University of Wisconsin–Madison

Nursing Work Obstacles: Workload, Quality of Working Life, and Quality and Safety of Care Among Intensive Care Nurses

  • Overview: The main purpose of this study was to investigate the relationships between performance obstacles and facilitators, perceived workload, quality of working life (QWL), and perceived quality and safety of care among intensive care nurses. The hypothesis follows that performance obstacles had both direct and indirect effects on QWL and perceived quality and safety of care among ICU nurses. The indirect effect was hypothesized to occur through the influence of performance obstacles on perceived workload.

    Methods: A cross-sectional study was conducted among 300 nurses in 17 different ICUs from 7 different hospitals to test the relationships among the variables of interest. A self-administered questionnaire was used to collect data. The questionnaire included questions on performance obstacles, perceived workload, QWL, perceived quality and safety of care, and demographic/background information.

    Findings: Results provided support for direct relationships between: performance obstacles and perceived workload, performance obstacles and QWL, performance obstacles and perceived quality and safety of care, perceived workload and QWL, and perceived workload and perceived quality and safety of care.

    Performance obstacles include: inadequate workspace, displaced equipment or patients’ charts, poorly stocked supplies, inadequate information from physicians, and a hectic/disorganized work environment. The existence of these obstacles related to a notably higher perceived workload, lower QWL, and lower perceived quality and safety of care. High perceived workload significantly increased stress and tension among ICU nurses. Furthermore, a high perceived workload had a negative impact on perceived quality and safety of care. The mediating role of perceived workload in the relationship between performance obstacles and QWL, and performance obstacles and perceived quality and safety of care was moderately supported. Results from this study suggest where to focus efforts in ICU work organization redesign.

    Funding: Agency for Healthcare Research and Quality (AHRQ)

  • Ayse Gurses, PhD
    Associate Professor, School of Medicine
    John-Hopkins University

    PhD Adviser
    Pascale Carayon, PhD
    Procter & Gamble Bascom Professor in Total Quality
    Department of Industrial and Systems Engineering
    Director, Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Committee Members
    Patricia Flatley Brennan, RN, PhD
    Lillian S. Moehlman-Bascom Professor of Nursing and Industrial and Systems Engineering
    Theme Leader, Living Environments Laboratory
    University of Wisconsin-Madison

    Robert B. Miller, PhD
    Associate Dean for Undergraduate Programs School of Business
    University of Wisconsin-Madison

    Maureen Smith, MD, MPH, PhD
    Professor of Population Health Sciences, of Family Medicine, and of Surgery
    University of Wisconsin-Madison

    Harold J. Steudel, PhD
    Professor Emeritus of Industrial and Systems Engineering
    University of Wisconsin-Madison

    Kenneth Wood, DO
    Chief Medical Officer
    Geisinger Medical Center, Danville, PA

  • Hoonakker, P., Carayon, P., Gurses, A., Brown, R., Khunlertkit, A., McGuire, K., & Walker, J.M. (2011). Measuring workload of ICU nurses with a questionnaire survey: The NASA Task Load Index (TLX). IIE Transactions on Healthcare Systems Engineering, 1 (2), 131-143. PMCID: PMC3388621

    Gurses, A.P., Carayon, P., & Wall, M. (2009). Impact of performance obstacles on intensive care nurses’ workload, perceived quality and safety of care, and quality of working life. Health Services Research, 44 (2 Pt. 1), 422-443.PMCID: PMC2677047

    Gurses, A. & Carayon, P. (2009). A qualitative study of performance obstacles and facilitators among ICU nurses. Applied Ergonomics, 40 (3), 509-518.

    Gurses, A.P. & Carayon, P. (2009). Exploring performance obstacles of intensive care nurses. Applied Ergonomics, 40 (3), 509-518. PMID: 18951120

    Gurses, A. P. & Carayon, P. (2007). Performance obstacles of intensive care nurses. Nursing Research 56 (3), 185-194.

    Gurses, A.P. & Carayon, P. (2006). Performance obstacles and nursing workload in intensive care units: A cluster analysis approach. In Pikaar, Koningsveld, & Settlers (Eds.). Proceedings of the IEA 2006 Congress, Elsevier Ltd.: London.

    Carayon, P. & Gurses, A. (2005). Nursing workload and patient safety in intensive care units: A human factors engineering evaluation of the literature. Intensive and Critical Care Nursing, 21, 284-301.

    Gurses, A.P. (2005). Performance obstacles and facilitators, workload, quality of working life, and quality and safety of care among intensive care nurses. PhD Dissertation, (Order No. 3175496), University of Wisconsin – Madison.

    Gurses, A.P. & Carayon, P. (2005). ICU nursing workload: Causes and consequences. Final Report, AHRQ Publication, Rockville, MD.

    Gurses, A.P. & Carayon, P. (2005). Identifying performance obstacles among intensive care nurses. Proceedings of the Human Factors and Ergonomics Society (HFES) 49th Annual Meeting, Santa Monica, CA. pp. 1019-1023.

  • Performance Obstacles of ICU Nurses Questionnaire

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