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Dhaini SR, Abed Al Ahad M, Simon M, Ausserhofer D, Abu-Saad Huijer H, Elbejjani M. Repeated assessments and predictors of nurses' shift-specific perceived workload. Nurs Forum 2022; 57:1026-1033. [PMID: 35790004 DOI: 10.1111/nuf.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/10/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Suzanne R Dhaini
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Mary Abed Al Ahad
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, Scotland
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- College of Health-Care Professions Claudiana, Bozen, Italy
| | | | - Martine Elbejjani
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Maghsoud F, Rezaei M, Asgarian FS, Rassouli M. Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach. BMC Nurs 2022; 21:273. [PMID: 36209155 PMCID: PMC9548180 DOI: 10.1186/s12912-022-01055-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Nursing workload and its effects on the quality of nursing care is a major concern for nurse managers. Factors which mediate the relationship between workload and the quality of nursing care have not been extensively studied. This study aimed to investigate the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and quality of nursing care. Methods In this cross-sectional study, 311 nurses from four different hospitals in center of Iran were selected by convenience sampling method. Six self-reported questionnaires were completed by the nurses. The data were analyzed by SPSS version 16. Structural equation modeling was used to determine the relationships between the components using Stata 14 software. Results Except direct and mutual relationship between workload and quality of nursing care (P ≥ 0.05), the relationship between other variables was statistically significant (P < 0.05). The hypothesized model fitted the empirical data and confirmed the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and the quality of nursing care (TLI, CFI > 0.9 and RMSEA < 0.08 and χ2/df < 3). Conclusion Workload affects the quality of the provided nursing care by affecting implicit rationing of nursing care, job satisfaction and emotional exhaustion. Nurse managers need to acknowledge the importance of quality of nursing care and its related factors. Regular supervision of these factors and provision of best related strategies, will ultimately lead to improve the quality of nursing care.
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Affiliation(s)
- Fatemeh Maghsoud
- Medical Surgical Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahboubeh Rezaei
- Trauma Nursing Research Center, School of Nursing and Midwifery, Kashan University of Medical Sciences, 5th of Qotb -e Ravandi Blvd, P.O.Box: 8715981151, Kashan, Iran.
| | - Fatemeh Sadat Asgarian
- Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Rassouli
- Department of Pediatric and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abed Al Ahad M, Elbejjani M, Simon M, Ausserhofer D, Abu-Saad Huijer H, Dhaini SR. Variability, shift-specific workloads and rationed care predictors of work satisfaction among Registered nurses providing acute care: A longitudinal study. Nurs Open 2021; 9:1190-1199. [PMID: 34908247 PMCID: PMC8859047 DOI: 10.1002/nop2.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/01/2021] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Mary Abed Al Ahad
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Martine Elbejjani
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Inselspital, Bern, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,College of Health-Care Professions Claudiana, Bozen, Italy
| | | | - Suzanne R Dhaini
- Institute of Nursing Science, University of Basel, Basel, Switzerland
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Self-assessment of Rationing and Quality of Nursing Care. J Nurs Care Qual 2021; 37:E48-E53. [PMID: 34775421 DOI: 10.1097/ncq.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nursing care rationing has been a widespread problem in everyday nursing practice for many years. PURPOSE The aim of this research study was to assess the prevalence of care rationing among nurses working in Poland. METHODS The study was conducted among a population of 1310 nurses. To examine the dependencies between the sociodemographics and unfinished nursing care, the Polish adaptation of the Perceived Implicit Rationing of Nursing Care questionnaire and an investigator-developed questionnaire were used. RESULTS The mean level of missed care was 1.16 (SD = 0.7). The significant predictors of care rationing were associated with the quality of patient care (βstd = -.43, P < .001) and general work satisfaction (βstd = -.15, P < .001). CONCLUSIONS Job satisfaction and the quality of nursing care should be constantly monitored as these factors are significantly associated with the levels of care rationing.
