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OBJECTIVES: To systematically assess the nursing workload in an Intermediate Care Unit. DESIGN: Single-centre prospective observational study. The nursing activities within the initial 72 h of hospitalization were recorded on a prespecified chart and standardized as activities/5 min/patient/day. SETTING: This study was conducted at the Intermediate Care Unit of the Altovicentino Hospital (Italy) from September 1 to December 31, 2022. MAIN OUTCOME MEASURE: We considered working overload as an average number of nursing activities/5 min/patient/day higher than the 85th percentile and investigated independent risk factors associated with it. RESULTS: A total of 183 patients were included. During their hospital stay, the average number of nursing activities per patient was 30 per 5-minute interval per day (range: 22-40). On the first day of hospitalization, the primary activities were predominantly administrative and managerial tasks. In contrast, on the second day, activities related to therapeutic management and primary care predominated. Various scores related to the patient's condition, including comorbidity, functionality, frailty, intensity, and severity, were analyzed for their association with nursing workload using multivariate analysis. However, only the National Early Warning Score was found to be an independent risk factor for nursing workload overload (OR 1.399, 95 % CI 1.205-1.624, p < 0.001). CONCLUSION: The study results demonstrated a significant variation in nursing workload within the same department. Subsequent studies are necessary to confirm the ability of the National Early Warning Score in predicting nursing over workload. IMPLICATION FOR CLINICAL PRACTICE: This study provides a detailed analysis of nursing workload in intermediate care settings, emphasizing the need for adequate resource allocation due to the potential for rapid deterioration in patients' conditions. By correlating nursing activities with patient severity indices, such as the National Early Warning Score, the findings support more effective organizational strategies to enhance care for patients at high risk of health decline.

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The effective management of human resources in nursing is fundamental to ensuring high-quality care. The necessary staffing levels can be derived from the nursing-related health status. Our approach is based on the use of artificial intelligence (AI) and machine learning (ML) to recognize key workload-driving predictors from routine data in the first step and derive recommendations for staffing levels in the second step. The precedent analysis was a multi-center study with data provided by three hospitals. The SPI (Self Care Index = sum score of 10 functional/cognitive items of the epaAC (epaAC = nursing assessment tool for AcuteCare (abbreviated from the German-language effiziente Pflege-Analyse AcuteCare))) was identified as a strong predictor of nursing workload. The SPI alone explains the variance in minutes with an adjusted R2 of 40% to 66%. With the addition of further predictors such as "fatigue" or "pain intensity", the adjusted R2 can be increased by up to 17%. The resulting model can be used as a foundation for data-based personnel controlling using AI-based prediction models.

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AIMS: There is well-established data linking the adequacy of nurse staffing to patient outcomes. Evidence-based standards for staffing are therefore critical to drive improvements in clinical care. One such evidence-based approach is the use of patient acuity-based tools. The objective of this study is to determine the performance of a neonatal acuity tool in an Australian tertiary neonatal health-care setting, focusing on the classification of patient acuity and nursing:patient staffing ratios compared to current practice. METHODS: Acuity data were collected in a neonatal intensive care unit (NICU) and special care baby unit (SCBU) over a 10-week period in 2023. Patient data were scored in the 16 domains at two time points (prior to morning and evening nursing shift changeover) for all admitted newborns. RESULTS: For ventilated newborns nursed with a nurse:patient staffing ratio of 1:1, 78% of scores were within the L4-high acuity (score ≥ 26) band, with the remaining scores within the L3-high acuity (18-25) band. For newborns on non-invasive respiratory support in NICU staffed 1:1, the proportion scoring within the L4 acuity band was higher in the nasal high-flow group compared to the nasal continuous positive airway pressure group (P = 0.032), an effect not seen for those nursed 1:2 in NICU or for those on nasal high-flow nursed in SCBU either 1:2 or 1:3. CONCLUSION: This study of how a neonatal acuity classification system compares with current nurse:patient staffing allocations in an Australian tertiary NICU, suggests refinements in staffing ratios for specific patient groups on respiratory support are possible.

