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Work Overload and Its Effect on Patient Care

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CE1023 | Contact Hours: 2


The purpose of this course is to educate healthcare professionals on the implications of work overload on the nursing profession. This includes both personal and professional consequences as well as patient care and effects on the healthcare system. At the conclusion of this course, the healthcare professional will be able to:

1. Define work overload and identify its risk factors among the nursing profession.
2. Recognize signs and symptoms of work stress and overload.
3. Discuss the prevalence of work overload among the nursing profession.
4. Understand the personal and professional consequences of nursing work overload.
5. Implement strategies to manage stress and work overload.






Sara Hilgenberg, LPN


All learners must complete the entire activity and complete the evaluation to receive contact hours.


This nursing continuing professional development activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91).

In addition to states that accept American Nurses Credentialing Center (ANCC) courses, CE Leaders is an approved provider by the Florida Board of Nursing, and a registered provider with the Arkansas State Board of Nursing, District of Columbia Board of Nursing, Georgia Board of Nursing, Kentucky Board of Nursing, New Mexico Board of Nursing, South Carolina Board of Nursing and West Virginia Board of Registered Nurses (Provider # 50-33450).


No one with the ability to control content of this activity has a relevant financial relationship with an ineligible company.


Stress is commonly defined as physical, mental or emotional strain or tension (1). Surveys conducted by the American Psychological Association consistently find that work is a significant source of stress by a majority of Americans (2). A reported 83% of United States workers report some kind of work related stress, which causes one million people to miss work every day (3). The World Health Organization (WHO) lists burnout, a type of work related stress, as an “occupational phenomenon” (4). According to the WHO, burnout is a syndrome conceptualized as a result from chronic workplace stress that has not been successfully managed and is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy (4). Burnout is more prevalent among professions that help others, especially among nurses. Since nurses are especially vulnerable to burnout, it is of great concern for many reasons. One, registered nurses represent the largest sector of healthcare professionals, with nearly 3.1 million in the United States, and they are on the frontlines for direct patient care (5). Another reason is that, regardless of that seemingly high number, The American Nurses Association (ANA) reports that more registered nurse jobs will be available through 2022 than any other profession in the United States (6). Higher workloads and shortages among nurses have been associated with lower ratings of quality of care, errors and poor patient outcomes (7, 8). Increasing job satisfaction among nurses and reducing their high level of workload is critical to maintaining an adequate number of nurses and quality of patient care.


1. The Healthy Nurse, Healthy Nation (HNHN), is a program of the American Nurses Association Enterprise designed to improve the health of registered nurses:

2. Self-care strategies from the American Holistic Nurses Association:

3. UNC School of Medicine’s Heroes Health Initiative provides a free mobile application that allows nurses to track their mental health and find appropriate mental health resources:

4. Nursegroups is a volunteer-led emotional wellness initiative created in response to the COVID-19 pandemic. If you’re interested in joining a confidential videoconference group to discuss your mental health challenges, NurseGroups is a great resource. You can join an individual session or sign up for recurring invites on a weekly basis. You can also find useful self-care resources:

5. Behavioral Health Treatment Services Locator: This resource from SAMHSA allows users to find treatment facilities confidentially and anonymously, searching by address:

6. The CDC’s resources include guidance for public health and health professionals and information for people seeking mental health treatment:


1. American Institute of Stress. What is Stress? Available at Accessed August 20, 2022.

2. American Psychological Association. Coping with Stress at Work. Available at Updated October 14, 2018. Accessed August 20, 2022.

3. What is Burnout? How to Recognize the Signs and Recover from Work-Related Stress. Available at Published April 27, 2020. Accessed August 20, 2022.

4. Burn-out “Occupational Phenomenon”: International Classification of Diseases. Available at Published May 28, 2019. Accessed August 20, 2022.

5. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Registered Nurses. Available at Accessed August 20, 2022.

6. Haddad L, Annamaraju P, Toney-Butler T. Nursing Shortage. Available at Updated February 22, 2022. Accessed August 20, 2022.

7. Aiken L, Clarke S, Sloane D, Sochalski J, Silber J. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA. 288(16):1987-1993. Available at Published October 2002. Accessed August 21, 2022.

8. Paulsen RA. Taking Nurse Staffing Research to the Unit Level. J Nursing Management. 49(7):42-48. Available at Published June 11, 2018. Accessed August 21, 2022.

9. Kirch, W. Work Overload. Encyclopedia of Public Health. pp1466. Available at Published 2008. Accessed August 21, 2022.

10. Pascale C, Gurses A. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 30: Nursing Workload and Patient Safety—A Human Factors Engineering Perspective. Available at Published April 2008. Accessed August 22, 2022.

