Workload – a critical ethnography of nursing culture and a complex climate

The issue of measuring nursing workload has been historically problematic because of inherent difficulties associated with identifying ‘what nursing work actually is’ and ‘what nursing work is actually done’ in multiple contexts. Quantifying nursing work merely through tasks to be performed or how complex the patient needs may be, can fail to acknowledge the intuitive and personalised ways of ‘doing’ nursing and consequently many of the central tasks performed to facilitate nursing care. This research originated from a request by nurses in an acute surgical unit to investigate ‘a workload problem’. Nursing workload involve more than ‘hands on patient care’ or ‘being at the bedside’. Whilst patient care is central to nursing care, the role and functions of nursing work incorporate significant amounts of ‘invisible’ work. This study aimed to identify culture and climate as an influence on nursing workload in an acute surgical unit of a large regional hospital in Queensland, Australia. The findings identified that culture and climate, while not always acknowledged by nurses and administrators, constructs, have significant power and influence over the amount and timing of nursing workload. However, the central premise of these findings is that the extent of climatic influences on the organisation of nursing work, in conjunction with traditional nursing practices, has created a ‘disconnect’ between professional expectations and workload reality. This disconnect is further exacerbated by the removal of nursing leadership positions that allow bureaucratic and other agendas to prevail over nursing practice. The study was undertaken in two phases. The first phase was a Systematic Review of extant literature. The second phase embraced a critical ethnographic approach of observation and interview of Registered Nurses at work. Purposive sampling of Registered Nurses within the specific unit was used for the recruitment of participants, after ethics approval was given. The study period involved 60 hours of observation and 11 interviews forming the data collection. Thematic and critical analysis resulted in the development of a conceptual diagram of nursing workload that ‘makes visible’ the cultural and climatic influences on nursing workload.