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INTRODUCTION: Remote patient monitoring systems (RPMS) are increasingly integrated into hospital wards to improve patient safety and reduce the workload on healthcare professionals (HCPs). This study evaluates the efficacy of RPMS in general wards, focusing on their impact on nursing efficiency, patient care, HCPs, and patient satisfaction. METHODS: A comprehensive time-motion study was conducted along with surveys targeting HCPs and patients in M.S. Ramaiah Memorial Hospital, Bangalore, India, which has implemented RPMS in general wards. The study involved observing and comparing nursing activities in RPMS-equipped wards versus control wards without RPMS across various shifts. In addition, feedback on the system's impact on patient safety, overall care quality, and usability was gathered through a survey form. RESULTS: RPMS decreases the amount of time nurses spend on routine monitoring, communication, and coordination, enabling a 43.11% increase in time available for patient care. More than 89% of HCPs noted improvements in the level of care and overall patient safety. More than 80% of the HCPs also noted improvement in the patient's experience. More than 50% of HCPs find RPMS easy to use and user-friendly. More than 60% of the patients noted an overall improvement in care quality. CONCLUSION: RPMS has proven to be a valuable asset in hospital wards, enhancing patient monitoring and safety while reducing the workload on staff. In addition, significant time savings on routine tasks and high satisfaction levels from both staff and patients underscore the system's benefits.

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The effective management of human resources in nursing fundamental to ensuring high-quality care. The necessary staffing levels can beis derived from the nursing-related health status. Our approach is based on the use of artificial intelligence (AI) and machine learning (ML) to recognize key workload-driving predictors from routine clinical data in the first step and derive recommendations for staffing levels in the second step. The study was a multi-center study with data provided by three hospitals. The SPI (Self Care Index = sum score of 10 functional/cognitive items of the epaAC) was identified as a strong predictor of nursing workload. The SPI alone explains the variance in workload minutes with an adjusted R2 of 40% to 66%. With the addition of further predictors such as "fatigue" or "pain intensity", the adjusted R2 can be increased by up to 17%. The resulting model can be used as a foundation for data-based personnel controlling using AI-based prediction models.

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INTRODUCTION: In order to be positioned to address the increasing strain of burnout and worsening nurse shortage, a better understanding of factors that contribute to nursing workload is required. This study aims to examine the difference between order-based and clinically perceived nursing workloads and to quantify factors that contribute to a higher clinically perceived workload. DESIGN: A retrospective cohort study was used on an observational dataset. METHODS: We combined patient flow, nurse staffing and assignment, and workload intensity data and used multivariate linear regression to analyze how various shift, patient, and nurse-level factors, beyond order-based workload, affect nurses' clinically perceived workload. RESULTS: Among 53% of our samples, the clinically perceived workload is higher than the order-based workload. Factors associated with a higher clinically perceived workload include weekend or night shifts, shifts with a higher census, patients within the first 24 h of admission, and male patients. CONCLUSIONS: The order-based workload measures tended to underestimate nurses' clinically perceived workload. We identified and quantified factors that contribute to a higher clinically perceived workload, discussed the potential mechanisms as to how these factors affect the clinically perceived workload, and proposed targeted interventions to better manage nursing workload. CLINICAL RELEVANCE: By identifying factors associated with a high clinically perceived workload, the nurse manager can provide appropriate interventions to lighten nursing workload, which may further reduce the risk of nurse burnout and shortage.

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AIMS: To identify and compare new or increased nursing tasks in South Korea during the pandemic, categorized by hospital type and department. BACKGROUND: Although COVID-19 is no longer considered a global public health emergency, the threat of novel infectious diseases remains. Reflecting on the COVID-19 pandemic is essential to prepare effectively for future outbreaks. METHODS: This cross-sectional exploratory study, following the STROBE checklist, included 948 registered nurses with more than a year of clinical experience currently working in various hospitals. Questionnaires gathered demographic data, work characteristics, and the frequency of nursing task performance. Statistical analysis encompassed descriptive and inferential methods. RESULTS: The most common new or increased nursing task across all hospital types was 'Access control for family caregivers.' General wards prioritized tasks related to family caregivers, while specialized units like ICU and ER focused on infection control. CONCLUSION: Understanding how COVID-19 has impacted nursing tasks is crucial for gaining insights into efficient resource allocation, targeted education, and policy formulation during similar public health crises. The pandemic has given rise to new family caregiver-related tasks in the nursing profession. Consequently, continuous nursing research is essential for establishing guidelines and fostering a supportive work environment, which is crucial for the successful implementation of these tasks.

