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

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.

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.

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.

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.

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.