Perceived Workload of Nurses Scale

Abstract

The Perceived Workload of Nurses Scale (PWNS; known in German psychometric literature as the Skala zur Erfassung der Arbeitsbelastung von Pflegekräften) is a standardized, self-report psychometric instrument designed to measure subjective occupational stress and perceived workload among clinical nursing staff. Rooted in classic cognitive transactional stress theories and organizational motivation paradigms, the scale operationalizes workload not merely as quantitative operational volume, but as an experiential mismatch between professional demands and individual coping capabilities within institutional healthcare environments. The instrument comprises 12 manifest items structured into two oblique, theoretically distinct subscales: Coordination and Information Problems (7 items), which captures systemic workflow friction, interprofessional communication barriers, and role ambiguity; and Psychophysical Overload (5 items), which gauges acute somatic exhaustion, emotional strain arising from patient suffering, and temporal deficits undermining patient-centered care. Items are rated on an unweighted 5-point Likert-type frequency metric ranging from 1 (never / nie) to 5 (always / immer). Psychometric evaluation across multi-center hospital cohorts (combined N = 298) demonstrates satisfactory internal consistency, with Cronbach’s alpha reaching .83 for the omnibus scale, .82 for Coordination and Information Problems, and .72 for Psychophysical Overload. Confirmatory factor analytic investigations corroborate a two-dimensional oblique measurement model with tau-equivalent indicators exhibiting robust goodness-of-fit. The scale serves as an efficient diagnostic and research vehicle for occupational health psychology, hospital sociology, and healthcare ergonomics, identifying actionable institutional stressors that precipitate clinical burnout, turnover intention, and compromised patient safety.

Keywords

Perceived Workload of Nurses Scale, occupational stress, nursing workload, psychophysical overload, coordination problems, hospital ergonomics, burnout, transactional stress theory, nurse-physician collaboration, psychometrics

Authors

The conceptual genesis and iterative psychometric standardization of the Perceived Workload of Nurses Scale reflect a multi-decade progression across German sociological and occupational health research groups:

• Original Instrument Developers (1974):
  • G. Bartholomeyczik
  • Sabine Bartholomeyczik — Later renowned as a pioneer of nursing science in Germany and Professor of Nursing Science at the Witten/Herdecke University.
  • J. Beckmann
  • M. Bernhard
• Revision and Psychometric Refinement Authors (1982, 1986):
  • Margarete Freigang-Bauer — Institute of Medical Sociology, University of Marburg.
  • Carl-Walter Kohlmann — Department of Psychology, University of Mainz; later Professor of Educational and Health Psychology at the Schwäbisch Gmünd University of Education.
  • H. Nolte — Institute of Medical Sociology, University of Marburg.
  • Johannes Siegrist — Professor Emeritus of Medical Sociology at the Heinrich Heine University Düsseldorf, globally acknowledged for developing the Effort-Reward Imbalance (ERI) model of occupational health.

Historical institutional affiliations center primarily on the Department of Medical Sociology at the University of Marburg, Germany. Direct author correspondence details are unmaintained in contemporary psychometric registries; academic inquiries regarding historical standardization data are typically directed through German social science archival repositories such as GESIS – Leibniz Institute for the Social Sciences (ZIS repository).

Purpose

The primary purpose of the Perceived Workload of Nurses Scale is to provide an empirically grounded, psychometrically sound diagnostic vehicle to evaluate the subjective manifestations of work stress among hospital nurses. In inpatient healthcare systems, quantitative measures of workload—such as patient-to-nurse staffing ratios, bed occupancy percentages, or administrative task logs—often fail to capture the phenomenology of cognitive, affective, and bodily strain experienced by front-line clinical providers. The PWNS was engineered to bridge this gap by evaluating workload as a dynamic relational construct arising from hospital organizational dynamics, interprofessional communication deficits, and intense emotional confrontations with illness and dying.