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INTRODUCTION: Intensive care units commonly use the Nursing Activities Score (NAS) to measure nursing workload, however, some settings use TrendCare. Historically 100 NAS points reflected one nurse, however research now suggests greater than 61 NAS points per nurse increases hospital mortality. OBJECTIVES: To determine if: 1) TrendCare accurately reflects critical care nursing workload as measured by the NAS and 2) the required nursing hours calculated by each of the scoring systems differed between indigenous and non-indigenous patients. METHODS: Using a prospective observational design, data were collected between 9 August - 25 November 2021. Nursing workload was assessed over three shifts using TrendCare and the NAS. RESULTS: Analysis included 183 patients and 829 TrendCare and NAS scores. The mean NAS for intensive care patients was >61 on all three shifts (morning M = 67.1 ± 18.2, afternoon M = 66.1 ± 18.1, night M = 64.0 ± 18.1). The mean NAS for high dependency patients (morning M = 46.1 ± 11.1, afternoon M 45.9 ± 11.0, night Mdn 46.1 [40.5-54.1]) identified a nurse:patient ratio of 1:2 reflected a NAS >90. The NAS and TrendCare found no difference in nursing hours between indigenous and non-indigenous patients, however higher scores for respiratory (H = 7.3, p = <.01), cardiovascular (H = 12.7, p = <.001) and renal (H = 12.7, p = <.001) support, and care for relatives and patients (H = 13.8, p = <.001) on some shifts were identified in indigenous patients. CONCLUSION: TrendCare nursing hours likely reflect a 1:1 nurse: patient ratio for intensive care patients but likely under-estimates high dependency care nursing workload. The NAS activities highlighted some activities required more time for indigenous patients on some shifts. IMPLICATIONS FOR CLINICAL PRACTICE: TrendCare likely reflects intensive care nursing workload but not high dependency nursing workload. A NAS of no greater than 61 points per nurse better reflects nursing workload in both the intensive and high dependency care units. Indigenous patients may require more nursing hours for nursing activities related to severity of illness.

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BACKGROUND: COVID-19 is associated with increased nursing workload, therefore a high nurse-to-patient ratio would be required. AIM: To analyse difference in nursing workload, as expressed with the Nursing Activities Score (NAS), between COVID-19 patients versus control patients without COVID-19 disease (NCOVID-19 group) in an Italian Extracorporeal Membrane Oxygenation (ECMO) centre. STUDY DESIGN: Retrospective analysis of prospectively collected data, enrolling consecutive patients admitted to a general Intensive Care Unit, between 1st May 2019 and 28th February 2021. A multivariate analysis was then performed to assess if COVID-19 disease was an independent predictor of higher NAS and to assess which other factors and procedures are independently associated with increased workload. RESULTS: We enrolled 574 patients, of which 135 (24%) were in the COVID-19 group and 439 (76%) in the NCOVID-19 group. The average NAS was higher in the COVID-19 group (79 ± 11 vs. 65 ± 15, T = -10.026; p < 0.001). Prone positioning, continuous renal replacement therapy (CRRT) and ECMO were used more frequently in the COVID-19 group. A higher fraction of patients in the COVID group showed colonization from multidrug resistant bacteria. COVID-19 group had a higher duration of mechanical ventilation and longer ICU stay. The COVID-19 diagnosis was independently associated with a higher NAS. Other independent predictors of higher NAS were the use of prone positioning and continuous renal replacement therapy (CRRT). Colonization from multidrug resistant bacteria and ECMO support were not independently associated with higher NAS. CONCLUSIONS: The higher nursing workload in COVID-19 patients is mainly due to specific procedures required to treat the most hypoxemic patients, such as prone positioning. Colonization with multidrug resistant bacteria and ECMO support were not independently associated with a higher NAS. RELEVANCE TO CLINICAL PRACTICE: Higher workload in COVID-19 patients was due to specific interventions, such as prone positioning and CRRT, with the related nursing activities, as continuous presence at patient's bed, mobilization, positioning and complex hygienic procedures.

