The Relationship Between Nurse Workload and Patient Safety Culture in Hospital Inpatient Wards

Rogayah Rogayah; Fathiyati Fathiyati

doi:10.46749/jiko.v10i2.226

The Relationship Between Nurse Workload and Patient Safety Culture in Hospital Inpatient Wards

Rogayah Rogayah, Fathiyati Fathiyati

Abstract

Background: Nurses' workload is one of the factors that can influence the quality of service and the implementation of patient safety. High workload can increase the physical and mental demands of nurses, thus potentially influencing the formation of a patient safety culture in hospitals. This study aims to analyze the relationship between nurses' workload and patient safety culture in hospital inpatient wards. Methods: This study used a quantitative design with a cross-sectional approach. The study sample consisted of 150 nurses working in inpatient wards and were selected according to the study's inclusion criteria. Data collection was carried out using a nurses' workload questionnaire and a patient safety culture questionnaire that had been adjusted to the characteristics of nursing services. Data analysis included univariate and bivariate analyses. The Spearman correlation test was used to determine the relationship between nurses' workload and patient safety culture with a significance level of α = 0.05. Results: Most nurses had a moderate workload, namely 78 respondents (52.0%), while the patient safety culture was mostly in the sufficient category, namely 83 respondents (55.3%). Spearman's test results showed a significant relationship between nurse workload and patient safety culture (r = -0.386; p < 0.001), with a negative relationship and moderate strength. Conclusion: There is a significant relationship between nurse workload and patient safety culture. Workload management, staffing adequacy, and strengthening a safety culture require hospital management attention.

Keywords

Nurse Workload; Patient Safety Culture; Nurses; Inpatient Ward

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References

Alrabae, Y. M. A., et al. (2021). The association between self-reported workload and perceptions of patient safety culture: A study of intensive care unit nurses. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.15646

Carthon, J. M. B., Hatfield, L., Plover, C., et al. (2019). Association of nurse engagement and nurse staffing on patient safety. Journal of Nursing Care Quality, 34(1), 40–46. https://doi.org/10.1097/NCQ.0000000000000334

Fagerström, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents and mortality: An observational study from Finland. BMJ Open, 8(4), e016367. https://doi.org/10.1136/bmjopen-2017-016367

Hong, K. J. (2025). Patient safety management activities and perceived workload of shift-work nurses, moderated by the perceived importance of patient safety management. International Nursing Review, 72(3), e13069. https://doi.org/10.1111/inr.13069

Kim, K. J., Yoo, M. S., & Seo, E. J. (2018). Exploring the influence of nursing work environment and patient safety culture on missed nursing care in Korea. Asian Nursing Research, 12(2), 121–126. https://doi.org/10.1016/j.anr.2018.04.003

Labrague, L. J. (2022). Linking nurse practice environment, safety climate and job dimensions to missed nursing care. International Nursing Review, 69(3), 350–358. https://doi.org/10.1111/inr.12736

MacPhee, M., Dahinten, V. S., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(1), 7. https://doi.org/10.3390/admsci7010007

Norsehan, N., Adrianto, R., Bakhtiar, R., Pakki, I. B., & Hilda, H. (2025). Analysis of the relationship between knowledge, perception, and workload of nurses on patient safety culture. Indonesian Journal of Global Health Research, 7(4), 767–776. https://doi.org/10.37287/ijghr.v7i4.6442

Park, J. H. (2020). Effects of nurses’ patient safety management importance, patient safety culture and nursing service quality on patient safety management activities in tertiary hospitals. Journal of Korean Academy of Nursing Administration, 26(3), 181–191. https://doi.org/10.11111/jkana.2020.26.3.181

Putra, K. R., Hany, A., Ningrum, E., Arisetijono, E., Taji, M., & Vatmasari, R. (2025). Patient safety culture, missed nursing care, and adverse events in university hospitals: A cross-sectional study. Iranian Journal of Nursing and Midwifery Research, 30(3), 349–355. https://doi.org/10.4103/ijnmr.ijnmr_210_23

Sani, M. M., Jafaru, Y., Ashipala, D. O., et al. (2024). Influence of work-related stress on patient safety culture among nurses in a tertiary hospital: A cross-sectional study. BMC Nursing, 23, 81. https://doi.org/10.1186/s12912-023-01695-x

