Impact of performance obstacles on intensive care nurses' workload, perceived quality and safety of care, and quality of working life

Health Services Research, April, 2009 by Ayse P. Gurses, Pascale Carayon, Melanie Wall

RESULTS

Sample Characteristics

Table 2 provides data on the demographics and background variables. Compared to the 2007 American Association of Critical Care Nurses (AACN) members' demographics (available at http://www.aacn.org/WD/Memberships/Docs/membdemographics.pdf), nurses in our sample were younger (54 percent compared with 26 percent under 40 years old, p-value <.001), had less experience as an ICU nurse (6.5 compared with 13 years, p-value< .001), had less advanced degrees (2 percent compared with 16 percent with a Masters degree or beyond, p-value <.001), and were mostly white (99 percent compared with 89 percent, p-value<.001). The sample was comparable to AACN 2007 members' demographics with respect to gender (86 percent compared with 89 percent female, p-value = .09) and with respect to having at least a Bachelors degree (74 percent compared with 76 percent, p-value = .30).

Correlation Analyses

Ten of the twelve performance obstacles were significantly correlated with workload (H1 supported: poor physical work environment, dealing with many family-related issues (e.g., many phone calls for nurses from patients' families and no policy or system is in place on how and when to return these phone calls), disorganized supplies area, seeking for patient charts, delay in getting medications from pharmacy, equipment-related issues, poor workspace design, poor handoffs, inadequate information from physicians, and poorly stocked patient rooms (Table 3). Nurses who encountered these obstacles over a shift reported experiencing higher workload than those who did not. Accompanying a patient during intrahospital transport and being a preceptor were the only obstacles not related to workload. Besides these, each obstacle was also significantly correlated with at least one measure of perceived quality and safety of care and OWL.

Workload was negatively correlated with both perceived quality and safety of care and QWL (Table 3). Nurses who experienced higher workload reported providing lower levels of overall quality of care, detailed nursing care, and safe care (H2a supported), and experiencing higher fatigue and stress (H2b supported).

Few demographic and background variables were significantly correlated to any of the outcome variables (Table 3). For example, nurses who were assigned two patients, who admitted a patient, and who worked on day shifts reported experiencing higher workload.

Structural Equation Modeling (SEM)

SEM was used to test all of the hypotheses. The model included 12 observed measures of performance obstacles, one observed measure of workload, and latent variables for perceived quality and safety of care and QWL (Figure 2). The model controlled for 13 demographic and background variables, which were treated as predictors of workload, perceived quality and safety, and QWL, and were allowed to correlate freely with performance obstacles. Finally, the equation errors for the perceived quality and safety of care and QWL latent outcome variables were allowed to correlate, acknowledging that the predictors in the model would not explain all the potential correlations between these two latent variables.