From an applied clinical perspective, modern inpatient hospital units are characterized by extreme temporal pressures, unpredictable patient emergencies, fragmented interdisciplinary hierarchies, and complex care documentation mandates. When nurses encounter continuous friction in obtaining critical patient information or navigating ambiguities in task allocation, these organizational obstacles interact synergistically with the physical rigors of manual patient handling and the emotional toll of clinical suffering. The PWNS differentiates these qualitative dimensions of strain, isolating systemic operational dysfunctions (such as physician-nurse communication breakdowns) from intrinsic caregiving demands (such as high patient acuity and psychological distress). This dual-focus enables hospital leadership, occupational safety officers, and nurse managers to pinpoint targeted structural interventions—for example, revamping handover communication protocols rather than implementing generic stress-reduction seminars.

In occupational health research, the PWNS serves several critical functions. It is deployed as an antecedent predictor in longitudinal investigations examining nurse turnover intentions, job dissatisfaction, absenteeism, and the onset of clinical burnout syndrome. Researchers also utilize the instrument within comparative hospital sociology studies to contrast different ward environments, such as conventional medical-surgical units versus psychosomatic or patient-centered holistic wards. By providing standardized benchmarking across institutional departments, the scale enables health system analysts to detect whether hospital restructuring, digital electronic medical record rollouts, or altered staffing models exacerbate perceived coordination hurdles or elevate psychophysical exhaustion among healthcare personnel.

Psychological Construct

The PWNS operationalizes perceived occupational workload as a multidimensional construct comprising two interrelated yet conceptually distinct domains: Coordination and Information Problems (organizational/structural strain) and Psychophysical Overload (somatic and emotional strain).

1. Coordination and Information Problems (Organizational Friction)

This dimension, captured by seven items (Items 4, 6, 8, 9, 10, 11, and 12), measures the degree of friction, ambiguity, and communicative impediment nurses experience within the institutional sociotechnical system. In hospital sociology, nursing is recognized as an integrative boundary-spanning profession situated at the nexus of medical directives, allied health inputs, administrative regulations, and direct bedside delivery. When structural coordination fails, the burden of organizational compensation falls disproportionately on nursing staff. This domain taps into several specific sub-facets:

• Ambiguity in Work Processes and Division of Labor (Item 4): Uncertainty regarding operational workflows, shifting station boundaries, or vague job descriptions that prevent smooth task execution.
• Interprofessional Communication Barriers (Items 6 and 10): Strained collaborative interactions with medical doctors and multidisciplinary staff, including insufficient opportunities to discuss clinical cases, therapeutic plans, and emerging patient needs.
• Information Withholding and Asymmetry (Item 8): Experiences wherein crucial clinical or operational data are omitted or delayed, forcing nurses to deliver care under high uncertainty.
• Bureaucratic Alienation and Disempowerment (Items 9, 11, and 12): Feelings that institutional regulations lack practical clinical sense, coupled with status inconsistency where nurses desire greater decision-making latitude than the hierarchy permits, while perceiving that colleagues and leadership disregard their professional input.

2. Psychophysical Overload (Somatic and Emotional Depletion)

The second dimension, represented by five items (Items 1, 2, 3, 5, and 7), captures the subjective perception that personal, physical, and psychological resources are overwhelmed by clinical task demands. This facet reflects direct bodily exhaustion and moral-emotional strain:

• Compromised Care Quality Due to Time Pressure (Item 1): The distressing psychological state arising when chronic temporal shortages prevent nurses from responding adequately to the expressed emotional and physical needs of patients, generating what modern research classifies as “moral distress” or “care left undone.”
• Acute Somatic Exhaustion (Item 2): Complete physical depletion experienced at the conclusion of a work shift, reflecting the unmitigated physical demands of lifting, mobilizing, and continuous ambulation without physiological recovery.
• Excessive Responsibility and Quantitative Work Overload (Items 3 and 5): A cognitive evaluation that the scope of clinical accountability exceeds individual authority or training, accompanied by the perception of an insurmountable mountain of work that can never be completed within shift boundaries.
• Emotional Burden of Patient Suffering (Item 7): The affective toll generated by sustained empathetic exposure to patient pain, chronic deterioration, interpersonal grief, and mortality.

