Patient Safety and Quality

Excessive nurse workload is a key factor affecting the safety of patients in intensive care units

Every day, 55,000 patients are cared for in the 6,000 intensive care units (ICUs) in the United States. Heavy or excessive nursing workload is a key factor affecting ICU patient safety and quality of care. A review of studies, supported by the Agency for Healthcare Research and Quality (HS11561 and HS14517), revealed that 1.7 errors per patient per day occur in ICUs. University of Wisconsin researchers Pascale Carayon, Ph.D., and Ayse P. Gurses, Ph.D., reviewed studies that indicate heavy nursing workload results in less adequate patient supervision, incorrect ventilator or equipment setup, and drug administration problems, as well as insufficient time for clinical procedures to be done properly, inadequate training or supervision, errors, overcrowding and resulting hospital-caused infections, and premature ICU discharge. All of these factors lead to worse patient outcomes. High workload may also lead to poor nurse-patient communication, impaired nurse-physician collaboration, nurse burnout, and job dissatisfaction.

The researchers propose that workload measures developed in the human factors engineering literature (called performance obstacles and facilitators) be used to assess situation-level workload. For example, if a nurse goes into a patient isolation room to perform a procedure and finds the equipment needed is not there, the nurse has to degown, get the equipment, then regown before re-entering the room. In this case, the additional workload stems from inadequate stocking of isolation rooms, a performance obstacle.

See "A human factors engineering conceptual framework of nursing workload and patient safety in intensive care units," by Drs. Carayon and Gurses, in the October 2005 Intensive and Critical Care Nursing 21, pp. 284-301.

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