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  • Subject Name : Nursing

Introduction

Heath care workload is associated with a huge amount of work allocated for nurses. Nursing workload measures do not ensure efficiency and do not accurately capture the complexity of nursing workload, particularly when the indicators relate to the workplace environment (Fishbein et al., 2019). Patient care’s efficiency has been found to decline when staffing is inadequate to get healthcare and other work completed. There are many negative health effects associated with greater workloads in the nursing field. The huge workload of nursing staff is a big concern for the health-care system in Australia. The key reasons that nurses receive additional workloads than it has ever been are due to increased demand for nursing, insufficient supply of nursing, decreased staffing and increased overtime, and shortened length of stay (Hertzum & Simonsen, 2016). These are criteria for improving work processes which can be changed to reduce the workload of nursing which minimizes the adverse effects of a heavy workload of nursing. This article explains the causes of the nursing workload, discusses the effect of the workload on patients and nurses. It also addresses the different facets of the process between the nursing workload in health care and patient safety.

Nursing Workloads at Different Levels

Unit Level- The unit-level workload is measured as the ratio of nurses to patients. With relation to nursing staffing, the nurse-patient ratio could be taken for determining units and the patient conditions. Previous research offers compelling strong evidence unit level clinical caseloads have a detrimental influence on patient outcomes. Recommendations from such studies on clinical care strategies are restricted to raising the number of staff in one unit, or decreasing the patient’s numbers allocated to each nurse (Hertzum & Simonsen, 2016). However, at times due to cost and a staff shortage, it might not be feasible to obey such standards.

Job Level- The degree of workload dependent on the characteristics of the job as a nurse (ICU nurse vs. operating room nurse) or the specialization as degree of complexity varies. The various hospital departments or wards have different levels owing to the load of work. Similar to the ward nurses, including the ICU nurse would have more jobs (Baraki et al., 2017). Employment-level workload metrics are evident when analyzing nurses of different disciplines or job criteria for workload rates (ICU nurses vs. ward nurses). In those other cases, due to the various contextual factors that occur at each unit, the two-unit nurses can have different workload levels. The conceptualization workload at the task level does not justify the disparity between those two nurses' workloads.

Patient-Level- Most patient-level workload metrics were established based on the clinical factors associated with the patient's condition. The factors depending on the patient's state of health (poor communication, supplies not stored well) can have a significant effect on the nursing workload. The individual with chronic health issues, neonates, or older patients requires more health care and time relative to the young patients (Dagget, Molla & Belachew, 2016).

Situation-Level- Concerning the total number of cases referred to a nurse and the specific problems of the patient, the situation-level workload happens. It is due to the nature of the health care settings which explains the workload faces of a nurse. Conditions such as poor working setting, differing family needs, poorly supplied equipment, and ineffective communication between members of the multidisciplinary team — greatly affects the workload at the situation level (Batt & Terwiesch, 2017). For example, multiple close family members can call a nurse on different occasions, and ask very different queries about the condition of the same patient. This type of situation creates a performance barrier that dramatically increases the nurse's work (situation-level). Also, it is tedious to respond to all of the numerous calls and communicating the status of the patient's condition to many family members.

Nursing Workload’s Impact on Nurses

High workload for nurses in health care settings is a major job stressor. Depression and burnout (e.g., cynicism, frustration, and psychological distress) may result from heavy workload in nursing care. Exhausted and fatigued nurses might not work productively and efficiently, as their cognitive and behavioral resources might well be decreased and this inadequate efficiency can affect patient care and health (Wen et al., 2016). Workload may be a contributing factor to the mistakes. Errors were categorized as falls and failures, failures in the implementation, and inaccuracies in the details. Imperative pressure workloads can reduce a nurse's attention to vital safety activities, creating the environment for mistakes and insufficient clinical care. Several studies have shown the link between the work habits of the nurses, such as tremendous workloads and lack of job satisfaction. The frustration with the work of nurses will affect morale, absenteeism, turnover, and low job satisfaction and seriously harm the quality of nursing care and organizational efficiency (Ahmad et al., 2019). Investigators identified positive correlations between employee commitment and work efficiency, and enhancing health and medical care quality.

Breaches of standards and codes are characterized as intentional deviations from those practices (i.e. written rules, regulations, orders, or protocols) deemed appropriate for safe or secure operations to be sustained. The violation literature highlights the importance of the social factors and contributes to organizational, where action is regulated by operating protocols, codes of conduct, laws, and regulations. The approach highlights factors that may lead to failures in the work environment. The world of health care has started investigating breaches of guidelines by caregivers (Bagheri Hosseinabadi et al., 2019).