Theoretical Framework

The conceptual architecture of the Perceived Workload of Nurses Scale is anchored in foundational paradigms of transactional stress theory, organizational sociology, and motivational conflict theory.

The Cognitive Transactional Paradigm

Historically, the instrument’s creators (Bartholomeyczik et al., 1974; Freigang-Bauer et al., 1982) drew heavily from Richard Lazarus’s cognitive-transactional theory of stress (Lazarus, 1966; Folkman et al., 1986) and Joseph E. McGrath’s social-psychological model of organizational stress (McGrath, 1970). Within Lazarus’s conceptual framework, psychological stress is defined not as an external stimulus per se, nor as a purely physiological response, but as a specific relationship between the person and the environment that is appraised by the individual as taxing or exceeding their resources and endangering their well-being.

The PWNS directly assesses the output of primary appraisal within clinical settings. In primary appraisal, the nurse evaluates specific hospital conditions—such as an uncommunicative ward physician, an ambiguous division of responsibilities, or a critically overcrowded shift—with respect to personal stakes. If these operational conditions block personal or professional goals, they are appraised as threat, harm, or challenge, triggering negative psychological tension and affective arousal (e.g., frustration, anger, or moral distress). The authors conceptualize these situational encounters as cumulative: repeated exposure to unmitigated workplace stressors induces a chronic, compounding strain state that degrades psychological well-being over time.

Motivational Obstruction and Role Strain

Complementing Lazarus’s formulation, the theoretical framework incorporates McGrath’s (1970) motivational perspective on stress. According to this model, stress emerges when an individual experiences an environmental disruption or hindrance to an active motivational behavioral tendency. Nurses enter the clinical sphere with strong intrinsic motivations toward compassionate care, professional efficacy, and collaborative achievement. When hospital structural realities—such as rigid, senseless bureaucratic rules, asymmetric medical hierarchies, or excessive quantitative patient loads—thwart these professional strivings, severe motivational frustration occurs. This tension diminishes internal locus of control and induces chronic feelings of helplessness.

Later revisions of the PWNS also aligned the construct with Leonard Pearlin’s sociological stress process model (Pearlin et al., 1981). Pearlin emphasized that the most debilitating occupational stressors are often not acute, catastrophic life crises, but rather continuous, enduring role strains embedded in everyday institutional routines. The chronic, repetitive micro-frictions tapped by the PWNS—such as missing shift handover data or recurring disagreements over clinical duties—represent classic daily role strains that gradually erode an individual’s psychological resilience and somatic health.

Validity

The structural, construct, and discriminatory validity of the Perceived Workload of Nurses Scale was established through a series of iterative empirical investigations across multiple hospital settings in Germany during its foundational development.

Content and Construct Validity Through Item Selection

Initial content validation began with Bartholomeyczik et al. (1974), who surveyed N = 143 nurses across internal medicine and general surgical wards in three distinct general hospitals (two conventional municipal facilities and one anthroposophically oriented hospital; designated Study A). The initial item pool comprised 24 realistic hospital conflict scenarios evaluated along dual dimensions: frequency of occurrence and severity of associated subjective distress/anger. Psychometric item filtration eliminated nine items because an overwhelming proportion of participants rated them as either “never occurring” or “not at all distressing,” thereby establishing strong content relevance and eliminating floor effects.

