The Work Behind the Work: Logistical-Administrative Workload, Health Technology Satisfaction and Missed Nursing Care Among Belgian Hospital Nurses. - 2026
[en] [en] BACKGROUND: Hospital nurses face increasing logistical-administrative demands and the widespread use of digital systems. Both may affect job satisfaction and patient safety by increasing workload and contributing to missed nursing care.
OBJECTIVE: To quantify logistical-administrative workload and satisfaction with health technology among hospital nurses and to identify associations with job satisfaction and the prevalence of missed care.
DESIGN: Cross-sectional survey.
SETTING(S): A national cross-sectional survey of all nurses working in hospitals in Belgium was conducted between September 16 and October 18, 2024.
PARTICIPANTS: A total of 3613 hospital nurses (79% staff nurses and 21% nurse managers) completed the entire online survey.
METHODS: An online questionnaire assessed the proportion of time spent on administrative and logistical tasks, satisfaction with health technologies, job satisfaction, and 15 types of missed nursing care. Multivariable logistic and Poisson regression models, adjusted for sociodemographic and work environment factors, were applied.
RESULTS: Nurses reported spending a median of 18% per shift on logistical-administrative tasks, with staff nurses spending more time than nurse managers (20% vs. 10%, p < 0.001) on these tasks. Overall, 71.7% were satisfied with their job, yet 72.1% reported at least one missed care activity. Higher logistical-administrative workload was associated with greater odds of job dissatisfaction (ORa = 1.15, 95% CI [1.10-1.20]) and more missed care (IRRa = 1.12 [1.04-1.20]). Dissatisfaction with health technologies was similarly linked to job dissatisfaction (ORa = 1.30 [1.07-1.58]) and missed care (IRRa = 1.17 [1.10-1.24]). Poor or average work environment was strongly associated with job dissatisfaction (ORa = 15.51 [12.04-19.71]) and missed care (IRRa = 1.36 [1.28-1.50]).
CONCLUSIONS: Higher perceived logistical-administrative workload and lower satisfaction with health technologies were associated with increased job dissatisfaction and missed nursing care among hospital nurses. These findings highlight the importance of considering how administrative demands and digital tools are integrated into daily nursing work when addressing working conditions and care quality.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Paquay, Méryl ; Université de Liège - ULiège > Santé publique : de la Biostatistique à la Promotion de la Santé
Bellaccomo, Giordano ; Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium, ulb.ac.be
Dauvergne, Jérôme E ; Department of Anaesthesiology and Critical Care, Laënnec Hospital, CHU Nantes, Nantes Université, Nantes F-44000, France, chu-nantes.fr
Bruyneel, Arnaud ; Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium, ulb.ac.be
Language :
English
Title :
The Work Behind the Work: Logistical-Administrative Workload, Health Technology Satisfaction and Missed Nursing Care Among Belgian Hospital Nurses.
Michel L., A Failure to Communicate? Doctors and Nurses in American Hospitals, Journal of Health Politics Policy and Law. (2017) 42, no. 4, 709–717, https://doi.org/10.1215/03616878-3856149.
Ganty T., Szecel J., Diep A., Ghuysen A., and Paquay M., Multicentre Cross-Sectional Study to Assess Nursing Workload in Belgian Emergency Departments, Emergency Medicine Journal. (2025) 42, no. 7, 421–428, https://doi.org/10.1136/emermed-2024-214334.
Aiken L. H., Sermeus W., McKee M. et al., Physician and Nurse Well-Being, Patient Safety and Recommendations for Interventions: Cross-Sectional Survey in Hospitals in Six European Countries, BMJ Open. (2024) 14, no. 2, https://doi.org/10.1136/BMJOPEN-2023-079931.
Bruyneel A., Dello S., Dauvergne J. E., Kohnen D., and Sermeus W., Prevalence and Risk Factors for Burnout, Missed Nursing Care, and Intention-to-Leave the Job Among Intensive Care Unit and General Ward Nurses: A Cross-Sectional Study Across Six European Countries in the COVID-19 Era, Intensive and Critical Care Nursing. (2025) 86, https://doi.org/10.1016/j.iccn.2024.103885.
Kohnen D., De Witte H., Schaufeli W. B., Dello S., Bruyneel L., and Sermeus W., Engaging Leadership and Nurse Well-Being: The Role of the Work Environment and Work Motivation—A Cross-Sectional Study, Human Resources for Health. (2024) 22, no. 1, https://doi.org/10.1186/s12960-023-00886-6.
Zhao Y., Lu H., Zhu X., and Xiao G., Job Satisfaction Among Hospital Nurses: An Updated Literature Review, International Journal of Nursing Studies. (2025) 162, https://doi.org/10.1016/j.ijnurstu.2024.104964.
