CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Nurses are the largest group of health professionals in most hospitals and the ones who spend the most time at the patient's bedside. The quality of care a hospital delivers therefore depends heavily on whether its nurses can do their work well, and that in turn depends on the demands placed on them. Patient workload, meaning the volume and intensity of nursing work generated by the number and needs of the patients assigned to a nurse, is one of the most important of those demands. When the number of patients per nurse rises beyond what a nurse can safely manage, time for assessment, communication, medication administration and documentation is squeezed, and the risk of omissions and errors grows.

The global picture shows how widespread the pressure is. The World Health Organization (2025) estimated that the world had 29.8 million nurses in 2023, but that this masked a shortage of 5.8 million, and that nurses are very unevenly distributed. The global average density was 37.1 nurses per 10,000 people, with the African Region at the lower end of the distribution, and about 70% of the projected shortage in 2030 was expected to be concentrated in Africa and the Eastern Mediterranean (World Health Organization, 2025). In settings like these, each nurse is likely to carry more patients, and the consequences are measurable. In a study of 300 hospitals in nine European countries covering 422,730 surgical patients, each additional patient in a nurse's average workload was associated with 7% higher odds of death within 30 days of admission (Aiken et al., 2014).

Nigerian evidence points in the same direction. In a survey of 210 nurses drawn from three tertiary health facilities in Southwest Nigeria, workload was significantly and negatively related to nurses' efficiency (r = −0.557, p < 0.05), and the relationship was stronger than that for work stress (Olaopa, 2026). Findings from the Federal Capital Territory are less straightforward. Among 311 nurses in public hospitals, work overload was reported to have a positive effect on productivity (β = 0.441, p < 0.05), whereas role conflict and role ambiguity reduced performance (Gambo, 2024). These contrasting results suggest that the effect of workload on effectiveness may depend on how nurses experience and interpret it, which makes nurses' own perceptions an important object of study.

Perception matters because it shapes how nurses respond to their working conditions. A nurse who sees the patient load as manageable and well supported is likely to cope and remain engaged, while one who sees it as excessive may cut corners, withdraw or burn out. Hospital managers who understand these perceptions are better placed to adjust staffing, scheduling and task allocation before effectiveness and patient safety suffer.

This study focuses on Rivers State University Teaching Hospital in Port Harcourt, formerly known as Braithwaite Memorial Specialist Hospital. It is a government-owned hospital that was named after Eldred Curwen Braithwaite, a British doctor and a pioneer of surgery, and the state later repositioned it to serve as the teaching hospital of the Rivers State University (Rivers State University Teaching Hospital, 2025). As a large public referral facility in the Niger Delta, it is a suitable setting in which to examine how nurses perceive the effect of patient workload on their effectiveness.

1.2 Statement of the Problem

Heavy patient loads are a recurring concern for nurses in Nigerian public tertiary hospitals, where nursing shortages are compounded by high patient demand. Evidence from other tertiary facilities indicates that higher workload is associated with lower nurse efficiency (Olaopa, 2026), and international evidence links heavier nurse workloads to worse patient outcomes (Aiken et al., 2014). At the same time, Nigerian findings are not uniform (Gambo, 2024), and the studies reviewed for this work do not cover the hospital in Port Harcourt that forms the focus of this study.

Without local evidence, hospital management and health authorities lack a firm basis for judging whether nurses at this hospital feel overloaded, in what ways they believe it limits their effectiveness, and what would help. Nurses who perceive their workload as unmanageable may deliver care that is hurried, incomplete or error-prone, with consequences for patients and for the hospital's reputation as a teaching institution. This study therefore examines nurses' perception of patient workload and its effect on their effectiveness at Rivers State University Teaching Hospital, Port Harcourt.

1.3 Objectives of the Study

The main objective of the study is to investigate nurses' perception of the effect of patient workload on their effectiveness at Rivers State University Teaching Hospital, Port Harcourt. The specific objectives are to:

1. Determine the level of patient workload as perceived by nurses in the hospital.
2. Examine nurses' perception of the effect of patient workload on their effectiveness.
3. Identify the factors nurses perceive as contributing to heavy patient workload.
4. Identify measures nurses believe would reduce workload and improve their effectiveness.

1.4 Research Questions

The following questions guide the study:

1. What is the level of patient workload as perceived by nurses in the hospital?
2. How do nurses perceive the effect of patient workload on their effectiveness?
3. What factors do nurses perceive as contributing to heavy patient workload?
4. What measures do nurses believe would reduce workload and improve their effectiveness?

1.5 Research Hypotheses

The following null hypotheses will be tested at the 0.05 level of significance:

H01: There is no significant relationship between nurses' perceived patient workload and their perceived effectiveness.

H02: There is no significant difference in nurses' perception of the effect of patient workload on their effectiveness based on years of work experience.

1.6 Significance of the Study

The study is expected to be useful to several groups. For nurses, it gives a platform to document how workload affects their work, which can support requests for better staffing and working conditions. For hospital management, it provides evidence on how nurses experience their workload and where adjustments to staffing, scheduling and task allocation may be most needed. For the Rivers State health authorities, the findings can inform decisions on recruitment and deployment in public hospitals. For patients, a more manageable nursing workload supports safer and more attentive care, consistent with evidence that heavier nurse workloads are associated with poorer outcomes (Aiken et al., 2014). For researchers, the study adds evidence from a Niger Delta teaching hospital to a Nigerian literature in which findings on workload and nurse performance are still mixed (Gambo, 2024; Olaopa, 2026).

1.7 Scope of the Study

The study is limited to nurses working in clinical units of Rivers State University Teaching Hospital, Rivers State. It focuses on nurses' own perceptions of patient workload and of its effect on their effectiveness, and it does not measure patient outcomes directly. Other influences on effectiveness, such as pay, equipment and leadership, are considered only where nurses identify them as linked to workload.

1.8 Definition of Terms

Nurse: A registered professional who provides direct nursing care to patients in the hospital's clinical units.

Patient workload: The volume and intensity of nursing work generated by the number of patients assigned to a nurse and the care those patients need.

Perception: A nurse's own view or judgement of how heavy the patient workload is and how it affects the nurse's work.

Effectiveness: A nurse's ability to deliver timely, safe and good-quality care to assigned patients, including completing tasks, avoiding errors and interacting adequately with patients and colleagues.

References

Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824–1830.

Gambo, N. (2024). Workplace stress and nurses' performance of public hospitals in Federal Capital Territory, Nigeria. European Journal of Business and Innovation Research, 12(4). https://eajournals.org/ejbir/vol12-issue-4-2024/workplace-stress-and-nurses-performance-of-public-hospitals-in-federal-capital-territory-nigeria/

Olaopa, O. O. (2026). Work stress, workload and the efficiency of nurses in tertiary health facilities in Southwest, Nigeria. International Journal of Health and Psychology Research, 14. https://eajournals.org/ijhpr/vol14-issue-2-2026/work-stress-workload-and-the-efficiency-of-nurses-in-tertiary-health-facilities-in-southwest-nigeria/

Rivers State University Teaching Hospital. (2025). Rivers State University Teaching Hospital. https://www.rsuth.ng/?p=2751

World Health Organization. (2025). State of the world's nursing 2025. https://www.who.int/publications/i/item/9789240110236