TOPLINE: 

A study of neonatal nurse practitioners (NNPs) at two level IV NICUs identified competing tasks, poor coordination, frequent interruptions, limited ancillary support, and staff shortages as primary contributors to NNP workload. Good team rapport and experienced staff helped mitigate workload. 

METHODOLOGY:

• Investigators conducted a qualitative study involving 32 NNPs with experience ranging from 1 to 28 years across two level IV NICUs affiliated with two large academic health centers.
• They observed NNPs during their regular work shifts, followed by 30-minute virtual semi-structured interviews that focused on workload barriers and facilitators both during the observation period and in their overall work experiences.
• Observation data were collected using a tool with structured sections to record work system-related factors and unstructured sections for handwritten notes; the notes and interviews were transcribed after the sessions.

TAKEAWAY:

• Competing task demands, poor coordination with clinicians, frequent interruptions from nonemergency issues, and limited ancillary support during nights or weekends were major workload drivers for NNPs in NICUs.
• A limited number of experienced registered nurses, unanticipated admissions or complicated discharges, increased patient acuity, and staff shortages leading to increased patient assignments were also major contributors to workload.
• Facilitators that reduced workload included having good rapport with attending physicians and fellows, coworkers who are willing to help, effective task delegation, having experienced registered nurses, and adequate support staff such as flex nurse practitioners, pharmacists, and nutritionists on the team.

IN PRACTICE:

“By identifying specific workload barriers for workload management, this study highlights key areas for potential targeted interventions to reduce NNP workload in NICUs,” the authors wrote. “It also reveals the facilitators within NICU NNP teams that frequently help alleviate their workload.”

SOURCE:

The study was led by Lamia Alam, Vanderbilt University Medical Center, Nashville, Tennessee. It was published online on September 2, 2025, in Proceedings of the Human Factors and Ergonomics Society Annual Meeting.

LIMITATIONS:

This study had a qualitative observational design, which was not validated against objective workload or outcome measures.

DISCLOSURES:

The study was funded by a grant from Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.