Non-direct patient care factors influencing nursing workload: a review of the literature

Aims. The aim of this paper was to detect which non-direct patient care factors are related to nursing workload in acute hospital nursing care and to develop a conceptual model to describe the relationship between the non-direct patient care factors and nursing workload. Background. Since the 1930s, efforts to measure nursing workload have been undertaken. Still, it remains unclear which of the non-direct patient care elements are essential to the nursing workload. Data sources. PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, Engineering Village 2, Elin and the British Nursing Index were searched from 1970 up to July 2009. Review methods. Studies were included in this integrative review if they described factors that are related to nursing workload or if they presented models that explored the association between potential factors, excluding the factors related to direct patient care. Results. Thirty publications were included. The influencing variables were classified in five categories based on their level of impact: the hospital and ward, nursing team, individual nurse, patient and family and meta-characteristics. The variables were also classified, based on their cause-effect relationship. Some factors have a direct impact on the patient-nurse relationship, while others have an effect on the work fluency or on the subjective perception of the nursing workload. A conceptual model was built, based on the interaction between both classifications and derived from the systems theory. Conclusions. Nursing workload has a multi-causal aetiology. The influencing factors from this review can be integrated in a workload measurement tool.