INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
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Nursing Workflow Optimization Plan for Improving Efficiency and
Staff Well-Being in Inpatient Settings
Methuselah Seridon
University of Perpetual Help System, Philippines
DOI: https://doi.org/10.51244/IJRSI.2025.120800317
Received: 06 Sep 2025; Accepted: 12 Sep 2025; Published: 09 October 2025
ABSTRACT
Nursing workflow efficiency and staff well-being were critical factors in ensuring safe and effective inpatient
care delivery. However, nurses in hospital settings frequently faced heavy workloads, disorganized processes,
and staffing shortages, which compromised both patient outcomes and nurse job satisfaction. This study
examined the relationships among demographic characteristics, perceived workload, and workflow efficiency
of nurses in inpatient units to develop a structured workflow optimization plan. Guided by the Maslach
Burnout Theory and utilizing a quantitative, descriptive-correlational design, the research was conducted at Al
Salama Hospital in Jeddah, Saudi Arabia. A stratified random sample of 51 nurses completed a validated, self-
structured questionnaire that measured nurses’ demographics, workload perceptions, and workflow efficiency.
Findings revealed that nurses reported a very high level of perceived workload, characterized by emotional
exhaustion, chronic fatigue, and increased stress, while also rating workflow efficiency as generally high,
particularly in task completion and documentation processes. Statistical analysis revealed significant
relationships between years of experience, shift schedules, and nurse-to-patient ratios with workload
perceptions, and between years of experience and shift schedules with workflow efficiency. These results
highlighted the need for targeted interventions addressing workload distribution, staffing ratios, and scheduling
systems to improve nurse well-being and care quality. Based on these findings, a Nursing Workflow
Optimization Plan: NURSE OPT was proposed, integrating Lean Management strategies and the Job
Demands-Resources model to streamline processes, reduce staff overload, and foster a supportive work
environment. The plan provided a framework for healthcare institutions to enhance efficiency, safeguard
patient safety, and strengthen nurse resilience.
Keywords:
Nurses, Optimization Plan, Staff Well-Being, Workflow Efficiency, Workload
INTRODUCTION AND BACKGROUND OF THE STUDY
Inpatient healthcare settings were often tasked with striking a balance between increasing nurse efficiency and
decreasing the burden on staff, both of which had profound implications for the quality of patient care as well
as nurses’ well-being. Nurses were pressured due to inadequate funding, which resulted in workforce shortages
and a lack of human resource planning in an aging global population, overwhelming health systems ([Zubrinic
et al., 2023]). These systemic obstacles threatened healthcare sustainability, particularly for inpatient
environments with high-acuity patients experiencing multi-morbidity and repeated new-onset conditions.
The COVID-19 pandemic brought to the forefront the importance of adequate staffing and resource allocation
in healthcare systems. Nurse managers were immediately forced to adapt operations by obtaining personal
protective equipment, implementing new safety protocols, and disseminating new clinical protocols, all the
while securing safe, quality care in an unusual environment (Weston, 2022). These experiences exposed
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vulnerabilities in the existing nursing system and highlighted the demand for a resilient and adaptive nursing
workforce.
On top of this, there was a significant increase in labor productivity in healthcare, primarily due to severe
workforce shortages. Therefore, organizations were forced to look for creative efficiency enhancement tools
that maximized the use of current staff and resources ([Kesti et al., 2023]). In this regard, nurses, who
represented the most numerous professional category in hospitals, contributed not only to direct patient care
but also to improving the efficiency of hospital management and organization ([Mensinger et al., 2021]).
Engagement in the optimization of work conditions, including staffing and the practice environment, was
necessary for retaining nurses and delivering safe, high-quality care. Research carried out during the pandemic
tended to point out the necessity of adopting flexible business strategies and responding promptly in terms of
patient care policy in healthcare facilities ([Alkathlan et al., 2023]). These shifts highlighted the need for
evidence-based, systematically implemented changes in nursing processes.
