Development of a subjective workload assessment for nurses

Understanding perceptions of workload and workload demands for nurses providing direct care is an area that has not been well researched and is important to maintaining a safe practice environment. This study focused on nurses' perception of workload as part of daily nursing practice as defined in human factor's literature, rather than on traditional methods (e.g., task performance time and number of patients). The purpose was to develop and estimate the psychometric properties of the Subjective Workload Assessment for Nurses (SWAN). The sample of 188 medical-surgical registered nurses in Texas was derived from a database purchased from the Texas Board of Nurse Examiners (BNE). Data were collected via mail survey using two researcher developed instruments: the SWAN and General Information Questionnaire (GIQ); and the Nursing Task Load Index (Nursing TLX) developed by Gregg. The five hypotheses were addressed using the following statistical analyses: content validity index (CVI) for determining content validity, Cronbach's alpha for internal consistency, principal components factor analysis for exploration of possible underlying dimensions (i.e., construct validity), and Pearson's r for convergent validity. Descriptive statistics were used to describe the sample, workload, and work environment characteristics.

The SWAN was found to have content and construct validity for the nurses in this study. The SWAN Section 1, 2, and 3, GIQ Section 1, and the Nursing TLX demonstrated internal consistency with this sample. Findings supported the interrelationship between the activity complexity (effort needed), performance circumstances (time demands), and individual characteristics (personal motivation) described in the literature. Findings also indicated the indirect influence of factors such as managerial support, staffing type, and non-patient care job requirements on the subjective assessment of workload. Further study is needed to continue refinement of the SWAN, to estimate stability, and to establish psychometric properties with nurses in other practice areas. Differences in the availability and importance of selected items in the work environment for nurses in this study indicate the need for further study of the work environment and its relationship to subjective workload assessment.