During the major revision by Freigang-Bauer, Kohlmann, Nolte, and Siegrist (1982) conducted in a large university medical center in Hesse (N = 180 nurses; Study B across internal medicine, gynecology, dermatology, and psychiatry), construct validity was systematically evaluated. Exploratory factor analyses revealed that two of the 15 tested items exhibited unacceptably low communalities and inadequate item-total discrimination, failing to reflect the latent stress construct. Their elimination yielded a refined 13-item matrix that cleanly mirrored organizational vs. personal strain dimensions.

Known-Groups and Comparative Ward Validity

In a subsequent comparative hospital sociology investigation (Kohlmann, Freigang-Bauer, & Nolte, 1986; Study C), the scale was administered across 15 internal medicine wards in eight hospitals (N = 118 nurses). To test organizational validity, the sample deliberately contrasted eight traditionally organized, hierarchically driven internal medicine wards against seven experimental wards practicing integrated internistic-psychosomatic patient care models. The scale successfully differentiated between these institutional paradigms: wards with participatory management structures and structured multidisciplinary case conferences demonstrated statistically significant reductions in Coordination and Information Problems scores, confirming the tool’s sensitivity to genuine structural differences in healthcare delivery.

Convergent and Criterion Validity

Although the initial archival documentation notes an absence of formal multi-trait multi-method matrices, external construct validity is supported by the substantial correlation observed between the objective structural attributes of the wards and subjective nurse scores. Furthermore, item-total correlations across the pooled sample of Studies B and C (N = 298) showed robust discriminatory power, with corrected item-total correlations ranging from .36 to .60 (median r = .495). Highly discriminating items included Item 10 (“lack of opportunity to discuss patients with doctors/coworkers,” r = .60), Item 12 (“feeling that coworkers do not consider your suggestions,” r = .59), and Item 6 (“collaboration with doctors and coworkers is dysfunctional,” r = .58), demonstrating that interprofessional collaboration sits at the core of the perceived workload construct.

Reliability

The internal consistency of the Perceived Workload of Nurses Scale has been established through empirical psychometric assessments across multiple nurse cohorts in Germany.

Internal Consistency (Cronbach’s Alpha)

In the developmental cohort examined by Freigang-Bauer et al. (1982; Study B, N = 180), internal consistency estimates yielded a Cronbach’s alpha of .84 for item frequency scores and .83 for strain intensity ratings, demonstrating high measurement precision across both rating approaches.

Following the final reduction to 12 manifest items in the pooled psychometric sample combining Study B and Study C (total N = 298 nurses), internal consistency parameters were reported as follows:

• Omnibus Scale (Total 12 Items): α = .83
• Coordination and Information Problems Subscale (7 Items): α = .82
• Psychophysical Overload Subscale (5 Items): α = .72

The internal consistency coefficient for the 7-item Coordination subscale (.82) confirms strong scale homogeneity suitable for both group-level research comparisons and departmental organizational diagnostics. The 5-item Psychophysical Overload subscale, while slightly lower at .72, comfortably exceeds the accepted .70 psychometric threshold for exploratory and applied organizational research, especially given its concise 5-item breadth.

Item Discrimination Indices

Part-whole corrected item-total correlation coefficients (ƒ_it) computed on the combined validation sample (N = 298) demonstrate consistent discrimination without problematic redundancies:

• Item 1 (Time constraints limit patient care): r = .49
• Item 2 (Physically completely exhausted after work): r = .38
• Item 3 (Feeling forced to assume too much responsibility): r = .40
• Item 4 (Work distribution and workflows unclear): r = .50
• Item 5 (Work volume is insurmountable): r = .49
• Item 6 (Dysfunctional cooperation with physicians/coworkers): r = .58
• Item 7 (Emotionally heavily strained by patients): r = .36
• Item 8 (Deprived of vital clinical information): r = .56
• Item 9 (Desiring more responsibility than granted): r = .36
• Item 10 (Insufficient opportunity to discuss patients/tasks): r = .60
• Item 11 (Obligated to follow nonsensical regulations): r = .54
• Item 12 (Suggestions/wishes disregarded by coworkers): r = .59

All items exceed the standard psychometric threshold of .30 for item-total correlations, confirming that each manifest indicator contributes reliably to the measurement of the overarching workload construct.