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Background: Professional nurses who study part-time are faced with demanding tasks, demanding routine, having to cope with their studies and family commitments. Some nurses try different tactics to cope with their demanding tasks, such as the consumption of energy drinks, to alleviate tiredness and fatigue. Although these energy drinks can alleviate fatigue and boost their energy levels, they have adverse effects to their health such as migraines, insomnia, seizures, arrhythmias and other cardiovascular complications. Aim: To determine the health effects of energy drinks among nurses studying part-time. Setting: Selected university in the Gauteng province, South Africa. Methods: Descriptive, quantitative method that was contextual in nature was used. Self-administered questionnaire was used to collect data from a conveniently sampled population to determine the health effects of the use of energy drinks. Data analysis were done by means of descriptive statistics using the Statistical package for Social Sciences version 26. Results: Findings indicated that nurses studying part-time experience fatigue (n = 86; 49%). To alleviate fatigue (n = 91; 52%), they use energy drinks. Conclusion: Use of energy drinks is prevalent among the nurses because of fatigue caused by studying while working. To reduce the use of energy drinks, the participants need study leave and to be supported by their families and employers. Contribution: The study encourages reduction or prevent the use of energy drinks by nurses who work and study part-time. Participants must use time management as a coping mechanism.

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(1) Background: Missed nursing care, an omission error characterized by delayed or omitted nursing interventions, poses significant risks to patients' safety and quality of car.; (2) Methods: This is a quantitative cross-sectional study on 151 nurses who work in NICUs in three main networks in the Eastern Health Province, Saudi Arabia: Dammam (n = 84), Qatif (n = 53), and Jubail (n = 14). The study uses a self-reported questionnaire (MISSCARE) and applies the 5-point Likert Scale. Statistical analysis data were analyzed using SPSS version 23.0. (3) Results: The primary reasons for missed care were shortage of nursing staff and unbalanced patient assignments. Missed nursing care negatively affects job satisfaction and was positively correlated with nurses' intentions to quit their jobs. Inadequate equipment, supplies, and breakdowns in communication between nurses and other healthcare professionals were also significant factors contributing to missed care. (4) Conclusions: Missed nursing care is associated with overwork, nursing shortages, and lower job satisfaction, impacting the quality of care provided in the NICU. Improving working conditions, nurse staffing, and patient assignment planning should be prioritized to address this issue effectively.

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Nursing research is rapidly increasing, yet contributions from numerous countries that may interest the international nursing community are impeded because many research articles are published in authors' native language and not in English. The objectives of this work were to systematically review papers published in Italian related to job satisfaction and the quality of nursing care, and to discuss their findings in light of the international literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used. The Directory of Open Access Journals (DOAJ) and Indice della Letteretura Italiana di Scienze Infermieristiche (ILISI) databases were consulted for eligible studies published from January 2015 to November 2022. Two hundred sixteen papers were identified, 11 of which were selected for review: 8 on job satisfaction, two on workload issues, and 1 on quality of nursing care. The quality of included studies was assessed through the Effective Public Health Practice Project quality assessment tool (EPHPP). The results of our review were in line with those of international literature, and they can help to fill the knowledge gap on the quality of nursing performance in Italian care settings. In addition, the proposed method can provide further elements of discussion among literature providers and reviewers.

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OBJECTIVES: One of the interventions to reduce risk of central line associated bloodstream infection (CLABSI) is routine replacement of the intravenous administration sets. Guidelines advises a time interval that ranges between four and seven days. However many hospitals replace intravenous administration sets every four days to prevent CLABSI. RESEARCH METHODOLOGY: In this single centre retrospective study we analysed whether the extension of the time interval from four to seven days for routine replacement of intravenous administration sets had impact on the incidence of CLABSI and colonization of the central venous catheter. Secondary outcomes were the effects on nursing workload, material use and costs. RESULTS: In total, 1,409 patients with 1,679 central lines were included. During the pre-intervention period 2.8 CLABSI cases per 1,000 catheter days were found in comparison with 1.3 CLABSI cases per 1,000 catheter days during the post-intervention period. The rate difference between the groups was 1.52 CLABSI cases per 1,000 catheter days (95% CI: -0.50 to +4.13, p = 0.138). The intervention resulted in a saving of 345 intravenous single use plastic administration sets and 260 hours nursing time, and reduced cost with an estimate of at least 17.250 Euros. CONCLUSION: Extension of the time interval from four to seven days for routine replacement of intravenous administration sets did not negatively affect the incidence of CLABSI. IMPLICATIONS FOR CLINICAL PRACTICE: Additional benefits of the prolonged time interval were saving of nursing time by avoiding unnecessary routine procedures, the reducing of waste because of reducing the use of disposable materials and healthcare costs.

