Workload, missed nursing care, ethical climate, and work interruptions among emergency department registered nurses:...

Nurses working in emergency departments encounter a wide range of professional challenges stemming from the inherently complex, unpredictable, and high-intensity nature of emergency care. These challenges exert a considerable influence on their clinical performance. Among the most critical factors, workload and work interruptions are thought to negatively affect both the occurrence of missed nursing care and the ethical climate within the emergency departments. In light of these considerations, we sought to examine the relationship between workload and missed nursing care, with particular attention to the mediating roles of ethical climate and work interruptions among emergency department registered nurses.

This descriptive-analytical study was conducted among 700 emergency registered nurses in southern Fars Province, Iran. Data were gathered using a demographic questionnaire, the Missed Nursing Care Questionnaire, the Hospital Ethical Climate Survey, the Nursing Work Interruption Scale, and the NASA Task Load Index. Structural equation modeling was used for analysis.

The participants' mean age and mean work experience were 35.26 years (SD=6.80), and 8.71 years (SD=5.38), respectively. The pearson correlation analysis revealed positive associations between workload and missed nursing care was positive and statistically significant (r = 0.225, p < 0.01), and workload was negatively and significantly-related to ethical climate (r=-0.222, p < 0.01). In contrast, workload was significantly and positively correlated with work interruption (r = 0.199, p < 0.01). We found a negative correlation between ethical climate and work interruption (r = -0.168, p < 0.01), and work interruption was also strongly and positively associated with missed nursing care (r = 0.482, p < 0.01). Finally, ethical climate was negatively and statistically- significantly related to missed nursing care. Furthermore, the indirect effect of workload on missed nursing care, through the sequential mediation of ethical climate, and work interruption was also statistically significant (bootstrap 95% confidence interval 0.09, 0.034).

We have revealed a significant positive relationship between workload, work interruptions, and missed nursing care among emergency registered nurses in Iran. We suggest that fostering a positive ethical climate within the emergency department may play a crucial role in reducing missed nursing care and improving overall care quality. Additionally, given that excessive workload and frequent interruptions were associated with both ethical climate and care delivery, it may be essential for nursing leadership to implement systematic and proactive strategies to address these stressors.