Give Me a Break: An Empirical Study of Quality Implications of Nurse Exhaustion in Intensive Care

Abstract

Problem definition: We study the impact of worker exhaustion on service quality in the context of neonatal intensive care nursing teams and the moderating effects of staffing levels and task complexity.

Academic/ practical relevance: Increased levels of exhaustion among intensive care nurses in the wake of COVID-19 has implications for care quality. However, staffing guidelines and staff scheduling decisions are typically based on measures of workload per worker (nurse-to-patient ratios) and neglect exhaustion effects that occur when nurses work uninterrupted over prolonged periods.

Methodology: We combine daily nurse staffing and medical outcome data from 62 German neonatal intensive care units over a period of six months, following 847 babies with very low birth weight. We measure daily team exhaustion as the average number of consecutive days that each team member has worked since her last break day. Using survival analysis, we estimate the impact of team exhaustion on the time to full enteral feeding of the patient and investigate the moderating effects of workload (nurse-to-patient ratio) and task complexity.

Results: Team exhaustion has a statistically significant and clinically relevant negative impact on the time to enteral feeding. While for less complex patients exhaustion has a negative impact only in combination with high workloads, complex patients are negatively affected independently of workload levels.

Managerial implications: Workforce planning and management systems need to complement staffing level targets with exhaustion metrics. While for non-complex tasks, high staffing levels can safeguard against negative exhaustion effects, this is no longer the case for complex tasks.

Note:
Trial Registration Details: This study is registered in the German Clinical Trial Register (DRKS00004589)

Funding Information: The study was funded by the Federal Ministry of Education and Research (project grant 01GY1152.

Declaration of Interests None to declare.

Ethical Approval Statement: This study was approved by the corresponding Ethics Commission, Faculty of Medicine, University of Cologne (#12-228).

Keywords: healthcare management, workload, exhaustion, hospital operations, intensive care