Analysis of Workload and Job Satisfaction Among Intra-Operative Nurses: Impact of Procedure Type

Abstract

Introduction: The Netherlands is experiencing a critical shortage of healthcare workers, particularly nurses. Operating rooms (ORs) face high turnover rates due to their unique and demanding environment. The introduction of Robot-Assisted Surgery (RAS) has added further complexity to the OR setting. While RAS offers benefits for patients and surgeons, its impact on the workload and job satisfaction of intra-operative nurses remains unclear. Given the link between workload and job satisfaction and nurse retention, it is essential to investigate how RAS affects the workload and job satisfaction of intra-operative nurses compared to laparoscopic and open procedures. This study aims to provide a nuanced understanding of these aspects and identify key influencing factors.

Method: A multi-method approach was employed among intra-operative nurses at Leids Universitair Medisch Centrum (LUMC), combining subjective data from questionnaires—including the Surgical Task Load Index (SURG-TLX)—with insights from semi-structured interviews. Additionally, objective data were analyzed from hospital records and video recordings. The study focused on the gynecology department, evaluating workload and job satisfaction across three main types of procedures: open, laparoscopic, and RAS. Variations in workload and job satisfaction during the pre-operative, intra-operative, and post-operative phases were also examined.

Results: The overall workload was deemed acceptable, with an average score of 34.58, below the detrimental threshold of 50. RAS procedures scored higher across multiple domains, resulting in a higher average workload score of 40.82, compared to 32.60 for open procedures and 30.32 for laparoscopic procedures. Open procedures were associated with greater job satisfaction than both laparoscopic and RAS procedures. Key factors affecting workload and job satisfaction included: team dynamics, procedural variation, preparation and equipment, working environment, appreciation and recognition, and physical demand. Interviews revealed that intra-operative nurses experienced more stress during RAS procedures, particularly in the preoperative phase, largely due to a lack of technological knowledge. Additionally, they felt less involved, and the working environment was perceived as less pleasant. Objective data from hospital records supported these findings, showing that RAS procedures typically had longer durations and more frequent overruns, often involving patients with lower acuity scores. This combination of reduced procedural complexity and extended surgery times contributed to a higher perceived workload and lower job satisfaction. The extended periods of dim lighting and the more crowded operating room further exacerbated the working environment’s discomfort, increasing the perceived workload and reducing job satisfaction. Video data analysis indicated less interaction with the operating table and reduced movement of personnel during RAS procedures, which potentially contributed to a diminished sense of activity and involvement, thereby increasing the perceived workload.

Conclusion: RAS procedures impose a greater workload on intra-operative nurses compared to open and laparoscopic procedures across multiple domains and result in less job satisfaction compared to open procedures. Data from questionnaires, interviews, hospital records, and video analysis consistently show a diminished sense of involvement and increased perceived workload during RAS procedures. This study underscores the need for improvements in preparation protocols, OR scheduling, intra-operative nurse involvement, and working conditions. These enhancements could help reduce perceived workload, increase job satisfaction, and ultimately address the growing nursing shortage in the Netherlands.