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Preference cards are a foundation for perioperative inventory management processes; however, they can add to nurses' perceived workload, introduce variability into supply management processes, and increase costs. The purpose of this quality improvement project was to implement an automated perioperative inventory management system to decrease nurses' workload and increase their efficiency. Goals included improving preference card accuracy, decreasing add-on supplies, and decreasing the supply costs for each procedure. Using a preintervention-postintervention survey design, the project team evaluated the outcomes of workload, preference card accuracy, add-on supplies, and procedural cost. Nurses' perception of workload decreased in the supply management processes and cost of supplies categories and increased in the documenting supply use category. A four-month 7.7% improvement in preference card accuracy reduced the average procedure supply cost by $86.72 for each procedure and saved the hospital $260,467. The number of add-on supplies was reduced by 4,177 for a 20% reduction.

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BACKGROUND: Medication administration errors by nurses form a high proportion of medical errors in medical institutions. Studies have shown that such errors are closely linked to nursing workload. OBJECTIVE: To quantitatively explore the effects of different types of nursing workloads on different medication administration errors. METHOD: Three medical institutions were selected as the objects of error data collection based on the following criteria: the medical institution experience in error data collection, the complete range of medical departments, and the institution size. Error cases were self-reported from all nurses in all medical departments. The relationship between the error types and nursing workload types were quantitatively examined using partial least squares and structural equation modeling. RESULTS: The study recorded 290 medication administration errors, and extracted four error types and nine nursing workload types. The workload type for each error type was also identified and the path coefficient was found to be between 0.087 to 0.416. CONCLUSION: This study confirmed the effect of workload on medication administration errors and determined a theoretical mechanism for this effect. Research results will provide the evidence for nursing managers to reduce workload and ensure quality in the nursing administration process.

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Objetivo: Descrever o dimensionamento do quadro de pessoal de Enfermagem na atenção básica em um município do Amazonas. Metodologia: Método qualitativo de caráter descritivo, com investigação do objeto fundamentada no Estudo de Casos Múltiplos, segundo Yin (2015). A pesquisa foi realizada em duas Unidades Básicas de Saúde ­ UBS, localizadas no distrito do Cacau Pirêra, município de Iranduba, no estado do Amazonas. Aprovada pelo Comitê de Ética em Pesquisa da Universidade Paulista ­ CEP/UNIP, sob o Parecer de nº 5.968.666 e CAAE 67017022.1.0000.5512. Resultados: Conforme Resolução COFEN n° 543 de 2017, as unidades em estudo obtiveram quantidade insuficiente de profissionais de determinadas categorias que resulta em pressão da carga de trabalho, porém também obtiveram números de profissionais de outras categorias em equilíbrio conforme suas respectivas demandas. Considerações Finais: Percebe-se o quão importante é essa ferramenta de gestão, que permite ampliar a visão para as condições de trabalho da equipe no momento atual, uma vez que projeta o quantitativo adequado de profissionais para favorecer assistência qualificada. Espera-se, portanto, que essa pesquisa estimule futuras investigações que levem em consideração o dimensionamento para além do ambiente intra-hospitalar e subsidie políticas que efetivem esse olhar mais ampliado sobre o tema.

