Nursing Workload and Patient Safety

This assignment examines the relationship between nursing workloads and patient safety. Students will analyze provided research articles focusing on how nurse-perceived patient adverse events, medication administration errors, burnout, and overall quality of care are influenced by heavy nursing workloads. The analysis should draw upon the studies provided to demonstrate the connection between these factors.

Running head: PROFESSIONAL ISSUE
Professional issue
Name of the student:
Name of the University:
Author’s note

1PROFESSIONAL ISSUE
Introduction
Burnout, medical errors and adverse events in nursing practice are some of the major
challenges that affect nurse’s performance and influence their motivation and satisfaction with
the nursing job. All the above mentioned issues are mainly caused by the situation of high
nursing working load which acts as the main mediator of escalating injuries, poor health
outcomes and deterioration in quality of care in health care setting (Koy et al. 2015). This essay
provides a detailed insight into the professional issue of nursing workload and explains the
negative impact of the issue on the nursing practice. With special emphasis on impact of the
nursing workload issue on individual nurse and the nursing profession, it also explains about
useful strategies that can be adapted to minimize the impact of the issue on nursing practice and
patient safety.
Professional issues of nursing workload:
High workload is a critical professional issue in nursing practice. Heavy workload for the
nurses is defined by the amount of nursing time, the amount of physical exertion in shift,
complexity of care and level of nursing competency (Alghamdi 2016). Increase in any of these
factors contributes to high workload and high burden for nurses. In short, nursing workload can
be defined as the amount of time spend by nurses in direct or indirect care of patient, workplace
and professional development (Alghamdi 2016). The overload experienced by nurses can be
categorized into unit level, job level, patient level and situation level. The specialty of nurses and
type of practice also determines the level of workload for nurses (Consiglio et al. 2014).

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The changing health care environment has mainly contributed to heavy workload for
nurses. With the increase in ageing population, the demand of nurses in health care system has
increased. In addition, inadequate supply of nurses and reduced staffing levels had made it
necessary for nurses to work overtime. The above trend in health care practice has influenced
nursing workload, quality of care as well as patient safety. Work environment factors and
staffing level also determines’ nurses satisfaction with their job and commitment towards
delivering high quality care (Carayon and Gurses 2008). However, many nurses have reported
their due to high workload, they have lost motivation in work as it has contributed to high
number of errors and patients safety related issues. The complex work environment and the
demand to work outside shift have increased the mental workload of nurses too (Caruso 2014).
As high nursing workload can have an impact on nurse’s productivity, satisfaction level,
turnover rate, work stress and patient safety, it is necessary to find strategies to reduce the
workload burden of nurse in care.
Significance of the professional issue to nursing:
The issue of nursing workload is of significant professional importance for nursing
practice because it has direct impact both on the nurses individually as well as the nursing
profession. High workload contributes to poor nursing performance, poor satisfaction with the
job, burnout issues and high rate of nursing errors. The evidence by Hayes, Douglas and Bonner
(2015) has shown that the performance of the nurse is highly affected by the work environment,
stress level, work characteristics and job satisfaction. The study also pointed out that even when
the work environment is favorable, then also nurses experience high level of burnout. This is
mainly because of the complexity of the job and greater level of stress involved in delivering
care. The nursing workload is also defined by nurse’s competency in the job and research has

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showed that younger nurse experience higher level of stress compared to experienced nurses.
The lowest level of job satisfaction and highest level of burnout is mainly found in newly placed
nurse as they are not accustomed to handling the complexities of the job (Flinkma and Salanterä
2015). As nurses are the one who spend the maximum time in the care of patient, it is very
important to respond to the workload issue for nurses. Implementing strategies in the direction of
addressing workload and high level of burnout in nurses is likely to increase job satisfaction
level and turnover rate of nurses.
Association has also been found between nursing workload and the nursing profession.
This can be said because the stress level or workload of nurses is also increased by decreased
staffing ratio and increase in worse outcome for patients. Link has been found between nurse-
staffs ratios and patient outcome. For example, the investigation about staffing level and
mortality in patients has revealed that high workload/staffing ratios is associated with increased
risk of death in critically ill patients (Shekelle 2013). Hence, the evidence mainly implies that
maintaining the nurse staffing level is crucial to manage workload as well as improve patient
outcome. Both competency to manage complex situation and promoting positive outcome of
patient is an indication of quality nursing practice, however high workload has impact on these
areas of the nursing profession.
The nursing burnout is highly linked to nurse practice environment and nurse working
characteristics. Van Bogaert et al. (2014) has shown that variation in perceived nurse practice
work environment and burnout feelings results in adverse patient events and high rate of
complains, medication errors and nosocomial infection. The nursing unit team particularly plays
a role in quality of care and patient safety and treating sensitive issues of patients. However,
there is plenty of evidence to prove the association between poor quality of care and feelings of

