• Jennifer Browne and Carrie Jo Braden.
• Jennifer Browne is an assistant professor at the University of the Incarnate Word Ila Faye Miller School of Nursing, San Antonio, Texas. Carrie Jo Braden is a professor at University of Texas Health San Antonio School of Nursing.
• Am. J. Crit. Care. 2020 May 1; 29 (3): 182-191.

BackgroundIncreased nursing workload can be associated with decreased patient safety and quality of care. The associations between nursing workload, quality of care, and patient safety are not well understood.ObjectivesThe concept of workload and its associated measures do not capture all nursing work activities, and tools used to assess healthy work environments do not identify these activities. The variable turbulence was created to capture nursing activities not represented by workload. The purpose of this research was to specify a definition and preliminary measure for turbulence.MethodsA 2-phase exploratory sequential mixed-methods design was used to translate the proposed construct of turbulence into an operational definition and begin preliminary testing of a turbulence scale.ResultsA member survey of the American Association of Critical-Care Nurses resulted in the identification of 12 turbulence types. Turbulence was defined, and reliability of the turbulence scale was acceptable (α = .75). Turbulence was most strongly correlated with patient safety risk (r = 0.41, n = 293, P < .001). Workload had the weakest association with patient safety risk (r = 0.16, n = 294, P = .005).ConclusionsAcknowledging the concepts of turbulence and workload separately best describes the full range of nursing demands. Improved measurement of nursing work is important to advance the science. A clearer understanding of nurses' work will enhance our ability to target resources and improve patients' outcomes.Copyright© 2020 American Association of Critical-Care Nurses.

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