A Bell-Shaped Association between both the Objective and Perceived Nursing Workload and Workload Satisfaction of Intensive Care Nurses

Background: Nursing workload is an important issue in ICU management. However, not much is known about the association between nursing workload and satisfaction of nurses with their workload. Objective: The aim of this study is to assess the association of the objective, time and activity-based nursing workload and the perceived nursing workload with the satisfaction of nurses about their workload on the Intensive Care. Methods: We measured the objective nursing workload with the Nursing Activities Score and the perceived nursing workload measured with the NASA-TLX during 226 shifts in eight different Intensive Cares Units (ICUs). Nurses were asked to rate their satisfaction about the nursing workload during that shift on a scale from 0 (not satisfied at all) till 10 (maximum satisfaction). We used logistic regression models to analyze the association between both the Nursing Activities Score and the NASA-TLX with workload satisfaction (satisfied (>=6) or not (<6)) of nurses about the workload. Results: In our study we showed that a Nursing Activities Score between 73.9 - < 83.7 points per nurse leads to a significant higher chance of a nurse being satisfied about his/her nursing workload (OR = 2.92 (1.01 – 8.45)). An increase of the overall workload with a NASA-TLX score of 27 is leading to a significant higher chance of a nurse being satisfied about the nursing workload (NASA-TLX 27 - <32: OR(CI)=3.26 (1.23 – 8.64); NASA-TLX  32: OR(CI) = 3.04 (1.11-7.98). Analyzing the subcategories of the NASA-TLX showed a significant higher chance of a nurse being satisfied about the workload in case of a high demand in the subcategories ‘mental demand', ‘physical demand' and ‘effort'. Conclusion: Our study showed that nurses are most satisfied on their workload when the Nursing Activity Score is around 80, and when the perceived overall workload as measured with the NASA-TLX is high (above 27). Especially a perceived high mental demand, physical demand or effort contributes to a higher chance of the nurse being satisfied. A further increase of the objective or perceived nursing workload to a very high demand or a low objective or perceived nursing workload diminish these positive associations. Managers responsible for capacity planning should take these results into consideration to avoid burn-out and bore- out of ICU nurses.