Impact of performance obstacles on intensive care nurses' workload, perceived quality and safety of care, and quality of working life

Abstract

Objectives: To study the impact of performance obstacles on intensive care nurses' workload, quality and safety of care, and quality of working life (QWL). Performance obstacles are factors that hinder nurses' capacity to perform their job and that are closely associated with their immediate work system.

Data sources/study setting: Data were collected from 265 nurses in 17 intensive care units (ICUs) between February and August 2004 via a structured questionnaire, yielding a response rate of 80 percent.

Study design: A cross-sectional study design was used. Data were analyzed by correlation analyses and structural equation modeling.

Principal findings: Performance obstacles were found to affect perceived quality and safety of care and QWL of ICU nurses. Workload mediated the impact of performance obstacles with the exception of equipment-related issues on perceived quality and safety of care as well as QWL.

Conclusions: Performance obstacles in ICUs are a major determinant of nursing workload, perceived quality and safety of care, and QWL. In general, performance obstacles increase nursing workload, which in turn negatively affect perceived quality and safety of care and QWL. Redesigning the ICU work system to reduce performance obstacles may improve nurses' work.

Figure 1

The Conceptual Research Model

Figure 2

Final Structural Equation Model (Paths with Coefficients That Are Not Statistically Significant Are Not Shown) ^∼Nurses who are in the 60 and older age group reported providing significantly higher quality of care compared with other age groups (29 or younger, 30–39, 40–49, 50–59). Other age categories were not significantly different from each other in terms of the quality of care they reported to provide. ^$Nurses who are in the 60 and older age group reported experiencing significantly higher quality of working life (lower fatigue and stress) compared with other age groups. Other age categories were not significantly different from each other in terms of the stress they experienced. ^*p<.05; ^**p<.01; ^***p<.001.