Nurse workload has been associated with missed nursing care (necessary nursing care that is omitted or delayed) in adult populations. Limited evidence has shown the same dynamic in neonatal ICUs (NICUs). A prospective study was designed to provide further insight into the association between nurse workload and missed nursing care in NICUs.

Permanently employed RNs in an academic medical center NICU were eligible for the study if they provided direct patient care and completed unit orientation. Missed nursing care was evaluated by asking nurses to report on the omission of 11 essential neonatal nursing care practices. Workload on each shift was assessed using objective (infant-to-nurse staffing ratio and infant acuity score) and subjective measures. Subjective measures reflected how a nurse experienced the situational demands of work. A total of 136 nurses reported on the care of 418 infants during 332 shifts, each of which lasted 12 hours.

The researchers found a statistically significant association between nurse workload and the odds of missed nursing care in the NICU. These effects varied, depending on the workload measure and modeling strategy. The authors note that staffing ratios were strongly associated with some missed nursing care items when modeled alone, and ratio effects were amplified when modeled with acuity. There was a significant association between subjective workload ratings and all missed nursing care items, regardless of the modeling strategy.

Measuring subjective workload offers new possibilities for tailored workload interventions, the authors observe. In terms of study limitations, they point out that the study relied on self-reported data from a convenience sample, and potential social desirability bias may have influenced the results. The researchers also acknowledge that the site of the study may not be representative of most other NICUs.

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