Nurses’ Organization of Work and Its Relation to Workload in Medical Surgical Units: A Cross-Sectional Observational Multi-Center Study

Abstract

Introduction: Work contexts can affect nurses’ work and work outcomes. Work context factors of nurses, patients, or workflow can modulate nurses’ organization of work and determine increased workloads. Aim: The aim of this research was to analyze relationships between factors regarding the patient, the nurse, workflow, and nurses’ work organization, to investigate whether work organization is related to physical, mental, and emotional workloads, and to explore whether one dimension of workload influences the other dimensions. Methods: We used a cross-sectional design based on the Job Demand-Resources theory. We asked registered nurses, working in nine medical-surgical wards across three hospitals in Italy, to self-report on work organization and workloads regarding randomized shifts over three consecutive weeks. Four scales from the QEEW 2.0 questionnaire were used on an online survey for data collection. multivariable linear regressions with structural equation modelling were tested. The study was approved by the three local Ethics Committees. Results: We received 334 questionnaires regarding 125 shifts worked. Patient complexity (β = 0.347), patient specialties (β = 0.127), adequacy of staffing (β = −0.204), collaboration with colleagues (β = −0.155), unscheduled activities (β = 0.213), supply search (β = 0.141), and documentation (β = 0.221) significantly influenced nurses’ work organization. Nurses’ work organization was significantly related to physical, mental, and emotional nursing workloads. Conclusions: the patient, the nurse, and workflow aspects influence nurses’ work organization and workloads. Healthcare organizations, managers, and nurses should explore work settings to identify work turbulences early and implement strategies to improve nursing work conditions and workloads.

Nurses' motivations to leave the nursing profession: A qualitative meta‐aggregation

“…Therefore, building healthy work contexts is essential for nursing workforce retention (Ferramosca et al, 2023). Redesigning work systems by guaranteeing adequacy of staffing, proper work schedule and a balance of skill mix is highly important (Ferramosca et al, 2023). In addition, stimulating nurses' participation as main actors in the identification of appropriate solutions to improve nurses' work organization is also highly important to sustain the change process through active decision-making (Ferramosca et al, 2023).…”

“…Redesigning work systems by guaranteeing adequacy of staffing, proper work schedule and a balance of skill mix is highly important (Ferramosca et al, 2023). In addition, stimulating nurses' participation as main actors in the identification of appropriate solutions to improve nurses' work organization is also highly important to sustain the change process through active decision-making (Ferramosca et al, 2023). Nurses who have the ability to exert autonomy and control over their work, and have greater participation in decision-making have positive influence on nurses' professional engagement (Copanitsanou et al, 2017).…”

“…Recently, the International Council of Nurses (2022) described that there are a number of commonalities across all countries influencing intention to leave, including poor working conditions and failure to adopt safe staffing levels, which shows the actual challenges of the nursing work environment (Stewart et al, 2022). Ferramosca et al (2023) reported that working in shifts that are understaffed and with poor collaboration leads to disruption of nurses' work. As a consequence, the disruption of work organization and work processes lead to work pressure and stress on nurses, all together with inadequate staffing, which leads to a downward spiral, whereby nurses are intending to leave the profession.…”

“…As a consequence, the disruption of work organization and work processes lead to work pressure and stress on nurses, all together with inadequate staffing, which leads to a downward spiral, whereby nurses are intending to leave the profession. Therefore, building healthy work contexts is essential for nursing workforce retention (Ferramosca et al, 2023). Redesigning work systems by guaranteeing adequacy of staffing, proper work schedule and a balance of skill mix is highly important (Ferramosca et al, 2023).…”

Assessment of the Psychometric Characteristics of the Italian Version of the Nurse Manager Actions Scale

“…Work environments have a significant impact on nurses’ well-being and retention. Disorganized work processes [ 3 ], reduced resources, and increased workloads [ 4 ] can lead to nurses experiencing stress, emotional exhaustion, reduced performance or engagement, turnover intentions, or absenteeism [ 5 , 6 ]. On the other hand, good working environments that enhance nursing professional autonomy and professionalism [ 7 , 8 ] and supportive management can help nurses to increase productivity [ 9 ], find meaning in their work [ 10 ], and maintain well-being [ 11 ].…”