Factor Analysis

The internal latent architecture of the PWNS was systematically uncovered through sequential exploratory factor analyses (EFA) and confirmed via rigorous confirmatory factor analysis (CFA) modeling.

Exploratory Factor Analysis (Principal Axis Factoring)

In Study B (Freigang-Bauer et al., 1982; N = 180), a principal axis factoring (PAF) extraction was conducted on the revised 13-item instrument. Application of the Kaiser-Guttman criterion (eigenvalues > 1.0) and scree test inspection revealed a clear two-factor solution:

• Factor 1: Coordination and Information Deficits: Accounted for the largest share of common variance. Items loading highly on this factor captured interprofessional friction, communication breakdowns with medical staff, ambiguous division of labor, and status inconsistency (e.g., lack of opportunity for case discussions, unclear workflow allocation).
• Factor 2: Psychophysical Exhaustion: Captured somatic depletion, affective fatigue from patient suffering, and extreme temporal constraints (e.g., complete post-shift physical exhaustion, feeling unable to finish work).

Both orthogonal (Varimax) and oblique rotations were evaluated. Given theoretical expectations that structural workplace disorganization directly elevates individual physical and emotional exhaustion, the two factors demonstrated an appreciable positive latent correlation, favoring an oblique factor conceptualization.

Confirmatory Factor Analysis and Structural Equation Modeling

In Study C (Kohlmann, Freigang-Bauer, & Nolte, 1986; N = 118), the factor structure was submitted to confirmatory factor analysis (CFA) within a structural equation modeling framework. One item exhibiting cross-loadings in the 13-item version was removed, resulting in the definitive 12-item measurement model.

The authors specified and tested a formal measurement model comprising two oblique factors with tau-equivalent manifest indicators (meaning factor loadings within each dimension were constrained to equality, assuming each item reflects the latent construct with equivalent true-score sensitivity). This parsimonious model demonstrated an excellent fit to the empirical covariance matrix, meeting both inferential statistical thresholds (χ² goodness-of-fit test failing to reject the model) and descriptive goodness-of-fit criteria. The substantial inter-factor correlation substantiated the operational recommendation that while the two subscales reflect meaningful operational distinctions, their scores can also be combined into a valid single omnibus perceived workload score.

Instrument / Measurement Tool

The Perceived Workload of Nurses Scale is standardized as an unweighted, self-administered questionnaire designed for pen-and-paper or digital administration in healthcare research and organizational assessment settings.

• Instrument Name: Perceived Workload of Nurses Scale (PWNS; Skala zur Erfassung der Arbeitsbelastung von Pflegekräften)
• Target Population: Registered nurses, licensed practical nurses, nursing assistants, and clinical ward personnel operating within acute hospital or long-term inpatient care environments
• Administration Type: Self-report questionnaire (individual or group administration)
• Completion Duration: Approximately 5 to 8 minutes
• Total Item Count: 12 manifest statements
• Dimensional Structure: Two oblique subscales:
  • Coordination and Information Problems (Subscale 1): 7 items (Items 4, 6, 8, 9, 10, 11, 12)
  • Psychophysical Overload (Subscale 2): 5 items (Items 1, 2, 3, 5, 7)
• Standardized Response Scale: 5-point Likert-type frequency scale:
  • 1 = Never (nie)
  • 2 = Rarely (selten)
  • 3 = Sometimes (manchmal)
  • 4 = Often (häufig)
  • 5 = Always (immer)
• Scoring and Index Computation:
  • Subscale 1 (Coordination and Information Problems): Sum raw values of Items 4, 6, 8, 9, 10, 11, and 12. Score range: 7 to 35. Higher scores reflect severe organizational friction and interprofessional communication failure.
  • Subscale 2 (Psychophysical Overload): Sum raw values of Items 1, 2, 3, 5, and 7. Score range: 5 to 25. Higher scores indicate extreme bodily exhaustion, time scarcity, and emotional overextension.
  • Total Workload Score (Omnibus Index): Sum all 12 items. Score range: 12 to 60. A higher composite score denotes severe cumulative occupational strain. (Mean scores may also be computed by dividing sum scores by the respective item count to maintain a 1–5 interpretable metric).
• Normative Reference Values (Pooled Sample N = 298; Studies B & C):
  • Subscale 1 (Coordination & Info): Mean = 16.95, Standard Deviation = 4.62, Skewness = 0.42, Kurtosis = 0.82
  • Subscale 2 (Psychophysical Overload): Mean = 14.80, Standard Deviation = 3.12, Skewness = -0.10, Kurtosis = -0.32
  • Total Scale (Omnibus): Mean = 30.81, Standard Deviation = 6.62, Skewness = 0.21, Kurtosis = 0.56

