Measuring Nurses’ Subjective Workload in the Neonatal Intensive Care Unit

In this issue of JAMA Pediatrics, Tubbs-Cooley and colleagues describe findings from their prospective study of the association between workload and missed care among 247 nurses across 11 364 shifts in 10 neonatal intensive care units (NICUs). Replicating their prior single-center study, the researchers collected shift-level workload data for nurse participants, operationalized the following 3 ways: (1) number of assigned patients (verified with administrative data); (2) infant acuity scores for those patients (from the electronic health record [EHR]); and (3) subjective workload measured using 4 items from the NASA Task Load Index (NASA-TLX). Nurse participants completed the NASA-TLX and missed care measures near the end of each shift. The researchers found that nurses who reported higher subjective workload had significantly higher odds of reporting missed care across all 17 items on the missed care questionnaire in both individual and joint models. Both higher patient to nurse ratios and infant acuity scores were associated with significantly higher odds of missed care for fewer than a quarter of items in joint models.