Bruyneel A., Bouckaert N., de Noordhout C. M. et al., Association of Burnout and Intention-to-Leave the Profession With Work Environment: A Nationwide Cross-Sectional Study Among Belgian Intensive Care Nurses After Two Years of Pandemic, International Journal of Nursing Studies. (2022) 137, https://doi.org/10.1016/j.ijnurstu.2022.104385.
Borges do Nascimento I. J., Abdulazeem H., Vasanthan L. T. et al., Barriers and Facilitators to Utilizing Digital Health Technologies by Healthcare Professionals, NPJ Digital Medicine. (2023) 6, no. 1, https://doi.org/10.1038/s41746-023-00899-4.
Beks H., Clayden S., Wong Shee A. et al., Low-Value Health Care, De-Implementation, and Implications for Nursing Research: A Discussion Paper, International Journal of Nursing Studies. (2024) 156, https://doi.org/10.1016/j.ijnurstu.2024.104780.
Jones T. L., Hamilton P., and Murry N., Unfinished Nursing Care, Missed Care, and Implicitly Rationed Care: State of the Science Review, International Journal of Nursing Studies. (2015) 52, no. 6, 1121–1137, https://doi.org/10.1016/j.ijnurstu.2015.02.012.
Ball J. E., Bruyneel L., Aiken L. H. et al., Post-Operative Mortality, Missed Care and Nurse Staffing in Nine Countries: A Cross-Sectional Study, International Journal of Nursing Studies. (2018) 78, 10–15, https://doi.org/10.1016/j.ijnurstu.2017.08.004.
Griffiths P., Recio-Saucedo A., Dall’Ora C. et al., The Association Between Nurse Staffing and Omissions in Nursing Care: A Systematic Review, Journal of Advanced Nursing. (2018) 74, no. 7, 1474–1487, https://doi.org/10.1111/jan.13564.
Bruyneel A., Bouckaert N., Pirson M., Sermeus W., and Van den Heede K., Unfinished Nursing Care in Intensive Care Units and the Mediating Role of the Association Between Nurse Working Environment, and Quality of Care and Nurses’ Wellbeing, Intensive and Critical Care Nursing. (2024) 81, https://doi.org/10.1016/j.iccn.2023.103596.
Alghamdi M. G., Nursing Workload: A Concept Analysis, Journal of Nursing Management. (2016) 24, no. 4, 449–457, https://doi.org/10.1111/jonm.12354.
Van Den Heede K., Bruyneel L., Beeckmans D. et al., Safe Nurse Staffing Levels in Acute Hospitals, 2019, Belgian Health Care Knowledge Centre (KCE), https://doi.org/10.57598/R325C.
Yang J., Amrollahi A., and Marrone M., Harnessing the Potential of Artificial Intelligence: Affordances, Constraints, and Strategic Implications for Professional Services, Journal of Strategic Information Systems. (2024) 33, no. 4, https://doi.org/10.1016/j.jsis.2024.101864.
Laukka E., Hammarén M., Pölkki T., and Kanste O., Hospital Nurse Leaders’ Experiences With Digital Technologies: A Qualitative Descriptive Study, Journal of Advanced Nursing. (2023) 79, no. 1, 297–308, https://doi.org/10.1111/jan.15481.
Laakkonen N., Jarva E., Hammarén M. et al., Digital Competence Among Healthcare Leaders: A Mixed-Methods Systematic Review, Journal of Nursing Management. (2024) 2024, no. 1, https://doi.org/10.1155/2024/8435248.
Navarro Martínez O. and Leyva-Moral J. M., Digital Transformation Led by Nurses and Nursing Managers’ Priorities: A Qualitative Study, Journal of Nursing Management. (2024) 2024, no. 1, https://doi.org/10.1155/2024/8873127.
von Elm E., Altman D. G., Egger M., Pocock S. J., Gøtzsche P. C., and Vandenbroucke J. P., The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies, Lancet. (2007) 370, no. 9596, 1453–1457, https://doi.org/10.1016/S0140-6736(07)61602-X.
Vivet V., Durand C., Jouck P., Nkenne D., and Steinberg P., Infirmiers Sur Le Marché Du Travail, 2024, https://organesdeconcertation.sante.belgique.be/fr/documents/infirmiers-sur-le-marche-du-travail-2022.
Sermeus W., Aiken L. H., den Heede K. V. et al., Nurse Forecasting in Europe (RN4CAST): Rationale, Design and Methodology, BMC Nursing. (2011) 10, no. 1, https://doi.org/10.1186/1472-6955-10-6.
