects and their outcomes relative to the physical and psychological effects on new nurses. CONCLUSION: Findings from the literature demonstrate that incivility directed toward newly qualified graduate nurses is prevalent and can have significant negative impact on their self-esteem and confidence, which may ultimately impact on their workforce participation decisions and the quality of patient care. Supportive and empowering work environments are vital not only for improved nurse health and well-being, but also to retain new graduate nurses. The current nursing shortage emphasises the need for such conditions.

A mentoring programme to meet newly graduated nurses' needs and give senior nurses a new career opportunity: A multiple-case study.

AIM: To evaluate the implementation of a multifaceted mentoring programme in a large university hospital and describe its value from the perspectives of newly graduated nurses, experienced nurses and the hospital organisation. BACKGROUND: Healthcare organisations need long-term competence-planning strategies to retain nurses, prevent their premature departure from the profession and use their competencies. This paper reports a mentoring programme focused on supporting newly graduated nurse' transition to practice and senior nurses' professional development as supervisors. DESIGN: A multiple-case study. METHODS: We performed 35 interviews with nurses, supervisors and nurse managers in the five units that implemented the programme, mapped the programme at the hospital level and extracted the nurses' working hours. The interviews were analysed thematically using the theoretical lens of the head-heart-hand model to interpret the results. RESULTS: Of 46 units in the hospital, 14 had implemented one or several of the components in the mentoring programme. The programme corresponded to the newly graduated nurses' needs, gave senior nurses a new career opportunity and contributed to an attractive workplace. The main theme, Giving new nurses confidence, experienced nurses a positive challenge and the organisation an opportunity to learn, reflects the value of the programme's supervisory model to new and experienced nurses and to the organisation as a whole. CONCLUSION: The mentoring programme appeared to be a promising way to smooth the transition for newly graduated nurses. The experienced supervising nurses were key to the success of this complex programme, supporting the new nurses at the bedside and being available to respond to their questions and reflections. Embedding the supervisors in the units' daily practice was necessary to the success of the different parts of the programme. Despite the strategic and well-designed implementation of this mentoring programme aimed to solve the everyday challenge of nurse shortages in the hospital, it was a challenge to implement it fully in all the units studied.

Occupational commitment and job satisfaction mediate effort-reward imbalance and the intention to continue nursing.

AIM: Occupational commitment and job satisfaction are major predictors of the intention to continue nursing. This study's purpose was to verify the mediating effects of job satisfaction and three components of occupational commitment on the relationship between effort-reward imbalance and the intention to continue nursing. METHODS: A self-report questionnaire was distributed to 3977 nurses by the nursing department of 12 hospitals in the Tohoku and Kanto districts of Japan in 2013. Of these, 1531 (response rate: 38.5%) nurses returned the questionnaire by mail and the complete data that were provided by 1241 nurses (valid response rate: 31.2%) were analyzed. RESULTS: Structural equation modeling showed that the effort-reward ratio had negative effects on job satisfaction and affective and normative occupational commitment. Job satisfaction and affective and normative occupational commitment had positive effects on the intention to continue nursing, whereas the effort-reward ratio had no direct effect on the intention to continue nursing. Continuance occupational commitment was not a mediator, but it positively influenced the intention to continue nursing. CONCLUSION: The findings suggest that it is important to increase job satisfaction and affective and normative occupational commitment in order to enhance their buffering effects on the relationship between job stress and the intention to continue nursing. Measures to increase continuance occupational commitment also would be an effective method of strengthening the intention to continue nursing. Improvements in these areas should contribute to an increase in nurses' intention to continue nursing and prevent the loss of this precious human resource from the health sector.

A qualitative exploration of nurses leaving nursing practice in China.

AIM: This paper reports a theoretical understanding of nurses leaving nursing practice by exploring the processes of decision-making by registered nurses in China on exiting clinical care. BACKGROUND: The loss of nurses through their voluntarily leaving nursing practice has not attracted much attention in China. There is a lack of an effective way to understand and communicate nursing workforce mobility in China and worldwide. DESIGN: This qualitative study draws on the constant comparative method following a grounded theory approach. METHOD: In-depth interviews with 19 nurses who had left nursing practice were theoretically sampled from one provincial capital city in China during August 2009-March 2010. RESULTS: The core category 'Mismatching Expectations: Individual vs. Organizational' emerged from leavers' accounts of their leaving. By illuminating the interrelationship between the core category and the main category 'Individual Perception of Power,' four nursing behaviour patterns were identified: (1) Voluntary leaving; (2) Passive staying; (3) Adaptive staying and (4) Active staying.

Resources-tasks imbalance: Experiences of nurses from factors influencing workload to increase.

BACKGROUND: While nursing workload is a worldwide challenge, less attention has been given to the determining factors. Understanding these factors is important and could help nursing managers to provide suitable working environment and to manage the adverse outcomes of nursing workload. The aim of this study was to discover nurses' experiences of determinant factors of their workload. MATERIALS AND METHODS: In this qualitative study, the participants included 15 nurses working in two hospitals in Tehran, Iran. The data were collected through 26 unstructured interviews and were analyzed using conventional content analysis. The rigor has been guaranteed with prolonged engagement, maximum variance sampling, member check, and audit trail. RESULTS: Resource-task imbalance was the main theme of nurses' experiences. It means that there was an imbalance between necessary elements to meet patients' needs in comparison with expectation and responsibility. Resource-task imbalance included lack of resource, assignment without preparation, assigning non-care tasks, and patients' and families' needs/expectations. CONCLUSIONS: A deep and comprehensive imbalance between recourses and tasks and expectations has been perceived by the participants to be the main source of work overload. Paying more attention to resource allocation, education of quality workforce, and job description by managers is necessary.