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


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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.

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