| Energy Expenditure, Heart Rate, Work Pace, and Their Associations with Perceived Workload among Female Hospital Nurses Working 12-hour Day Shift (2009) | |||||||||||||||
Abstract | |||||||||||||||
| Background: The current nursing shortage is a growing public concern and threatens the quality of patient care in American hospitals. Unrealistic workloads are one of the top reasons for hospital nurses' leaving the profession. Although nursing workload is extensively discussed in the literature, little is known about the influence of these workloads on physiological strain to female hospital Registered Nurses (RNs). The first objective of the study was to describe the physiological responses to workload of female hospital RNs. Three physiologic parameters'energy expenditure (EE), heart rate (HR) and work pace (WP), were measured to identify physiological response patterns over a 12-hour shift; and then response patterns of the 1st eight hours were compared to the last four hours to determine if there was a change in the physiological response to work in the later part of the shift. The second objective of the study was to examine the association between the physiological parameters and perceived workload. Fatigue and recovery factors were examined in terms of their contributions to the physiological responses to work. Methods: Demographic and fatigue data were collected from a convenience sample of 145 healthy hospital female RNs. The nurses completed a work diary, and wore a physical activity monitor for one 12-hour day shift to continuously record their HR and WP. These measures were used to calculate EE. Correlations, t tests, one-way ANOVA, repeated-measure MANCOVA, and multiple regression analyses were performed to describe the physiological response patterns to workload and the association of these physiological responses with perceived workload, fatigue, and recovery. Findings: The average energy expenditure for the 12-hour shift was 551.4 ± 323 kcal, indicating a light intensity level. The average HR over a 12-hour shift was 96.9 ± 15.8 bpm. More than one third of nurses experienced mean HRs above 100 bpm during 12-hour day shift, indicating a poor fitness between workload and functional capacity. No differences of EE intensity and HR between 8am-; 3pm and 3- 7pm were found, whereas WP intensity during 8am - 3pm was higher than that during 3 - 7pm (p = .007). Nearly 84%, 53% and 45% of the subjects experienced moderate to high level of acute fatigue, insufficient inter-shift recovery, and chronic fatigue, respectively. Perceived workload was found to be significantly predictive of WP intensity but not for EE intensity and HR. Medical-surgical unit nurses experience significantly higher perceived workload and physiological strain than those working on step-down floors. Conclusions: There is a relationship between physiological state at work and perceived workload among hospital RNs and nurses may be modifying their WP intensity to protect themselves from excessive work strain. Insufficient recovery and high levels of chronic fatigue may be the result of chronic physiological work stress. The strain of workload has implications for the nurses' health and ultimately the safety of hospital patients. Findings indicate a need for collaboration of hospital nursing administration and staff nurses to address the issues such as staffing plan, work scheduling, and individual factors related to sufficient recovery. | |||||||||||||||
Publication details | |||||||||||||||
| |||||||||||||||