Nursing workload: a concept analysis

Abstract

Aim: The aim of the present study was to develop a comprehensive understanding of the concept 'workload' within the nursing profession in order to arrive at a clear definition of nursing workload based on the evidence in existing literature.

Background: Nursing workload is a common term used in the health literature, but often without specification of its exact meaning. Concept clarification is needed to delineate the meaning of the term 'nursing workload'.

Method: A concept analysis was conducted using Walker and Avant's method to clarify the defining attributes of nursing workload. As the subject matter was nursing focused, only one database was searched, the Cumulative Index for Nursing and Allied Health Literature (CINAHL). Articles that did not use 'workload' in the title or abstract were excluded. A model case, contrary case, related case and empirical referents were constructed to clarify the concept and to demonstrate how the workload is captured by the main attributes.

Results: The attributes of nursing workload found in the literature fall into five main categories: the amount of nursing time; the level of nursing competency; the weight of direct patient care; the amount of physical exertion; and complexity of care. The attributes were organised according to the leading antecedents, which were identified as the patient, nurse and health institution.

Implications for nursing management: Nurse managers need to address the workload issues with regard to the real nature of nursing work; this could increase nurses' productivity, nurses' satisfaction, turnover, work stress and provide sufficient staffing to patient care needs.

Conclusion: The concept analysis demonstrated clearly the complexity of the concept and its implications for practice and research. It is believed that the current concept analysis will help to provide a better understanding of nursing workload and contribute towards the standardisation of the nursing workload and the development of a valid and reliable measurement system.

Keywords: acuity; competency; complexity of care; intensity; nursing workload; staffing.