Current Issues and Future Perspectives of Nursing Workloads

Nurses play a significant role in health care system. However, nurses have been facing many challenges in healthcare settings. The heavy nursing workload is one of critical current issues that should be concerned and addressed. This paper will examine a nursing workload issue and articulate the issue why it is related to nursing and healthcare. 

 It has been said that nurses are experienced and burdened with heavy workloads. Having an excessive daily nurse task can be a major problem in health care system because nurses may not have enough time to complete patient care activities to the nursing standards efficiently and effectively. Increasing workload can be found from a variety of reasons. For example, the nursing shortage can be one of numerous factors causing heavy workloads. “Inadequate staff availability is commonly reported, because of inadequate baseline staffing, or failure to replace staff that are away ill or on vacation.” (Berry & Curry, 2012, p. 47). Another study has been found that nurses cannot get everything done if there are not enough nursing staffs (Neill, 2011, p. 132). When a nursing shortage happens, the higher amount of nursing workload can increase in a clinical unit. Moreover, another factor of nursing workload would be excessive non-nursing duties. “In the United States and Canada, around 35-45% of nurses spend their time on non-nursing duties including transporting patients and food delivery” (Aiken et al., as cited in Neill, 2011, p. 132). Similarly, Carayon & Gurses (2008) mentioned that a lot of nonprofessional nursing tasks need to be done during a shift such as cleaning, ordering, coordinating, or providing ancillary services resulting in nursing tasks left undone completely or unmet nursing care needs. Furthermore, inappropriate staff or staff not given adequate orientation in area assigned can be a major factor causing an overwhelming workload. For example, floating can cause workload when nurses are assigned to the unit where they feel their skills are inadequate, lack of confident or feel unfamiliar with work environments. In some situations, lack of appropriate designation of nursing staff required to care for the level of complexity of patients may encounter nursing workload as well. In Saskatchewan, over 45% of nurses reported that the number of appropriate staff available has decreased, but the acuity of patient care tasks has increased to 72%, as well, 34% of nurses in Ontario stated that inappropriate skill mix for the complexity care of patients will be a significance issue of workload (Berry & Curry, 2012, p. 49-50). As previously mentioned, ongoing staff shortages, a tremendous amount of multitasking in non-nursing care and inappropriate delegation of nursing responsibilities in area assigned can affect negative outcomes. 

Increasing nursing workloads are associated with both nursing and healthcare. There are various negative consequences of excessive nursing workload such as patient outcomes, nurses’ work, and health care organizations. Interestingly, according to the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, a heavy workload can influence a direct effect on the quality and safety of patient care because of lack of time, job dissatisfaction, nursing stress and burn out, nursing errors, violations, and systemic or organizational impact (as cited in Carayon & Gurses, 2008). Research showed that high nursing workload can reduce patient safety and quality of care (Ross, Rogers & King, 2018, p. 1). Two research studies have consistently demonstrated “clear relationships between inadequate nurse staffing and poor patient outcomes, including increases in mortality rates, hospital-acquired pneumonia, urinary tract infections, sepsis, hospital-acquired infections, pressure ulcers, upper gastrointestinal bleeding, shock and cardiac arrest, medication errors, falls, failure to rescue and longer than expected length of hospital stay” (Needleman et al., as cited in Berry & Curry, 2012, p. 27). Patient safety is an essential part of nursing care; however, unreasonable nursing workloads can decrease the quality of care leading to patient safety concerns (The British Columbia Nurses Union, 2015, p. 2). For example, nurses have no time to monitor patients’ status changes due to an overwhelming workload which can lead to negative patient care quality. Similarly, “under high workload, nurses may not have sufficient time to follow rules and guidelines for safe care, especially if following the rules and guidelines necessitate additional time, such as hand washing”. (Carayon & Gurses, 2008). Additionally, under a heavy workload, nurses are experiencing high rates of burnout, job dissatisfaction, turnover and exhaustion, as well as, absenteeism due to lack of control over nurses’ work. (Ross et al., 2018). Nurses feel overwhelmed, stressed, dissatisfied with their job because of high level of workload (Carayon & Gurses, 2008). Surprisingly, many nurses decide to leave their job and find something better.   Simultaneously, an excessively heavy workload can not only cause an increase in burnout, exhaustion and absenteeism, but also can affect health care organization. Berry and Curry (2012) claimed that “Nurse burnout, fatigue and absenteeism as a result of excessive workload continue to impact patient care outcomes at considerable cost to the system” (p 22). Also, it has been demonstrated that “turnover continues to plague the health care system. On average, one in five Canadian hospital nurses leaves his or her job every year, at a per capita cost to the institution of $25,000” (O’Brien-Pallas et al., as cited in Berry & Curry 2012, p. 22).

In conclusion, excessive nursing workload is a huge problem in nursing system that needs to be addressed and resolved. Therefore, nurses need to understand the situation of nursing issues, the effects or negative outcomes, and what it is involved in or relevant to nursing and healthcare organization which can lead to improve nursing care system and enhance quality of patient care.

References

• Berry, L., & Curry, P. (2012). Nursing workload and patient care. Ottawa: Canadian Federation of Nurses Unions. Retrieved from http://neltoolkit.rnao.ca/sites/default/files/Nursing%20Workload%20and%20Patient%20Care_0.pdf
• Carayon, P., & Gurses, A. P., (2008). Chapter 30. Nursing workload and patient safety – A human factors engineering perspective. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2657/pdf/Bookshelf_NBK2657.pdf  
• Neill, D. (2011). Nursing workload and the changing health care environment: A review of the literature. Administrative Issues Journal, 1(2), 132-143. Retrieved from https://files.eric.ed.gov/fulltext/EJ1055056.pdf
• Ross, C., Rogers, C., & King, C. (2018). Safety culture and an invisible nursing workload. Collegian Journal of the Royal College of Nursing Australia. Advanced online publication. https://doi.org/10.1016/j.colegn.2018.02.002 
• The British Columbia Nurses Union (BCNU). (2015). Nursing workload and patient safety. Retrieved from https://www.bcnu.org/AboutBcnu/Documents/position-statement-patient-safety.pdf