The study investigated two variables which were manipulated in nine anesthetics, surgery, and obstetrics scenarios. The first dimension was, action, which have been defined as improvisation, clinical protocol violation, or clinical protocol enforcement. The second dimension, patience result, has been described as good, bad, or weak. Sections of nursing staff and the patients and relatives were required to consider the nine cases regarding the inappropriateness of the behavior, the likelihood of more intervention (i.e. supervision by health care personnel and reporting to the media), and accountability for the result (i.e., the hospital worker, the patient, the process on its own). Results revealed that the strictest judgment was for breaches of procedures and poor results (Oliveira et al., 2016). If the results were positive or poor, they judged violations more negatively. The study authors cautioned against overreliance as a form of organizational defense against injuries or claims on protocols. Procedures can hinder creativity and make people less capable of working in novel circumstances (Habib, Shalkamy & El-Basyouny, 2019).

Nursing Workloads Impact on Patient Healthcare Outcomes

Nursing staff with such a huge work may not even have sufficient opportunity to execute tasks properly, apply industry standards or track patients who may hinder their interaction with physicians and other providers. So, there is no or little time to use double test the medications to be supplied to patients (Van der Heijden et al., 2017). Nurses with a heavy workload can be unhappy about their tasks, reducing their enthusiasm for high-quality results. High workload which creates dissatisfaction and can contributes to the creation of a negative attitude towards one's work. The hectic schedule can trigger stress and burnout, which can adversely affect their performance because the cognitive and emotional resources available to nurses for adequate treatment have been limited (Tong, (2018). Cognitive tasks (one component of nursing workload) can lead to mistakes, that could be falls and mishaps, or any other medical mistakes. Increased levels of workload will make it increasingly challenging for nursing staff to obey the standards and regulations, thereby jeopardizing the quality and safety of patient care. Sometimes because of the heavy workload, the nurses miss to observe the hygiene of the hands to hurry to their duties. There might not be a nurse available to assist other nurses in helping their patients whenever needed (Karlsson et al., 2019). Because of the job strain, they would not be able to work as a team to support the patients. At times the Professional Nursing Standards are compromised, by the extent of undermined nursing profession standards due to workload.

A few researchers have found a major association among lower staff turnover for nurses and high pneumonia incidence. The heavy workload seems to be responsible for causing various hospital-acquired infections in the patients. To order to properly determine the effect of workload on clinical outcomes, a greater interpretation of nursing overload is needed as the workflow is impacted by greater than just staffing rates.

Impacts on Nursing Workload

Healthcare organization is finding ways to achieve a reasonable balance between health outcomes and the size and experience of nursing staff, to provide their patients with high-quality care and outstanding service while ensuring operational efficiencies. It is difficult to assess critically whether the nursing ability on the hospital wards is optimally tailored to patient needs (Huber, 2017). They seek to ensure a fair and reasonable allocation of nursing staff across the wards, culminating in a workload that is distributed fairly and achievable for all nurses. This needs a decent balance between the needs of patients and nurses. One way to ensure a better match is for nursing workers to work with a system of care coordination. By principle, this would help balance the needed services with the available resources, which avoids unnecessary expenses to overstaff a medical ward and, but at the other hand, by understaffing a hospital, avoids a reduction by patient satisfaction or employee involvement (Connolly, Jacobs & Scott, 2018). There is a clear connection between the workload of nurses and the outcomes of patients, and the level of treatment stated by the nurse.

An effective workload management system can help to keep the workers safe, as an indicator of burnout and absenteeism is high workload. There is a connection between job demands including workload and output requirements. A strong bidirectional relationship between work dissatisfaction, stress, and burnout among the nursing shortage and registered nurses has been seen. All health systems face that scrutiny intending to cost control, either as a result of the effects of the restructuring of the health sector (Ellis, 2018). Healthcare system is labor-intensive, and the amount and composition of workers employed is essential to deciding treatment price and performance. Managers and health practitioners in any healthcare organization must aim to determine the most efficient personnel combination possible within the management and corporate goals that are available. Additionally, nursing personnel in the Netherlands is relatively limited, and this is not expected to improve in the immediate future. Job demand is projected to increase as the aging population, with implications for potential training and expertise as the availability of healthcare workers declines, leading in deficits of health care labor (Long et al., 2017). Workload has also been shown to an impact either explicitly and also as a moderating mechanism on the decision of the nurses to depart and on work outcomes. The turnover rate of nurses leads to higher training costs for student nurses or the use of temporary employees and thus has to be reduced significantly.