Nursing personnel workload was heavily influenced by documentation, admission, and medication therapy,
which required more time ([Almenyan et al., 2021]; [Schlak et al., 2022]). In addition, indirect care duties took
up 30–50% of nurses’ time (Sharma & Rani, 2020). The struggles within these tasks, including the highly
stressful environment of intensive care units, often resulted in cognitive overload, issues in concentration,
interpretation of information, and decision-making (Javadi‐[Pashaki et al., 2020]). This required re-evaluating
nursing practices to identify inefficiencies and implement solutions to make procedures more efficient and to
better use resources. The main goal of this discussion was to examine the various aspects of improving nursing
workflows in inpatient environments, focusing specifically on methods to boost efficiency and reduce staff
burden. Therefore, this paper described an organized and detailed approach to nursing workflow improvement
based on an extensive review of studies, practical experiences, and successful methods, and concentrated on
critical areas such as evaluating workloads, redesigning processes, technology implementation, and teamwork.
Application of the recommendations enabled healthcare organizations to develop a supportive work
environment, optimize the efficiency of nurses, achieve better patient outcomes, enhance job satisfaction
among nurses, and improve patient care ([Lenssen et al., 2025]).
Inpatient healthcare environments frequently grappled with the intertwined challenges of maximizing nursing
efficiency while simultaneously mitigating staff overload, a precarious balance that exerted a direct influence
on the caliber of patient care delivered and the overall welfare of the nursing personnel ([Ivziku et al., 2021]).
The escalating demands placed on nurses, stemming from factors such as insufficient healthcare funding and
failures in human resources planning amidst an aging population, culminated in a healthcare crisis,
significantly impacting nursing working conditions (Scott‐Marshall, 2024). The nursing staff's pivotal role in
ensuring access to quality health services and promoting favorable patient outcomes underscored the urgency
of addressing these challenges ([Galiano et al., 2023]).
Through firsthand professional experience, the researcher observed that disorganized workflows in a hospital's
inpatient environment greatly impacted the morale and efficiency of nursing staff. Issues such as poor task
delegation, unnecessary paperwork, and lack of coordination between departments frequently led to delays in
patient care and heightened emotional fatigue among nurses. These experiences showed a clear lack of
organized workflow protocols, emphasizing the need for specific enhancements. The researcher’s observations
pointed out a significant disparity between existing practices and ideal workflow management, highlighting the
importance of evidence-based solutions that addressed the actual challenges nurses encountered.
This study aimed to address the multifaceted challenges confronting nurses, including staff shortages,
increased workloads, and the imperative to optimize patient care amidst evolving healthcare landscapes. It
emphasized the development and implementation of structured nursing workflow improvement plans as a
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
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pragmatic approach to enhance efficiency, alleviate staff overload, and ultimately foster a more supportive and
productive work environment within inpatient settings. Exploring the issues that nurses faced during their
professional practice supported the development of protocols and plans to improve their preparedness
(Thobaity & Alshammari, 2020).
METHODOLOGY
The study employed a descriptive-correlational design within a quantitative framework. The descriptive aspect
systematically profiled nurses in terms of age, years of experience, unit assignment, shift schedule, nurse-to-
patient ratio, and their perceived workload and workflow efficiency, without manipulating variables ([Gray et
al., 2021]). Complementing this, the correlational aspect examined how demographic factors related to
workload and efficiency, and whether significant relationships existed between the two. This approach, widely
used in nursing research, allowed for the identification of associations and potential predictors without
inferring causation (Polit & Beck, 2021). The design was particularly appropriate for uncovering patterns that
could inform staffing, scheduling, and workflow interventions, while also supporting Maslach’s burnout
model, which links occupational stressors to measurable psychological outcomes. It was conducted at Al
Salama Hospital in Jeddah, Saudi Arabia, a multidisciplinary inpatient healthcare institution providing services
across various clinical departments. The target population included all registered nurses assigned to inpatient
care units such as the intensive care unit (ICU), medical-surgical wards, and pediatric units during the first
semester of Academic Year 2024–2025. As frontline providers directly involved in patient care delivery, these
nurses were considered appropriate respondents for assessing perceptions of workload and workflow efficiency.
To ensure proportional representation of participants across different inpatient units, a stratified random
sampling technique was employed.
To gather the required data, a self-structured questionnaire was developed as the primary research instrument.