Yasin Y. M., Kehyayan V., Khraim F., and Al-Lenjawi B., Psychometric Evaluation of the Acute Care Nurses’ Job Satisfaction Scale-Revised, Nursing Open. (2022) 10, no. 1, 488–497, https://doi.org/10.1002/nop2.1314.
Ausserhofer D., Zander B., Busse R., Schubert M., De Geest S., Rafferty A. M., Ball J., Scott A., Kinnunen J., Heinen M., Strømseng Sjetne I., Moreno-Casbas T., Kózka M., Lindqvist R., Diomidous M., Bruyneel L., Sermeus W., Aiken L. H., and Schwendimann R., Prevalence, Patterns and Predictors of Nursing Care Left Undone in European Hospitals: Results From the Multicountry Cross-Sectional RN4CAST Study, BMJ Quality and Safety. (2014) 23, no. 2, 126–135, https://doi.org/10.1136/bmjqs-2013-002318.
Racy S., Davidson P. M., Peeler A., Hager D. N., Street L., and Koirala B., A Review of Inpatient Nursing Workload Measures, Journal of Clinical Nursing. (2021) 30, no. 13-14, 1799–1809, https://doi.org/10.1111/jocn.15676.
Lake E. T., Gil J., Moronski L., McHugh M. D., Aiken L. H., and Lasater K. B., Validation of a Short Form of the Practice Environment Scale of the Nursing Work Index: The PES-5, Research in Nursing & Health. (2024) 47, no. 4, 450–459, https://doi.org/10.1002/nur.22388.
Caillet A., Dauvergne J. E., Poiroux L., Blanchard P. Y., and Bruyneel A., Analysis of the Prevalence of Missed Nursing Care Using Three Workload Assessment Methods: A Nationwide Cross-Sectional Study Among Intensive Care Nurses, Nursing in Critical Care. (2025) 30, no. 3, https://doi.org/10.1111/nicc.70055.
Kruk M. E., Gage A. D., Arsenault C. et al., High-Quality Health Systems in the Sustainable Development Goals Era: Time for a Revolution, Lancet Global Health. (2018) 6, no. 11, e1196–e1252, https://doi.org/10.1016/S2214-109X(18)30386-3.
Keshavarz H., Saeidnia H. R., and Wang T., Navigating Technostress: A Deep Dive Into Health Practitioners’ Technological Challenges in Hospital Settings, BMC Health Services Research. (2025) 25, no. 1, https://doi.org/10.1186/s12913-024-12196-1.
Kopuz K., Turgut M., and Aydın G., Technostress Among Nurses: Boon or Bane? The Moderated Mediation Model, BMC Nursing. (2025) 24, no. 1, https://doi.org/10.1186/s12912-025-03721-6.
Asgari E., Kaur J., Nuredini G. et al., Impact of Electronic Health Record Use on Cognitive Load and Burnout Among Clinicians: Narrative Review, JMIR Medical Informatics. (2024) 12, https://doi.org/10.2196/55499.
Papathanasiou I., Tzenetidis V., Tsaras K., Zyga S., and Malliarou M., Missed Nursing Care; Prioritizing the Patient’s Needs: An Umbrella Review, Healthcare. (2024) 12, no. 2, https://doi.org/10.3390/healthcare12020224.
Wirth T., Kräft J., Marquardt B., Harth V., and Mache S., Indicators of Technostress, Their Association With Burnout and the Moderating Role of Support Offers Among Nurses in German Hospitals: A Cross-Sectional Study, BMJ Open. (2024) 14, no. 7, https://doi.org/10.1136/bmjopen-2024-085705.
Van den Heede K., Florquin M., Bruyneel L. et al., Effective Strategies for Nurse Retention in Acute Hospitals: A Mixed Method Study, International Journal of Nursing Studies. (2013) 50, no. 2, 185–194, https://doi.org/10.1016/j.ijnurstu.2011.12.001.
Van den Heede K., Bouckaert N., Detollenaere J. et al., Nurse Staffing on Belgian Intensive Care Units: The Impact of Two Years of COVID-19 Pandemic, 2022, Belgian Healthcare Knowledge Centre (KCE), https://www.kce.fgov.be, Accessed July 4, 2022.
Sermeus W., Aiken L. H., Ball J. et al., A Workplace Organisational Intervention to Improve Hospital Nurses’ and Physicians’ Mental Health: Study Protocol for the Magnet4Europe Wait List Cluster Randomised Controlled Trial, BMJ Open. (2022) 12, no. 7, https://doi.org/10.1136/bmjopen-2021-059159.
Paquay M., Simon R., Ancion A., Graas G., and Ghuysen A., A Success Story of Clinical Debriefings: Lessons Learned to Promote Impact and Sustainability, Frontiers in Public Health. (2023) 11, https://doi.org/10.3389/fpubh.2023.1188594.