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Kołtuniuk A, Witczak I, Młynarska A, Czajor K, Uchmanowicz I. Satisfaction With Life, Satisfaction With Job, and the Level of Care Rationing Among Polish Nurses-A Cross-Sectional Study. Front Psychol 2021; 12:734789. [PMID: 34650492 PMCID: PMC8505674 DOI: 10.3389/fpsyg.2021.734789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/27/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Rationing of nursing care is a serious issue that has been widely discussed throughout recent years in many countries. The level of satisfaction with life and of satisfaction with job as the nurse-related factors may significantly affect the level of care rationing. Aim: To assess the rationing of nursing care among the Polish nurses and the impact of nurse-related variables, i.e., satisfaction with life and satisfaction with job on the level of nursing care rationing. Materials and Methods: A cross-sectional study was conducted among 529 Polish registered nurses employing in two University Hospitals. Three self-report scales in the Polish version were used in this study, namely, Basel Extent of Rationing of Nursing Care-revised version (BERNCA-R), Satisfaction with Life Scale (SWLS), and Satisfaction with Work Scale (SWWS). Results: The respondents indicated that the most frequently rationed activity is studying the situation of individual patients and care plans at the beginning of the shift. The least frequently rationed activity indicated by the respondents was adequate hand hygiene. The patient-to-nurse ratio and the level of satisfaction with job are significant independent factors affecting the level of care rationing. Conclusions: The assessment of the level of satisfaction with life and identification of factors affecting this assessment will enable reducing the occurrence of care rationing.
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Affiliation(s)
- Aleksandra Kołtuniuk
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Izabela Witczak
- Department of Health Care Economics and Quality, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Karolina Czajor
- Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Saar L, Unbeck M, Bachnick S, Gehri B, Simon M. Exploring omissions in nursing care using retrospective chart review: An observational study. Int J Nurs Stud 2021; 122:104009. [PMID: 34298321 DOI: 10.1016/j.ijnurstu.2021.104009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 05/30/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Omissions in nursing care can compromise patient safety. To date, this phenomenon has been investigated almost exclusively via nurse surveys. However, such surveys restrict the range of activities which can be assessed for omissions, and patient level analysis. As an alternative, retrospective chart review methodology has been used successfully in other research fields, but not yet for omitted nursing care. OBJECTIVES To describe characteristics and frequency of omitted nursing care using a retrospective chart review methodology. DESIGN, SETTING AND PARTICIPANTS Observational single center study in two German neurological inpatient units. A random sample of 100 patient admissions was used. METHODS A structured chart review protocol to detect nursing omissions was developed and applied. The full range of expected nursing care activities were assessed regarding the importance of documenting them and whether they had been fully or partially omitted. Vital sign measurements were assessed regarding both the measurement target number and the number of measurements recorded. RESULTS In total, 1885 activities-a mean of 19 per patient-were identified. Of the reviewed activities, 52% (n = 971) were fully or partially omitted. Patients experienced between one and 22 omitted nursing care activities during their hospital stay (8-84% of expected care activities). Ranging from 6% to 100% some activities were more commonly omitted than others during admission. The most frequently omitted nursing activity was giving emotional care (88%, n = 66); the least frequently omitted was teaching (10%, n = 29). Vital signs were recorded only 50% (n = 141) of the targeted number of times. CONCLUSIONS Using a retrospective chart review protocol to identify omissions in nursing care allows the assessment of a broad range of nursing activities. Additionally, this is the first-time patient-level data on a broad range of activities have been analyzed. The newly developed chart review methodology can complement established survey methods and provide a new perspective on the phenomenon of omitted nursing care.
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Affiliation(s)
- Lili Saar
- Department of Neurology, Universitätsklinik Freiburg, Breisacherstrasse 64, Freiburg im Breisgau D-79106, Germany.
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun SE-791 88, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm SE-171 77, Sweden.
| | - Stefanie Bachnick
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Nursing Science, University of Applied Sciences (hsg Bochum), Bochum, Germany.
| | - Beatrice Gehri
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Psychiatry, University Hospital Basel, University of Basel, Basel CH- 4002, Switzerland.
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Nursing, Nursing Research Unit, Inselspital Bern University Hospital, Bern 3010, Switzerland.
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Elbejjani M, Abed Al Ahad M, Simon M, Ausserhofer D, Dumit N, Abu-Saad Huijer H, Dhaini SR. Work environment-related factors and nurses' health outcomes: a cross-sectional study in Lebanese hospitals. BMC Nurs 2020; 19:95. [PMID: 33061841 PMCID: PMC7545948 DOI: 10.1186/s12912-020-00485-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/24/2020] [Indexed: 01/14/2023] Open
Abstract
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.
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Affiliation(s)
- Martine Elbejjani
- Clinical Research Institute, and Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mary Abed Al Ahad
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Inselspital, Bern, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,College of Health-Care Professions Claudiana, Bozen, Italy
| | - Nuhad Dumit
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | | | - Suzanne R Dhaini
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
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