Nurses' subjective workload assessed with the NASA-TLX and its relationship with the nursing activities score (NAS) and nurses' demographic factors: a prospective cross-sectional study

Ann-Margret Hasselgård; Heidi Torgersen Larsen; Ann-Cathrin Melby; Sylvi Vullum; Sigbjørn Flatland; Kristine Aasheim Imsland; Stina Willadsen; Julie Hoseth Berntsen; Antonija Petosic; Aliaksandr Hubin; Siv Karlsson Stafseth

doi:10.1016/j.iccn.2026.104428

Nurses' subjective workload assessed with the NASA-TLX and its relationship with the nursing activities score (NAS) and nurses' demographic factors: a prospective cross-sectional study

Intensive Crit Care Nurs. 2026 May 26:95:104428. doi: 10.1016/j.iccn.2026.104428. Online ahead of print.

Affiliations

¹ Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway; Postoperative Unit Ullevål, Oslo University Hospital, Oslo, Norway; Postoperative/Intensive Care Unit, Diakonhjemmet Hospital, Oslo, Norway. Electronic address: ann-margret.hasselgard@ldh.no.
² Intensive Care Unit, St Olavs Hospital, Trondheim, Norway.
³ Western Norway University of Applied Sciences, Bergen, Norway; Medical Intensive Care Unit, Department of Heart Disease, Haukeland University Hospital Bergen, Norway. Electronic address: ann-cathrin.melbye@hvl.no.
⁴ Akershus University Hospital, Lillestrøm, Norway. Electronic address: Sylvi.Vullum@ahus.no.
⁵ Intensive and Postoperative Unit, Lillehammer Hospital, Innlandet Hospital Trust, Norway. Electronic address: Sigbjorn.Flatland@sykehuset-innlandet.no.
⁶ Intensive Care and Postoperative Unit, Stord Hospital, Fonna Hospital Trust, Norway. Electronic address: kristine.aasheim.imsland@helse-fonna.no.
⁷ Intensive Care Unit, Namsos Hospital, Norway. Electronic address: stijen123@gmail.com.
⁸ Postoperative/Intensive Care Unit, Diakonhjemmet Hospital, Oslo, Norway. Electronic address: hosethberntsen@gmail.com.
⁹ Department of Postoperative and Intensive Care Nursing and Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address: uxanpi@ous-hf.no.
¹⁰ Bioinformatics and Applied Statistics, KBM, Norwegian University of Life Sciences, Norway. Electronic address: aliaksandr.hubin@nmbu.no.
¹¹ Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway; Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway. Electronic address: siv.stafseth@ldh.no.

PMID: 42190327
DOI: 10.1016/j.iccn.2026.104428

Abstract

Aim: With an international shortage of experienced critical care nurses, there is an increasing focus on improving staff retention. This study examined the subjective nursing workload in Norwegian intensive care units (ICUs) and its relationship with the Nursing Activities Score (NAS) and nurses' demographics.

Method: A prospective cross-sectional study utilized the National Aeronautics and Space Administration Load Index (NASA-TLX) to measure six demands of subjective nursing workload (mental, physical, temporal, effort, performance, and frustration), the NAS and nurses' demographic data. Relationships were analyzed using mixed effect Beta regression.

Results: A total of 3,476 questionnaires from 12 ICUs (81.3% response rate) were analyzed. Most critical care nurses were over 46 years of age (52.3%) with most registered nurses younger than 46 years (71.6%). The mean (SD) NASA-TLX score was 48.8 (17.5). The mean (SD) NAS per shift per nurse varied from 56.4% (42.8) to 139.5% (20.7). Higher NAS scores were associated with higher NASA-TLX scores (p < 0.001) in areas of mental (p < 0.001), physical (p = <0.001), temporal (p = <0.001), and effort (p = >0.001), frustration (p = <0.001) but not with performance (p = 0.35). Age, educational level, experience and shifts were associated with all the NASA-TLX six demands, although less so with performance and frustration.

Conclusion: High subjective workload was consistently associated with higher NAS scores. These findings highlight the importance of integration of subjective and objective measures of workload. A multifaceted understanding of workload is essential to protect nurses' wellbeing, support a healthy work-life balance, and address workforce challenges. Proactively monitoring both areas of workload enables management to identify areas of improvement, address staffing issues, and implement targeted interventions to promote nursing retention.

Implication for clinical practice: This study underscores the value of workload assessments as an effective tool for identifying staffing challenges in ICUs. Managers can implement targeted strategies, such as focusing on the needs of specific groups. In optimizing workload management, the unit can retain nursing staff.

Keywords: Critical care; Cross-sectional study; NASA-TLX; Nursing Activities Score (NAS); Nursing workload.