The tool was designed to measure nurses’ perceived workload and workflow efficiency in inpatient settings
and consisted of five parts: demographic profile (age, years of experience, unit assignment, shift schedule, and
nurse-to-patient ratio), perceived workload (adapted from the emotional exhaustion dimension of the Maslach
Burnout Inventory), perceived workflow efficiency (task management, transitions, timeliness of care),
interplay between workload and workflow (staffing, burnout, effectiveness), and strategies for improvement.
Sections two through four employed a five-point Likert scale ranging from “strongly disagree” to “strongly
agree” to facilitate standardized quantitative analysis. Developed from relevant literature and validated by
experts, the instrument ensured clarity, appropriateness, and suitability for descriptive and correlational
analysis that could guide nursing management strategies and policies.
The data gathering procedure was carefully structured to maintain rigor and address ethical considerations.
Ethical approval was obtained from the appropriate institutional review board before data collection
commenced, and informed consent was secured from all participants. Questionnaires were then distributed to
selected inpatient units, either through email or as paper-based forms, and were designed to assess essential
domains such as work pressure, job satisfaction, perceived stress, and patient outcomes. To protect privacy, all
data were anonymized, safeguarded, and stored securely throughout the research process.
The statistical treatment of the data combined descriptive and inferential analyses. Demographic characteristics
such as age, years of experience, unit assignment, shift schedule, and nurse-to-patient ratio were summarized
using frequencies, percentages, means, and standard deviations. Perceived workload and workflow efficiency
were similarly analyzed through mean scores and standard deviations. Inferential methods were applied to test
relationships among variables: Pearson’s correlation examined associations between workload and workflow
efficiency, as well as with continuous demographics, while one-way ANOVA and independent t-tests compared
categorical groups. For cases where normality assumptions were not met, non-parametric alternatives such as
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
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Spearman’s rank correlation were employed to ensure validity. A significance level of p < 0.05 was used as the
basis for interpretation.
Finally, the study adhered strictly to ethical standards to ensure participant safety and data integrity. It was
conducted in accordance with the Declaration of Helsinki, the Philippine Data Privacy Act of 2012 (R.A.
10173), and the Implementing Rules and Regulations of the National Privacy Commission. Ethical approval
was granted by the Institutional Research Ethics Committee of Al Salama Hospital in coordination with the
researcher’s academic institution. Participants were fully informed about the study’s purpose, procedures, risks,
and benefits, and written informed consent was obtained prior to their participation. Data confidentiality was
safeguarded through password-protected electronic files and securely locked storage for physical records,
which will be retained for five years before disposal.
RESULTS AND DISCUSSION
The results of this study highlighted several important patterns in the demographic composition and work
experiences of nurses in the inpatient settings. Most respondents were mid-career professionals aged 30-39, a
stage associated with consolidated clinical skills, adaptability, and receptiveness to workflow innovations such
as electronic health records and telehealth integration ([Sanches et al., 2024]; [Tiase et al., 2023]; [Vilendrer et
al., 2022]). Younger nurses contributed enthusiasm, digital fluency, and openness to change but required
structured mentorship and guided exposure to complex cases to ensure safe practice (Waterfield & Barnason,
2022; [Ivziku et al., 2021]). In contrast, senior nurses, though fewer, provided invaluable expertise,
institutional knowledge, and mentorship that helped stabilize workflows and integrate theory with practice
([Rababa et al., 2022]; [Soodmand et al., 2022]). This workforce profile suggested strong potential for
adaptability but also highlighted the need for intentional mentorship and knowledge transfer from experienced
nurse practitioners.
Work experience further shaped nursing practice. The majority of the nurses in inpatient settings had more than
a decade of professional practice, enabling them to provide stability, leadership, and support for less
experienced colleagues. Mid-career nurses showed both competence and adaptability, positioning them as
effective contributors to workflow improvement initiatives ([Sanches et al., 2024]). Early-career nurses, on the
other hand, required stronger supervision, workload regulation, and role modeling to develop competence and
confidence ([Ivziku et al., 2021]). Together, the age and work experience profiles of the nursing workforce
revealed a strong capacity for innovation and quality care, provided mentorship and workload equity were
sustained.
