Workload Intensity, the Nursing Practice Environment, and Adverse Events


Name: Patricia Patrician

Rank: COL (Ret)

Organization: University of Alabama at Birmingham

Performance Site: University of Alabama at Birmingham, AL

Year Published: 2010

Abstract Status: Final


The purpose of this study is to determine the effects of the intensity of nurses’ work (as measured by patient acuity and an index of admissions, discharges, and transfers) and the nursing practice environment, on the relationship between staffing and outcomes at the shift level.  Our research thus far has demonstrated statistically significant inverse relationships between better nurse staffing and lower incidents of patient and nurse adverse events.  Shifts that had higher total hours of nursing care, and a higher proportion of those hours provided by registered nurses (i.e., RN skill mix) were significantly associated with lower adverse events.  Specific to the military, staff category (i.e., the proportion of staff who were military, civilians, contractors, or reservists) was also associated with outcomes.  Our past findings suggest that having more highly experienced nurses on a shift was associated with better outcomes.

The current study has the capacity to inform military nursing leaders of connections between staffing, the practice environment, workload intensity and outcomes.  This is important as the services create their own Professional Practice Models that may look quite different than those in the civilian sector.  Our research team understands that the nature of the military requires more non-RN providers, the military attracts young professionals early in their careers, and the military nurse demographic patterns are markedly different, with more men and more racially diverse personnel than in the civilian sector.   Military nurses view their roles and practice environments as being different and our preliminary MilNOD data supports this with higher practice environment scores than those found in civilian hospitals.  Because favorable nursing practice environments are known to influence retention, the information our study will provide can also impact the recruitment and retention priorities that exist among military nursing leaders.  Our data are unmatched in ability to immediately answer questions concerning how both the practice environment and the intensity of nurses’ work affect patient and nurse adverse events at the shift level, the sharp point of patient care.


Final Report is available on NTRL: