Interruptions Experienced by Emergency Nurses: Implications for Subjective and Objective Measures of Workload

Introduction: This study aimed to describe interruptions experienced by emergency nurses and establish convergence validity of 1 objective workload measure by linking interruption characteristics to objective and subjective measures of workload. Methods: Interruptions were captured in real time across 8- or 12-hour shifts using a previously validated Workflow Interruptions Tool (WIT). Data collected on each interruption included type, priority, and location where the interruption occurred. At mid- and end-shift, the Surgery Task Load Index (SURG-TLX) and the Rapid Cognitive Assessment Tool (RCAT) were administered to participating nurses to measure workload subjectively and objectively. Results: Thirty-eight emergency nurse shifts were observed. A total of 3,229 interruptions were recorded across 372.5 clinical hours and 38 shifts (means [M] = 85.0 interruptions per shift, standard deviation [SD] = 34.9; M = 8.7 interruptions per hour, SD = 3.36). The median duration per interruption was 13.0 seconds. A moderate positive association was identified between the number of interruptions experienced during a shift and the increased overall SURG-TLX workload reported at end-shift, r(36) = 0.323, P = 0.048. Also, a moderate positive association was identified between increased reaction times during the RCAT task and increased mental demand experienced at end of shift, r(36) = 0.460, P < 0.001. Discussion: This study observed interruptions throughout the entirety of a nursing shift and found that the majority of interruptions caused by the environment were low priority. Targeting interventions to reduce low-priority and environmental interruptions may aid in alleviating the impact of interruptions on clinical staff and patient care. Furthermore, results demonstrate that the frequency of interruptions was perceived to increase the nursing staff workload overall.