Summary of Article “Nursing Turbulence in Critical Care: Relationships With Nursing Workload and Patient Safety”

Published: 2021/11/26
Number of words: 894


“Nursing Turbulence in Critical Care: Relationships with Nursing Workload and Patient Safety,” by Jennifer Browne and Carrie Jo Braden (2020), is an article that highlights some of the critical issues associated with overworking and workload in the nursing field. The authors study the complexities and activities that are not included in the nurses’ workloads, although they consume working time and affect productivity. According to Browne and Braden (2020), nurses’ heavy workload presents a significant problem that affects the quality of care and the overall patients’ outcomes. The heavy workload, according to the article, is at all times high, and this is due to the increased demand for nurses, reduced staffing or staffing ratio, inadequate supply of nurses and training, and many other issues. Nevertheless, the paper does not concentrate on these factors but looks at a different factor all together: environmental turbulence. Environmental turbulence is the unanticipated working complicities and activities that are not quantified by workload measures (Browne & Braden, 2020).  Examples of these activities include the time spent looking for working equipment or time spent looking for medication. Therefore to understand how these complexities or actions affect nurses, Browne and Braden utilized two separate studies: the pilot study and the primary study.


The authors used mixed exploratory sequential methods to gather and analyze the qualitative data in the pilot study. The data collected was then used to construct a quantitative turbulence scale. Importantly, the research methods used were comparable to the ones used by Berman’s 2-phase timeline approach. The pilot study’s details were enhanced by integrating the 10-step instrument. Also, the authors developed survey questions that were used in the pilot study. In this case, some of the questions were based on turbulence attributes identified during a literature review search. Questionnaires were also based on the American Association of Critical-Care Nurses (AACN) member feedback.

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The primary study utilized different methods altogether. For instance, the participating nurses were allowed to respond to a revised email survey sent by the American Association of Critical-Care Nurses. The study managed to send over 190,000 newsletters to the volunteering nurses, of which only 27,000 newsletters were opened. Importantly, the data received from the 27,000 responses were analyzed separately (Browne & Braden, 2020). The researchers performed qualitative coding using a deductive approach, which is often used to develop hypotheses based on existing theories. Establishing the validity and reliability of the nurses’ data in the primary study was of great importance as it ensured consistency in the development of operational development.  The authors also legitimized the qualitative data by developing a coding system, conducting committee checks, and using computer-assisted analysis.


The two studies were successful, and they provided conclusive results regarding turbulence and workloads in the nursing field. The pilot study received a 38 percent response rate. Similarly, the participating nurses reported 16.5 mean years of intensive care experience (Browne & Braden, 2020). The narratives provided in the pilot study were compiled for credibility and comprehensiveness. Importantly, the pilot study’s narratives described the necessary work; however, some of these works were not addressed in the workload measures. For instance, one participant described a situation where a doctor experienced challenges in reading chest radiography, rather than calling for help the doctor issues this extra job to the nurse. Other examples of working complexities included broken equipment, retrieval of lost data, and communication malfunctions. Most nurses reported that these working routines were not included in their workload even though they consumed a significant amount of time and energy.

The primary study included more females than males. Half of the participants were 45 years of age, and at least 50 percent had a nursing bachelor’s degree (Browne & Braden, 2020). The conclusions at the same time were somehow similar compared to the results gathered in the pilot study. The qualitative data were coded, and it revealed over 100 cases of turbulence. Nurses complained of many instances that affected their overall work output, including instant admissions and discharges, unexpected transfers in and out of units, communication breakdown, noise, and so on.

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Limitations and Strengths

Despite its success, the study had its limitations. Nonresponsive bias, according to the authors, affected the outcomes. For instance, some reported that they were uncomfortable with the research, while others were unwilling to participate in the study. Nevertheless, the strengths overpowered the limitations. Some of the advantages included reaching an acceptable sample size, short data collection period, and the mixed approach, which significantly improved and strengthened the findings.


Jennifer Browne and Carrie Jo Braden’s article concluded that nurses experience daily turbulence in their working environments. These turbulences were found to affect and consume a significant amount of time and energy. More importantly, the authors used mixed methods approaches which identified factors and variables that were previously misunderstood, underestimated, and ignored. The authors also found that current workloads do not adequately highlight the complexity of the nursing environment and nurses’ working routines. Rather than including these daily complexities in the workloads, they are addressed on their own.


Browne, J., & Braden, C. (2020). Nursing turbulence in critical care: Relationships with nursing workload and patient safety. American Journal of Critical Care29(3), 182-191.

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