Permissions & Fee and Test Year

The original iteration of the instrument was published in 1974 by Sabine Bartholomeyczik and colleagues, with the finalized, validated 12-item psychometric version published in 1986 by Carl-Walter Kohlmann, Margarete Freigang-Bauer, and H. Nolte.

The scale was developed as an open scientific research instrument within university-funded medical sociology programs in Germany. It is documented in public academic repositories, including the Leibniz Institute for the Social Sciences (GESIS / ZIS – Zusammenstellung sozialwissenschaftlicher Items und Skalen). The scale is free of licensing fees for non-commercial academic research, institutional workplace health promotion projects, and educational dissertations. Researchers using the instrument are expected to cite the primary validation sources (Bartholomeyczik et al., 1974; Freigang-Bauer et al., 1982; Kohlmann et al., 1986). Commercial health management consultants or digital software vendors deploying the items within paid corporate evaluation packages should verify archival permissions and acknowledge original authorship.

References

• Bartholomeyczik, G., Bartholomeyczik, S., Beckmann, J., & Bernhard, M. (1974). Belastungs- und Konfliktsituationen im Pflegebereich des Krankenhauses [Stress and conflict situations in the hospital nursing sector]. Forschungsbericht, Universität Marburg.
• Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50(5), 992–1003. https://doi.org/10.1037/0022-3514.50.5.992
• Freigang-Bauer, M., Kohlmann, C.-W., Nolte, H., & Siegrist, J. (1982). Arbeitsbelastungen und Kooperationsformen des Pflegepersonals im Krankenhaus [Workload and forms of cooperation among nursing personnel in hospitals]. Medizinsoziologische Forschungsberichte, Institut für Medizinische Soziologie, Philipps-Universität Marburg.
• Kohlmann, C.-W., Freigang-Bauer, M., & Nolte, H. (1986). Belastungsstrukturen im Pflegedienst des Allgemeinkrankenhauses [Structures of stress in general hospital nursing services]. Zeitschrift für Klinische Psychologie, Psychopathologie und Psychotherapie, 34(3), 226–238.
• Lazarus, R. S. (1966). Psychological stress and the coping process. McGraw-Hill.
• McGrath, J. E. (1970). A conceptual formulation for research on stress. In J. E. McGrath (Ed.), Social and psychological factors in stress (pp. 10–21). Holt, Rinehart & Winston.
• Pearlin, L. I., Menaghan, E. G., Lieberman, M. A., & Mullan, J. T. (1981). The stress process. Journal of Health and Social Behavior, 22(4), 337–356. https://doi.org/10.2307/2136676
• Siegrist, J. (1996). Adverse health effects of high-effort/low-reward conditions. Journal of Occupational Health Psychology, 1(1), 27–41. https://doi.org/10.1037/1076-8998.1.1.27

13. Items of the Scale (Questionnaire)