11. Gutsan E, Patton J, Willis W, Coustasse. Burnout Syndrome and Nurse-to-Patient Ratio in the Workplace. Available at Published April 2018. Accessed August 22, 2022.

12. Nurse Burnout: Risks, Causes, and Precautions for Nurses. Available at Accessed August 22, 2022.

13. Canadas-De la Fuente G, Vargas C, San Luis C, Garcia I, Canadas G. Risk Factors and Prevalence of Burnout Syndrome in the Nursing Profession. International Journal of Nursing Studies. Volume 52, Issue 1. Available at Published January 2015. Accessed August 23, 2022.

14. Nurse Burnout: Risks, Causes, and Precautions for Nurses. Available at Published July 2020. Accessed August 22, 2022.

15. Frothingham S. What are the Traits and Challenges of a Type D Personality? Available at Published October 10, 2019. Accessed August 22, 2022.

16. Mayo Clinic. Job Burnout: How to Spot it and Take Action. Available at Accessed August 20, 2022.

17. Managing Nurse Stress: Mental Health Tips and Resources. Available at Published July 31, 2020. Accessed August 24, 2022.

18. Lombardo B, Eyre C. Compassion Fatigue: A Nurse’s Primer. The Online Journal of Issues on Nursing. Volume 16-2011. Available at Published January 2011. Accessed August 24, 2022.

19. Soosova M. Association Between Nurses’ Burnout, Hospital Patient Safety Climate and Quality of Nursing Care. Central European Journal of Nursing and Midwifery. Available at Published December 2020. Accessed August 25, 2022.

20. Occupational Stress. My American Nurse. Available at Accessed August 26, 2022.

21. Nurse Burnout: Causes, Symptoms, and Prevention. Available at Accessed August 21, 2022.

22. Avoid Work Overload. Available at Published June 28, 2022. Accessed August 22, 2022.

23. Dyrbye L, Shanafelt T, Sinsky C, Cipriano P, Bhatt J, Ommaya A, et al. Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care. Available at Published July 5, 2017. Accessed August 24, 2022.

24. McHugh M, Kutney-Lee A, Cimiotti J, Sloane D, Aiken L. Nurses’ Widespread Job Dissatisfaction, Burnout, And Frustration With Health Benefits Signal Problems For Patient Care. Available at Published February 2011. Accessed August 24, 2022.

25. Dyrbye, L, Shanafelt, T, Johnson, P, Johnson L, Satele D, West C. A Cross-Sectional Study Exploring the Relationship Between Burnout, Absenteeism, and Job Performance Among American Nurses. BMC Nursing. 18, 57. Available at Published November 21, 2019. Accessed August 24, 2022.

26. Shah M, Gandrakota N, Cimiotti J, Ghose N, Moore M, Ali M. Prevalence of and Factors Associated With Nurse Burnout in the US. Available at Published February 4, 2021. Accessed August 24, 2022.

27. Leiter MP, Maslach C. Nurse Turnover: the Mediating Role of Burnout. J Nurs Manag. 2009;17(3):331-339. Available at Published April 17, 2009. Accessed August 23, 2022.

28. Oyeleye O, Hanson P, O'Connor N, Dunn D. Relationship of Workplace Incivility, Stress, and Burnout on Nurses' Turnover Intentions and Psychological Empowerment. J Nurs Adm. 2013;43(10):536-542. Available at,_Stress,_and.10.aspx. Published October 2013. Accessed August 23, 2022.

29. Kelly L, Gee P, Butler R. Impact of Nurse Burnout on Organizational and Position Turnover. Nursing Outlook. 69(1): 96-102. Available at Published October 4, 2020. Accessed August 24, 2022.

30. Zhang X, Tai D, Pforsich H, Lin VW. United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit. Am J Med Qual.33(3):229-236. Available at Published November 28, 2017. Accessed August 24, 2022.

31. Juraschek S, Zhang X, Ranganathan V, Lin V. Republished: United States Registered Nurse Workforce Report Card and Shortage Forecast. Am J Med Qual.34(5):473-481. Available at Published 2019. Accessed August 25, 2022.

32. Lee A, Cheong Y, Joynt G, Leung C, Wong W, Gommersall C. Are High Nurse Workload/Staffing Ratios Associated with Decreased Survival in Critically ill Patients? A Cohort Study. Available at Published May 2, 2017. Accessed August 24, 2022.

33. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-Staffing Levels and the Quality of Care in Hospitals. Available at Published May 30, 2002. Accessed August 25, 2022.

34. Brown T. ANA Releases New Position Statement on Nurse Fatigue. Medscape Medical News. Available at Published November 20, 2014. Accessed August 25, 2022.

35. Wiesen K. How Many Nurses are There in the U.S. – 2022 State Wise Data. Available at Accessed August 26, 2022.

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