Nursing Workloads and Psychological Empowerment in Hospitals: Structural Equations Modeling

Abstract

1. Background The efficiency and effectiveness of health services depend on nurses as an important part of the healthcare system. As a main human resource in hospital organizations, nurses play a significant role in the success and promotion of patient health; health organizations cannot be successful without efficient nurses. Due to the high rate of patient referrals to hospitals, workload is a challenge faced by nursing management. 1 Nursing in intensive care units (ICUs) is characterized by high complexity care and a greater demand for technical and scientific competence; immediate decision-making and the adoption of safe behaviors are directly related to the morbidity and mortality of patients. 2 Although the high workload of nurses in ICUs has been identified as a major problem, little attention has been given this issue. 3 The different aspects of a nurse's workload must be clarified so that the workload can be better managed and the satisfaction of critical care nurses in their workload increased. 4 From the point of view of nurses, the main barriers to the relationship between patients and nurses are the lack of nurses, lack of sufficient time, and lack of patient awareness. 5 The heavy workload of a hospital nurses is a major difficulty for hospitals. Evidence has shown that adverse patient outcomes are associated with some aspects of a nurse's workload. 6-8 The results of this study showed that different methods, such as patient-based and operator-based workload, can be used to measure the workload of ICU nurses. The NASA Task Load Index (TLX) is the best questionnaire Abstract Background: The high workload of nurses in hospitals has been identified as a patient safety and worker stress problem. Psychological empowerment is a motivational concept demonstrated in four dimensions: meaning, competence, self-determination, and impact. Objective: This study investigated the relationship between nurses' workloads and psychological empowerment using structural equations modeling (SEM). Methods: This descriptive correlation study was conducted using SEM. The study was conducted at 17 public hospitals affiliated with Iran University of Medical Sciences (IUMS) in the city of Tehran. The population study was nurses employed in critical care departments. Two questionnaires were used to gather data: the NASA and the Psychological Empowerment Questionnaires. Differences in categorical variables were analyzed using one-way analysis of variance (ANOVA). Confirmatory factor analyses were used to confirm the relationships between latent variables and indicator variables; SEM was used to find the direct and indirect effects of nurse's workload on psychological empowerment. Data analyses were performed using SPSS 18, and all models were tested in LISREL 8.8. Results: Correlations among indicators of nurse's workload showed that highest correlations were performances (0.61), and the highest correlations among psychological empowerment were competence (0.03). The overall correlations among nursing workloads and psychological empowerment were 0.74. The proposed structural model fit was acceptable (χ2 = 525.5, df = 89, RMSEA = 0.13, GFI = 0.91). Conclusion: Increasing the workload of nurses in hospitals will better engage the nurses and allow them to face new problems they encounter in their jobs.