Objective: To describe the dimensioning of nursing staff in primary care in a municipality of Amazonas. Methodology: Qualitative method of descriptive character, with investigation of the object based on the Multiple Case Study, according to Yin (2015). The research was carried out in two Basic Health Units - UBS, located in the district of Cacau Pirêra, Iranduba municipality, in the state of Amazonas. Approved by the Research Ethics Committee of Universidade Paulista - CEP/UNIP, under the Opinion No. 5.968.666 and CAAE 67017022.1.0000.5512. Results: According to COFEN Resolution n° 543 of 2017, the units under study obtained an insufficient number of professionals of certain categories that results in workload pressure, but also obtained numbers of professionals of other categories in balance according to their respective demands. Final Considerations: We realize how important this management tool is, which allows us to broaden the vision for the working conditions of the team at the current moment, since it designs the appropriate number of professionals to favor qualified assistance. It is hoped, therefore, that this research will stimulate future investigations that take into consideration the dimensioning beyond the intra-hospital environment and will provide input for policies that will make this broader view of the theme effective.

Propósito: Describir el tamaño del personal de enfermería en la atención básica de un municipio de Amazonas. Metodología: Método cualitativo de carácter descriptivo, con investigación de objetos basada en el estudio de casos múltiples según Yin (2015). La investigación se llevó a cabo en dos Unidades Básicas de Salud ­ UBS, ubicadas en el distrito de Cacau Pirêra, en el municipio de Iranduba, en el estado de Amazonas. Aprobado por el Comité de Ética de la Investigación de la Universidad Paulista (CEP/UNIP), con arreglo a los dictámenes no 5.968.666 y CAAE 67017022.1.000.5512. Resultados: De acuerdo con la Resolución 543 de la COFEN de 2017, las unidades estudiadas obtuvieron un número insuficiente de profesionales de ciertas categorías que resultan en presión de la carga de trabajo, pero también obtuvieron un número de profesionales de otras categorías en equilibrio de acuerdo con sus respectivas demandas. Consideraciones finales: Se puede ver lo importante que es esta herramienta de gestión, que permite ampliar la visión de las condiciones de trabajo del equipo en este momento, ya que proyecta la cantidad apropiada de profesionales para favorecer la asistencia calificada. Por lo tanto, se espera que esta investigación estimule futuras investigaciones que tengan en cuenta la dimensión más allá del entorno intrahospitalario y subvencionen políticas que lleven a cabo este enfoque más amplio sobre el tema.

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INTRODUCTION: Nursing workload (NWL) in the intensive care unit (ICU) is an essential parameter of patient safety. However, little attention has been dedicated to measuring NWL in ICU about patients surgically treated with myocardial ischemia (MI).  Methods: The objectives of this study are to describe and examine the NWL by applying the Nursing Activities Score in patients who underwent non-cardiac surgery and developed MI in the ICU. The statistical significance was set at 0.05. The statistical program SPSS 22.0 was used for the analysis. RESULTS:  The mean age was 69.1 years, whereas 32.4% of the patients had MI. Hypertension, diabetes mellitus, and dyslipidemia were the main comorbidities. On the first day in ICU, the NWL was similar in all patients (p = 0.947). In the following days, the NWL was significantly higher in patients with MI (p < 0.001). The NWL was considerably higher in patients with MI who died. CONCLUSIONS:  The present results are essential for planning and using nursing resources according to the care needs of postoperative patients with MI.

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BACKGROUND: An accurate and reliable patient classification system (PCS) can help inform decisions regarding adequate assignments for nurse staffing. This study aimed to evaluate the criterion validity of the Asan Patient Classification System (APCS), a new tertiary hospital-specific PCS, by comparing its rating and total scores with those of KPCS-1 and KPCS-GW for measuring patient activity and nursing needs. METHODS: We performed a retrospective analysis of the medical records of 50,314 inpatients admitted to the general wards of a tertiary teaching hospital in Seoul, South Korea in March, June, September, and December 2019. Spearman's correlation and Kappa statistics according to quartiles were calculated to examine the criterion validity of the APCS compared with the KPCS-1 and KPCS-GW. RESULTS: The average patient classification score was 28.3 points for APCS, 25.7 points for KPCS-1, and 21.6 points for KPCS-GW. The kappa value between APCS and KPCS-1 was 0.91 (95% CI:0.9072, 0.9119) and that between APCS and KPCS-GW was 0.88 (95% CI:0.8757, 0.8810). Additionally, Spearman's correlation coefficients among APCS, KPCS-1, and KPCS-GW showed a very strong correlation. However, 10.8% of the participants' results were inconsistent, and KPCS-1 tended to classify patients into groups with lower nursing needs compared to APCS. CONCLUSION: This study showed that electronic health record-generated APCS can provide useful information on patients' severity and nursing activities to measure workload estimation. Additional research is needed to develop and implement a real-world EHR-based PCS system to accommodate for direct and indirect nursing care while considering diverse population and dynamic healthcare system.

