Measurement study provides insight into personnel working in a neonatal intensive care unit.

A new tool to assess workload among advanced practice providers (APPs) and physicians in the neonatal intensive care unit (NICU) may provide a clearer picture of individual roles, potentially leading to better work-life balance in the unit, according to research by Vanderbilt University Medical Center.

Neonatal nurse practitioner Mary Eva Dye, DNP, APRN, and colleagues developed the workload measurement tool, with a validation study published in the Journal of Perinatology.

“This is a foundational study that will give us a tool that we can use in future studies.”

“This is a foundational study that will give us a tool that we can use in future studies,” said Dye, adding that the method is the first of its kind for measuring workload in the NICU.

The team integrated the too, dubbed WORKLINE, with the electronic health record (EHR) system, so that workload could be measured based on activity already being recorded by the EHR.

WORKLINE Validation

Dye and her team included a variety of data points from within the EHR. They implemented a scoring system with information on each patient, including weight, type of respiratory support received, details on nutritional support, and other information related to caring for the neonate.

WORKLINE was based on values assigned to each patient cared for by the provider on a given day, with the total score automatically calculated within the EHR.

To validate the WORKLINE model, Dye and her team took a novel approach. The researchers evaluated perceptions of workload among 27 APPs and 15 physicians in the NICU using a tool developed by researchers at the National Aeronautics and Space Administration, the NASA-Task Load Index (NASA-TLX).

An electronic version of the NASA-TLX was given to participants via text messages during shifts selected at random. Their submissions were anonymous. In total, there were 242 surveys completed by the 42 participants.

Dye and her team analyzed how well participants’ scores on the NASA-TLX matched with scores generated by WORKLINE.

Key Study Findings

In their analysis, Dye and her team found significant correlations between WORKLINE scores and NASA-TLX scores. In fact, Dye said the WORKLINE scores appeared to correlate better with NASA-TLX scores for advanced practice providers than did their caseload numbers.

“Not all patients are the same.”

Traditionally, caseload has been based on the number of patients per clinician, “but not all patients are the same,” Dye pointed out.

For example, treating a recovering infant nearing discharge will differ from treating an acutely ill child.

Future Impact

Dye and her team intend to provide additional inputs to optimize WORKLINE across the varied but important roles in the NICU. She emphasized the measure’s potential to contribute to improved care in the NICU, along with a good work-life balance for her colleagues.

“I want to make care in the NICU better for babies, so I want our workload to be appropriate and safe.”

“I did this because I want to make care in the NICU better for babies, so I want our workload to be appropriate and safe.”

In their report, the researchers noted that future research could examine workload thresholds related to performance or safety. They also highlighted the potential for WORKLINE to help balance workloads within the unit.


Mary Eva Dye, DNP

Mary Eva Dye, DNP, APRN, NNP-BC, is a neonatal nurse practitioner at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Her research focuses on the workload of health-care providers in the neonatal intensive care unit, in addition to mechanical ventilation of infants.