According to a new study published in the journal JAMA Pediatrics, how nurses perceive the difficulty of their workday plays an important role in patient care regardless of the size of the nurses’ caseload or how sick their patients are. The research notes the importance of keeping in mind the many on-the-job pressures that nurses face. It focuses on developing workload strategies that facilitate quality nursing care, notes lead researcher Heather L. Tubbs Cooley, Ph.D., RN, FAAN, associate professor in the College of Nursing, the Martha S. Pitzer Center for Women, Children, and Youth at The Ohio State University in Columbus, Ohio.

“The bottom line message here is that we find that the subjective reporting of the intensity of the workload on a shift is much more strongly associated with whether or not the nurse will miss care for her assigned infants rather than the ratio of nurses to patients,” Dr. Tubbs Cooley says. “We don’t really understand what drives that rating yet. We imagine there are so many different factors that would drive the feelings of intensity and pressure and are trying to understand what these are so that we can address them.”

‍What Did The Study Find?

The study focused on the nurses in a neonatal intensive care unit and collected data collected during 332 12-hour shifts from 136 NICU nurses. The researchers collected objective measures of infant-to-nurse staffing ratios and infant acuity, which measures the severity of a patient’s illness during each shift. The nurses who participated also answered questions that measured their perceived workload based on mental and physical demands, how hurried a nurse felt during a shift, and the effort required to accomplish patient care. 

“The measure that we used to assess the nurses’ subjective workload was developed at NASA and is still used today to measure the workload of astronauts, pilots, and air traffic controllers,” explains Dr. Tubbs Cooley. 

In the study, the researchers concluded, “The workload of NICU nurses is significantly associated with missed nursing care, and subjective workload ratings are particularly important. Subjective workload represents an important aspect of nurse workload that remains largely unmeasured despite the high potential for intervention.”

The study reported that missed care was reported on 326 (98.2%) of the 332 shifts and 2,502 (24.0%) of 10,428 corresponding nurse-infant shifts missed care data. When care was reported as missed, it was missed either rarely or occasionally. Overall, the nurses most frequently missed hourly checks of intravenous lines and adherence to the central line-associated bloodstream infection bundle. Less frequently, nurses reported missing standard safety checks of equipment and alarms, according to the study.‍

Why Is The Research Important?

The topic that the JAMA Pediatrics study focused on had long been an area of interest for the researchers, Dr. Tubbs Cooley said. While staffing ratios are important and draw a lot of attention, the in-the-moment workload judgments of the nurses are just as important, she says. For example, she notes that most neonatal intensive care units have a two-to-one or a one-to-one ratio of nurses to infants, depending on the infants’ needs. But even if a nurse is taking care of one baby but perceives the shift as very intense, they may be more likely to miss something, Dr. Tubbs Cooley explained. 

“It’s really important for health care leaders to make sure that the nurses’ perspective of their workload is incorporated into their work plan because that is the most predictive of the care that they are going to deliver on a given day,” Dr. Tubbs Cooley says.