Wang, L., Lu, H., Dong, X., et al. (2020). The effect of nurse staffing on patient-safety outcomes: A cross-sectional survey. Journal of Nursing Management, 28, 1758–1766. https://doi.org/10.1111/jonm.13138

Zabin, L. M., Abu Zaitoun, R. S., Sweity, E. M., & de Tantillo, L. (2023). The relationship between job stress and patient safety culture among nurses: A systematic review. BMC Nursing, 22, 39. https://doi.org/10.1186/s12912-023-01198-9

Nasirizad Moghadam, K., Chehrzad, M. M., Reza Masouleh, S., et al. (2021). Nursing physical workload and mental workload in intensive care units: Are they related? Nursing Open, 8(4), 1625–1633. https://doi.org/10.1002/nop2.785

Labrague, L. J., & Cayaban, A. R. (2025). Association between patient safety culture and missed nursing care in healthcare settings: A systematic review and meta-analysis. Journal of Advanced Nursing, 81(11), 7992–8004. https://doi.org/10.1111/jan.16758

Alrabae, Y. M. A., Aboshaiqah, A. E., & Tumala, R. B. (2021). The association between self-reported workload and perceptions of patient safety culture: A study of intensive care unit nurses. Journal of Clinical Nursing, 30(7–8), 1003–1017. https://doi.org/10.1111/jocn.15646

Brás, C. P. da C., Ferreira, M. M. C., Figueiredo, M. do C. A. B. de, & Duarte, J. C. (2023). Patient safety culture in nurses’ clinical practice. Revista Latino-Americana de Enfermagem, 31, e3838. https://doi.org/10.1590/1518-8345.6231.3838

Sanchis, D. Z., Haddad, M. do C. F. L., Girotto, E., & Silva, A. M. R. (2020). Patient safety culture: Perception of nursing professionals in high complexity institutions. Revista Brasileira de Enfermagem, 73(5), e20190174. https://doi.org/10.1590/0034-7167-2019-0174

Sturm, H., Rieger, M. A., Martus, P., Ueding, E., Wagner, A., Holderried, M., & WorkSafeMed Study Group. (2019). Do perceived working conditions and patient safety culture correlate with objective workload and patient outcomes: A cross-sectional explorative study from a German university hospital. PLOS ONE, 14(1), e0209487. https://doi.org/10.1371/journal.pone.0209487

Hessels, A. J., Paliwal, M., Weaver, S. H., Siddiqui, D., & Wurmser, T. A. (2019). Impact of patient safety culture on missed nursing care and adverse patient events. Journal of Nursing Care Quality, 34(4), 287–294. https://doi.org/10.1097/NCQ.0000000000000378

MacPhee, M., Dahinten, V. S., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(1), 7. https://doi.org/10.3390/admsci7010007

Ross, C., Rogers, C., & King, C. (2019). Safety culture and an invisible nursing workload. Collegian, 26(1), 1–7. https://doi.org/10.1016/j.colegn.2018.02.002

Sanchis, D. Z., Haddad, M. C. F. L., Girotto, E., & Silva, A. M. R. (2020). Patient safety culture: Perception of nursing professionals in high complexity institutions. Revista Brasileira de Enfermagem, 73(5), e20190174. https://doi.org/10.1590/0034-7167-2019-0174

Sloane, D. M., Smith, H. L., McHugh, M. D., & Aiken, L. H. (2018). Effect of changes in hospital nursing resources on improvements in patient safety and quality of care: A panel study. Medical Care, 56(12), 1001–1008. https://doi.org/10.1097/MLR.0000000000001002

Yudi, D., Tangka, J. W., & Wowiling, F. (2019). Hubungan beban kerja fisik dan mental perawat dengan penerapan patient safety di IGD dan ICU RSU GMIM Pancaran Kasih Manado. Jurnal Keperawatan, 7(1). https://doi.org/10.35790/jkp.v7i1.22885

Zabin, L. M., Abu Zaitoun, R. S., Sweity, E. M., & de Tantillo, L. (2022). Patient safety culture in Palestine: University hospital nurses’ perspectives. BMC Nursing, 21, 204. https://doi.org/10.1186/s12912-022-00987-y

DOI: https://doi.org/10.46749/jiko.v10i2.226