Conclusion

Heath care nurse workload is associated with the amount of work allocated for nurses. The heavy workload affects the nurses and the safety of the patients. The frustration with the work of nurses will affect morale, absenteeism, turnover, and low job satisfaction and seriously harm the quality of nursing care and organizational efficiency. Workload decreases productivity and it effects the quality of patient care; it is needed to bring down the complexity for nursing especially when indicators affect the workplace environment. The nursing workload should be identified and managed so that can provide a better understanding of nursing care. Also, the healthcare sector can enable strategies to minimize the workload in nursing staff so that the best patient care can be provided.

References

Ahmad, R., Lee, M. Y., Othman, A. E. A., Shaminan, A. S., Heng, C. S., Sumilan, H., & Ahmad, A. I. A. (2019). The impact of workload on job performance among doctors in Malaysian public hospitals. A Case Study. International Journal of Business and Society, 20(3), 1276-1293.

Bagheri Hosseinabadi, M., Khanjani, N., Etemadinezhad, S., Samaei, S. E., Raadabadi, M., & Mostafaee, M. (2019). The associations of workload, individual and organizational factors on nurses' occupational injuries. Journal of Clinical Nursing, 28(5-6), 902-911.

Baraki, Z., Girmay, F., Kidanu, K., Gerensea, H., Gezehgne, D., & Teklay, H. (2017). A cross sectional study on nursing process implementation and associated factors among nurses working in selected hospitals of Central and Northwest zones, Tigray Region, Ethiopia. BMC Nursing, 16(1), 54.

Batt, R. J., & Terwiesch, C. (2017). Early task initiation and other load-adaptive mechanisms in the emergency department. Management Science, 63(11), 3531-3551.

Connolly, M., Jacobs, S., & Scott, K. (2018). Clinical leadership, structural empowerment and psychological empowerment of registered nurses working in an emergency department. Journal of Nursing Management, 26(7), 881-887.

Dagget, T., Molla, A., & Belachew, T. (2016). Job related stress among nurses working in Jimma Zone public hospitals, South West Ethiopia: A cross sectional study. BMC Nursing, 15(1), 39.

Ellis, P. (2018). Leadership, management and team working in nursing. Learning Matters.

Fishbein, D., Nambiar, S., McKenzie, K., Mayorga, M., Miller, K., Tran, K., ... & Capan, M. (2019). Objective measures of workload in healthcare: A narrative review. International Journal of Health Care Quality Assurance.

Habib, K., Shalkamy, A., & El-Basyouny, K. (2019). Investigating the effects of mental workload on highway safety. Transportation Research Record, 2673(7), 619-629.

Hertzum, M., & Simonsen, J. (2016). Effects of electronic emergency-department whiteboards on clinicians’ time distribution and mental workload. Health Informatics Journal, 22(1), 3-20.

Huber, D. (2017). Leadership and Nursing Care Management-e-book. Elsevier Health Sciences.

Karlsson, A. C., Gunningberg, L., Bäckström, J., & Pöder, U. (2019). Registered nurses’ perspectives of work satisfaction, patient safety and intention to stay–A double‐edged sword. Journal of Nursing Management, 27(7), 1359-1365.

Long, P., Abrams, M., Milstein, A., Anderson, G., Apton, K. L., & Dahlberg, M. J. (2017). Effective care for high-need patients. Washington, DC.

Oliveira, A. C. D., Garcia, P. C., & Nogueira, L. D. S. (2016). Nursing workload and occurrence of adverse events in intensive care: A systematic review. Revista da Escola de Enfermagem da USP, 50(4), 683-694.

Tong, L. (2018). Relationship between meaningful work and job performance in nurses. International Journal of Nursing Practice, 24(2), e12620.

Van der Heijden, B. I., Mulder, R. H., König, C., & Anselmann, V. (2017). Toward a mediation model for nurses’ well-being and psychological distress effects of quality of leadership and social support at work. Medicine, 96(15).

Wen, J., Cheng, Y., Hu, X., Yuan, P., Hao, T., & Shi, Y. (2016). Workload, burnout, and medical mistakes among physicians in China: A cross-sectional study. Bioscience trends, 10(1), 27-33.

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