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BACKGROUND: The Malawi health system has taken numerous actions to reduce high nurse workloads, despite this, shortage of nurses especially in critical care settings still persists due to lack of prioritisation of critical care. Therefore, it is important to understand the effects of high nursing workload in Intensive Care Unit (ICU). This study aimed at exploring the perceptions of nurses regarding the effects of high nursing workload on patient care in ICU at Queen Elizabeth Central Hospital. METHODS: This qualitative descriptive study was conducted in a general ICU at Queen Elizabeth Central Hospital in Blantyre, Malawi. A purposive sample of 12 nurses working in the ICU was selected. Participants included full-time nurses working in the ICU. A total of 10 In-depth interviews were conducted to collect data upon which data saturation was reached. A semi-structured interview guide was used for data collection. Data was analysed manually using thematic analysis method by Braun & Clarke. RESULTS: Study findings indicated that high nursing workload compromises the delivery of quality nursing care to critically ill patients, compromises patient safety and has negative impact on nurses' wellbeing. CONCLUSION: The study findings portray that nurses are aware of the negative effects that high nursing workload has on patient care. The study findings support the need for more ICU nurses in order to reduce nurse workloads and the need for nurse managers and policy makers to develop strategies to manage nurse workloads and its effects on patient care.

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BACKGROUND: Evidence emphasises a strong relationship between nursing workload and job satisfaction. This study sets out to test empirically the roles of psychological meaningfulness and perceived organisational support on the nursing workload-satisfaction relationship. OBJECTIVE: To investigate empirically the role and impact of psychological meaningfulness and perceived organisational support on the relationship between nursing workload and job satisfaction. DESIGN: Prospective cross-sectional study. SETTING: A large acute care and teaching hospital in China. PARTICIPANTS: 500 nurses were asked to participate in this study and respond to a survey questionnaire. 426 nurses participated in this study, of which 395 responses (valid response 79%, 52% general nurses, 40% nurses in charge, and 9% senior nurses) were considered valid. METHODS: A multi-item questionnaire was used to assess the constructs of interest, which included demographic items; items related to nursing satisfaction, meaningfulness, and perceived organisational support; and lastly items assessing workload. Included items were a combination of previously validated scales and items co-developed between the research team and nurses of the study hospitals. Since the study relies on self-reported scales, the common latent factor technique was initially used to ensure that the common bias was not a major concern. Model fitness was tested using one-factor congeneric measurement. The research hypotheses were tested using the SPSS add-on PROCESS v3.3 model in a bootstrap approach. RESULTS: In the first part of the analysis, 43 of 51 factors survived the initial tests using common latent factor technique and model fitness measurements. We found that the direct effect of psychological meaningfulness on the workload-satisfaction relationship was significant. This suggests that psychological meaningfulness mediates the relationship. It further illustrates that perceived organisational support acts as a moderator for the relationship and accordingly it specifies conditions under which the workload can be related to job satisfaction. However, in the presence of psychological meaningfulness, the perceived organisational support moderated the workload-psychological meaningfulness relationship and its direct effect on workload-job satisfaction relationship became non-significant. CONCLUSION: Our study provides an understanding of how psychological meaningfulness and perceived organisational support may play out in the context of nursing work. To the best of our knowledge, this the first study to directly measure and explore these relationships in a quantitative manner. Our results indicate the critical role of perceived organisational support, where present, in allowing nurses to see the connection between their workload and their ultimate aspirations so that their work becomes more psychologically meaningful. TWEETABLE ABSTRACT: This study provides an understanding of how psychological meaningfulness and perceived organisational support affect nursing work.

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