Nursing Workloads, Frequent Interruptions and Job Satisfaction

While a number of studies continue to explore the correlation between nursing workloads and patient safety, some specific studies have been looking into the extent to which “care not done” is associated with heavy workloads.

For example, in one Canadian study, researchers looked at 472 acute care nurses from one province. They considered seven indicators of workload: (1) RN staffing levels, (2) patient acuity, (3) patient dependency, (4) nurses’ perceptions of heavy workload, (5) nursing tasks left undone, (6) compromised professional nursing standards and (7) interruptions to workflow. The principal aim of the study was to understand the effect of unit, job and task-level workload factors on three adverse patient outcomes – medication errors, patient falls, and urinary tract infections. Researchers also wanted to know the effect of workload factors on nursing outcomes, such as emotional exhaustion and job satisfaction.

RESEARCH RESULTS

What did they find?

Higher patient-RN ratios were weakly associated with all three adverse patient outcomes, while patient acuity was the strongest independent predictor of medication errors.

They also found that frequent interruptions were strong, independent predictors for all three adverse patient outcomes.
For example, nurses who experienced interruptions on a daily basis were three times more likely to report patient falls on a weekly basis than nurses who experienced interruptions less frequently.

In general, nurses who experienced heavy workloads on a daily basis were almost six times more likely to report patient falls on a weekly basis than nurses who experienced heavy workloads less frequently.

NURSE OUTCOMES

In terms of nurse outcomes, the results showed that frequent interruptions to workflow also was an independent predictor of emotional exhaustion. In addition, nurses who experienced heavy workloads on a daily basis were three and a half times more likely to report high emotional exhaustion than nurses who experienced heavy workloads less frequently.

The same was true for job satisfaction.

In addition to other factors, frequent interruptions were also associated with lower levels of job satisfaction.

Bottom line for these researchers – tasks left undone were found to be a significant factor with respect to perceived heavy workload and interruptions for all three patient outcomes. This suggests that “in addition to their direct effects, heavy workload and interruptions influence patient outcomes indirectly through their influence on nurses’ ability to complete essential tasks.” The researchers said heavy workloads and interruptions also compromise professional nursing standards.

The researchers say these two factors – nursing workloads and interruptions – could be the “litmus test” for nurses’ capacity to effectively deliver care within their work environments.

Ball JE, Murrells T, Rafferty AM, et al‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care BMJ Quality & Safety Published Online First: 29 July 2013. doi: 10.1136/bmjqs-2012-001767