Determining a set of measurable and relevant factors affecting nursing workload in the acute care hospital setting: A cross-sectional study

Background: While there has been great interest in the effect of nurse staffing levels have on the quality of care in hospitals, less attention has been given to determining the factors that affect the nursing workload. There are no existing studies that help define measurable factors that have a clear relation to nursing workload. Objectives: The aim of this study was to determine the most important and measurable factors, other than patient acuity, that influence nursing workload. Design: A cross-sectional design. Settings: Hospitals within the acute hospital care setting. Participants: Persons with a nursing educational background, working in Belgian acute care hospitals. Methods: A self-administered questionnaire was developed based on the results of an integrative review, the use of focus groups and a survey on measurability and relevance of the included factors. The questionnaire listed relevant and measurable factors related to nursing workload. Weight and frequency of each factor was assessed. Results: The initial list consisted of 94 factors. These factors were regrouped and organised into a questionnaire of 28 measurable and sufficiently relevant factors affecting the nursing workload. More than half of the initial factors seemed to be relevant, but hard to measure on a daily basis. Based on the impact of each factor, the number of work interruptions was the most important factor related to nursing workload. Conclusions: It is unlikely that a workload instrument will ever be able to take into account all possible factors affecting the nursing workload. Nevertheless, the number of work interruptions, the patient turnover rate and the number of mandatory registrations should be included in the development or revision of a workload measurement tool. © 2011 Elsevier Ltd.