Multicentre cross-sectional study to assess nursing workload in Belgian emergency departments

Excessive workload in emergency departments (ED) negatively affects patient safety, often leading to missed critical tasks due to time constraints. The Workload Assessment of Nurses on Emergency (WANE) scale developed in Belgium offers a detailed measurement of nursing workload, but its complexity makes it hard to use in practice. Our study aims to find a simpler method for assessing nursing workload in EDs.

A multicentre cross-sectional study was performed in four Belgian EDs between September 2022 and March 2023. Nursing workload was assessed using the WANE scale in each hospital, during 4-hour time periods. The associations between WANE scores, and nurses' subjective workload assessment, number of patients, patient triage levels, post-triage destination area and the Jones Dependency Tool Score were examined employing multiple linear regression models.

161 nurses, caring for 591 patients, were included. 67% of the variation in 'direct' care time could be explained with a model based on triage level and two items of the Jones Dependency Tool (ABC perturbation and mobility). The number of new patients admitted and nurses' perceived workload were also highly associated with the total nursing care time TNCT. The actual number of patients in the ED at any time explained 78% of the variation in TNCT. Each additional patient increases the TNTC by 45.22 min.

Simple indicators might be used to evaluate the nursing care time in Belgian EDs. A retrospective method is suggested, using the total number of patients over a defined period of time. This study reveals a path to a predictive method to calculate the direct care time for each patient with three simple indicators, available from nursing triage stage.