P3.103: Neonatal Intensive Care Nursing Activities, Perceived Workload, and Perception of Task-Shifting in Low-Resource Countries.

Background: Despite the increase in facility births across low-resource countries (LRCs), mortality rates for small and sick neonates remain high or have worsened. A poor ratio of health professionals to patients due to inadequate health system financing and the migration of skilled health professionals from LRCs to high-income countries is a key contributor to neonatal mortality.
Task-shifting – redistributing specific clinical tasks to lower-cadre personnel- has successfully improved HIV, tuberculosis, and maternal care in LRCs but remains underutilized in neonatal care. Strategically shifting non-critical neonatal intensive care unit (NICU) nursing tasks may optimize workforce distribution, enhance care quality, and reduce neonatal mortality. However, identifying appropriate tasks for redistribution requires a clear understanding of nursing workload and nurses' perceptions of task shifting.

Methods: We conducted a mixed-methods study in a tertiary-level NICU in southwest Nigeria. First, we video-recorded three senior nurses' first six hours of nursing during the morning, afternoon, and night shifts to capture routine clinical activities. Through content analysis, we categorized tasks and calculated the average completion time for each. Second, we used the NASA Task Load Index (NASA-TLX) to assess subjective workload across six domains: mental demand, physical demand, temporal demand, performance, effort, and frustration. Scores were calculated using the unweighted method, averaging responses across the domains. Lastly, we administered a structured survey to NICU nurses to explore their perspectives on task delegation and task-shifting.

Results: The most frequent activities recorded in the nine sessions included hands-on care (37%), documentation (26%), and oral feeding (17%) (see figure 1 and Table 1). Administrative tasks (59) and hands-on care (54) received the highest workload scores, indicating these responsibilities were seen as the most demanding. Among the 16 nurses surveyed, 14 (87.5%) had previously delegated tasks, and 13 (81.2%) believed that delegation enabled them to better focus on critically ill patients. However, only 2 (12.5%) supported formal task-shifting to lower-cadre staff. Nurses emphasized that acceptability would improve with close supervision, clear guidelines, competency assessments, robust training, and by limiting task-shifting to duties that do not involve high-risk interventions, such as respiratory support.

Conclusion: The primary activities of NICU nurses in LRC include hands-on care, documentation, and oral feeding. NICU nurses perceive substantial workload demands, particularly from direct care and administrative tasks. While most nurses see value in delegation, hesitancy toward formal task-shifting remains. Addressing concerns through structured supervision, clear protocols, and targeted training could improve acceptance and deserve further studies.