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burnout. For instance, Poghosyan et al. (2010) confirmed that dimension of practice environment
determines practice outcome, quality of care variables and patient satisfaction with care. Nursing
burnout is a direct consequence of high workload and nursing burning directly influences the
quality of care. The explorative study regarding the relationship between the quality of care and
nurse burnout among nurses in six countries has revealed that nurses experiencing burnout have
lesser capability to deliver high quality care and increase in errors results in emotional distress
and disengagement in nurses. Complex practice environment and longer shift time predispose
nurses to burnout. This implies that nurse burnout and nursing shortage is a challenging issue in
nursing practice as this mainly determines the patient safety level and quality of care. To
improve the nurse related quality of care, addressing the nurse-patient ratio and work
environment of nurse will be necessary (Humphries et al. 2017).
Impact of the professional issue on patient safety:
As the issue of nursing workload and nursing practice has direct impact on the
engagement of nurse and motivation in nursing practice, it will directly affect patient safety too.
The main goal of nursing practice is achieve optimal health outcome for patient and maintain
patent safety. Patient safety is defined by the reduction in the risk of adverse events for patient
starting from diagnosis to treatment in health care setting. To achieve the culture of patient
safety, special emphasis is paid on preventing errors, learning from errors and complying with
safety protocols throughout the health care delivery process (Weaver et al., 2013).
The main role of nurse in patient safety is related to avoiding medication errors and
preventing fall in patients. However, the opposite outcome has often been witnessed due to high
workload and burnout experience in nurses. The study by MacPhee et al. (2017) gives an insight

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into the impact of heavy nursing workload on patient outcomes. The cross-sectional study with
acute care nurses mainly investigated about the workload factors of staffing level, nurses
perception of heavy workload, interruptions in work flow and compromise care standard. The
patient outcomes that were evaluated included frequency of medication errors, patient falls and
urinary tract infections. The study result gave the indication that heavy workload and task
interruptions had a direct impact on patient and nurse outcomes. High patient-RN rations were
weakly associated with adverse patient outcomes and heavy workload was independent predictor
of adverse patient outcomes. This proves that different levels of nursing workload and workload
demands have differential effects on patient and patient related outcomes.
The chances of patient adverse events increase when the number of patients allocated to
single nurse is high. In the situation of insufficient nursing workforce and high workload, the
likelihood of medication errors, patients falls, nosocomial infections, death, cardiopulmonary
resuscitation failures and pressure sores increases (Cho et al. 2016). The study regarding nurse
perception of workload and adverse events showed that nosocomial infection (57.1%) was most
frequently experienced by patients followed by pressure sores (45.2%) and medication errors
(40%). The nursing workload variable of performance of non-nursing task was mainly associated
with high rate of falls and nosocomial infections in patients. Bed to nurse ratio had an impact on
incidence of pressure sores in patients (Kan et al. 2016). Parry et al. (2015) also gave the insight
that environmental domain of clinical workload and work environment and personal domain of
Registered Nurse’s characteristics and lived experience of work had an impact on medication
administrative behavior of nurses. Environmental domain was found to increase medication rates
in nurses. There is a need to establish the link between the environment and nurse’s behavior to
prevent adverse events and promote patient safety.

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Strategies to minimize the impact of chosen professional issues on nursing practice and
patient safety:
As patient related adverse events such as falls and medication is directly caused by high
nursing workload, there is a need to identify the strategies that can minimize the impact of the
nursing workload on patient safety. Two effective strategies include the following:
1. The first strategy is to enhance the positive practice environment in clinical setting to
retain skilful nurse and improve the quality of care. This can be done by addressing the
staffing levels and resource adequacy in nursing practice. The workload and work
demands needs to be balanced to ensure that appropriate number of nursing staffs are
there to handle patients in particular units. This will ensure that nurses work according to
role expectation and deliver care in an effective manner without causing any injury or
adverse events for patients. As low nurse-patient ration and high work demand often
results in burnout in nurses, there is also a need to maintain adequate staffing levels so
that all leave requirement for nurses can be fulfilled and they can get breaks or rest in
between shift (Twigg and McCullough 2014). This is vital for improving the retention
rate as well as improving the patient safety.
2. Medication error is one of the common patient related adverse outcome that is observed
in clinical setting due to poor staffing level and high nursing workload. Several
distractions and interruptions during the medication administration mainly results in
medication errors and poor outcome for patients. The frequency of such errors can be
significantly reduced by the creation of safe environment during medication preparation
and administration. One of the effective strategies is to put ‘Do not disturb’ labels during
drug administration to minimize disruptions and ensure full concentration of nurses

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during the procedures. There is also a need to support nurses in the implementation of
five rights of medication administration to promote safety of patient (Kim and Bates
2013). Westbrook et al. (2017) proved the effectiveness of ‘Do not interrupt’ intervention
on reducing interruptions during medication administration. It led to the declined in the
non-medication related interruptions faced by nurses and promoted safety of patients. In
addition, supportive environment to ensure compliance of nurses to five right of
medication administration can reduce the error rates.
Conclusion
The essay summarized the professional issues of nursing workload on quality of nursing
care and patient safety. The review of the impact of the professional issue on nursing practice
gives the idea that high workload and poor nursing performance occurs due to low patient-staff
ration, high work demand and lack of appropriate work environment to provide care. The
strategy of maintain staffing levels and reinforcing the right to safe medication administration is
crucial to minimize adverse events in nursing practice and reduce incidence of burnout in nurses.

8PROFESSIONAL ISSUE
Reference
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Published Online First: 23 February 2017. doi: 10.1136/bmjqs-2016-006123