In addition, in terms of work assignments, most nurses were concentrated in high-demand and high-acuity
units such as the Emergency Department, Medical-Surgical Ward, Pediatrics, and Intensive Care Units. These
environments required rapid decision-making, constant coordination, and resilience in managing unpredictable
workloads, which contributed to elevated stress and burnout risks ([Gao et al., 2020]; [Ivziku et al., 2021]).
Specialized units, although fewer in staff, required highly specific skills and precise adherence to structured
workflows, further illustrating the diversity of demands across inpatient settings (Nuamah & Mehta, 2020).
This indicated the necessity of tailoring workflow strategies and staffing policies to the unique demands of
each clinical environment.
Scheduling practices also influenced nursing experiences. The majority worked rotational shifts, which
provided 24-hour coverage but disrupted circadian rhythms, decreased continuity of care, and compromised
workflow stability (Silva & Gáspár, 2024; [Gao et al., 2020]). Day shifts tended to be the busiest, with
scheduled procedures and greater administrative demands, while night shifts were associated with reduced
staffing, sustained monitoring, and heightened fatigue ([Ivziku et al., 2021]; [Boeck et al., 2020]). These results
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suggested that shift variability compounded workload intensity, reinforcing the need for evidence-based
scheduling systems and adequate rest periods.
Workload was further shaped by nurse-to-patient ratios. The most common ratio of one nurse to four patients
aligned with general ward standards but became burdensome when patient acuity was high ([Gharbi et al.,
2024]). Higher ratios were linked to burnout and decreased care quality (Silva & Gáspár, 2024), while lower
ratios in intensive care improved patient safety but demanded advanced skills and sustained vigilance, which
could also contribute to fatigue ([Rababa et al., 2022]). These findings underscored the importance of aligning
staffing ratios with patient acuity rather than fixed numerical targets.
Despite these pressures, nurses in the inpatient settings generally perceived their workflow efficiency as high.
Organized routines, minimized redundancies, and structured documentation supported timely care delivery
([Vilendrer et al., 2022]; [Tiase et al., 2023]). However, handover and task transitions remained points of
vulnerability, consistent with earlier studies emphasizing the risks of miscommunication during care transitions
([Leary et al., 2023]). The coexistence of very high workload and high workflow efficiency suggested that
nurses sustained productivity under pressure but at the cost of increased strain, highlighting the need for
targeted process refinements.
Statistical analyses confirmed that workload and workflow efficiency were significantly shaped by years of
experience, shift scheduling, and patient load, while age and unit assignments showed limited influence. This
suggested that organizational structures, rather than demographic characteristics, were the strongest
determinants of nursing efficiency. Most notably, a moderate negative correlation demonstrated that higher
workload directly reduced workflow efficiency, affirming that the two dimensions are closely interlinked.
Efforts to improve one without addressing the other would likely have limited effects, underscoring the
importance of integrated workforce policies (Silva & Gáspár, 2024; [Arruum et al., 2024]).
The proposed Workflow Optimization Program offered a holistic response by combining structural measures,
such as communication protocols, role clarification, and technology training, with psychosocial supports,
including wellness workshops, peer support, and resilience-building activities. Its phased approach, from
standardizing communication to promoting continuous improvement, ensured that interventions were
comprehensive, sustainable, and nurse-centered ([Chowdhury et al., 2024]). By aligning operational efficiency
with staff well-being, the program demonstrated how integrated strategies could reduce errors, prevent burnout,
and safeguard patient safety in inpatient care.
In conclusion, since workload was generally influenced by work experience, shift schedules, and patient load,
balancing staffing and optimizing schedules are essential to sustaining nurse well-being and patient safety. To
address these challenges, the Workflow Optimization Program (NURSE-OPT) is recommended, emphasizing
routine workflow assessments, balanced staffing ratios, interdisciplinary collaboration, and active nurse
participation in identifying bottlenecks. Nursing education and training should also integrate workflow
management, while healthcare leaders and policymakers must support the program through adequate resources,
policy development, and continued evaluation, ensuring long-term improvements in efficiency and care quality.
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