title: A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life.
abstract: BACKGROUND
  Nursing workload is increasingly thought to contribute to both nurses' quality of working life and quality/safety of care. Prior studies lack a coherent model for conceptualising and measuring the effects of workload in healthcare. In contrast, we conceptualised a human factors model for workload specifying workload at three distinct levels of analysis and having multiple nurse and patient outcomes.
  
  
  METHODS
  To test this model, we analysed results from a cross-sectional survey of a volunteer sample of nurses in six units of two academic tertiary care paediatric hospitals.
  
  
  RESULTS
  Workload measures were generally correlated with outcomes of interest. A multivariate structural model revealed that: the unit-level measure of staffing adequacy was significantly related to job dissatisfaction (path loading=0.31) and burnout (path loading=0.45); the task-level measure of mental workload related to interruptions, divided attention, and being rushed was associated with burnout (path loading=0.25) and medication error likelihood (path loading=1.04). Job-level workload was not uniquely and significantly associated with any outcomes.
  
  
  CONCLUSIONS
  The human factors engineering model of nursing workload was supported by data from two paediatric hospitals. The findings provided a novel insight into specific ways that different types of workload could affect nurse and patient outcomes. These findings suggest further research and yield a number of human factors design suggestions.
authors.affiliation: Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Room 3218, Madison, WI 53706, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Holden
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Scanlon
authors.forename: Neal R
authors.initials: NR
authors.lastname: Patel
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: Kamisha Hamilton
authors.initials: KH
authors.lastname: Escoto
authors.forename: Roger L
authors.initials: RL
authors.lastname: Brown
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Alper
authors.forename: Judi M
authors.initials: JM
authors.lastname: Arnold
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Shalaby
authors.forename: Kathleen
authors.initials: K
authors.lastname: Murkowski
authors.forename: Ben-Tzion
authors.initials: BT
authors.lastname: Karsh
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D011788:Quality of Life; D014940:Work Schedule Tolerance; D016526:Workload / Q000592:standards*