Nurse workload, missed nursing care, and the contributing factors in the Neonatal Intensive Care Unit in a limited resource setting: A case from Indonesia

Abstract

Background: Nurses who are in charge of the Neonatal Intensive Care Units (NICUs) have a different workload and work assignments compared to other units. Evidence suggests that higher nurse workloads will increase the risk of missed nursing care. Missed nursing care in the NICU will eventually worsen the neonatal prognosis. This is a major problem in developing countries, which currently still have a high neonatal mortality rate. Methods: This was a cross sectional study using questionnaires to collect data from 48 nurses who work in Dr. Soetomo Hospital NICU from April 15th 2021 to July 25th 2021. The collected data was then processed with descriptive statistics, meanwhile the correlation between workload with missed nursing care was analyzed with Pearson and Spearman correlation. Results: The total mean of NICU nurse workload score according to the NASA-TLX (National Aeronautics and Space Administration Task Load Index) was 68.36, indicating a moderate overall workload, with effort as the highest component. Overall, 91.67% of the nurses had missed at least 1 out of 21 basic neonatal nursing care components. Labor resource factor was the most frequent missed nursing care factor, in which urgent patient situations were the most frequent problem. There was no significant correlation between the total nurse workload and the frequency of any missed nursing care (P=0.536). Conclusions: Effort was the biggest component of the NICU nurse total workload. The most frequently missed nursing care was giving emotional support for the patient’s parents and/or family. Labor resource factor was the most frequent problem which caused missed nursing care. However, there is no statistically significant correlation between the total workload with the frequency of missed nursing care.

Exploring Missed Nursing Care in the NICU: Perspectives of NICU Nurses in Saudi Arabia’s Eastern Health Cluster

“…The findings of this research are similar to those of previous research on the same topic. Patient care activities with time-sensitive and core tasks need to receive higher priority than needs that may be perceived as time-consuming and not urgent in terms of patient safety, such as comfort care and parental emotional support, and thus there may be a perception that missing them will not have serious impacts on patients’ health [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

“…A recent study by Utomo et al (2022), intended to address the issue of missed nursing care in the NICU, emphasized the need for appropriate interventions in limited resource settings in order to reduce the amount of missed nursing care in the NICU. Therefore, identifying the factors associated with missed nursing care can inform the implementation of interventions to improve care delivery in the NICU [ 13 ]. The consequences of missed nursing care in the NICU can have significant implications for both infants and nurses.…”