Role of Work System Barriers and Facilitators in NICU NNP Workload: A Multi-Site Study

Neonatal Nurse Practitioners (NNPs) are essential in delivering complex care in Neonatal Intensive Care Units (NICUs), yet limited research has examined the work system factors shaping their workload. This qualitative study explored barriers and facilitators affecting NNP workload using direct observations and semi-structured interviews with 32 NNPs across two level-IV NICUs. Observational and interview data were analyzed using a situational workload framework through deductive and inductive coding. Key barriers included competing task demands, lack of coordination, frequent interruptions, limited ancillary support, staff shortages, and high or shifting patient acuity. Facilitators that helped mitigate workload included strong rapport with attending physicians and fellows, supportive coworkers, experienced nurses, effective task delegation, and adequate support staff (e.g., pharmacists, nutritionists). The study highlights how work system factors dynamically influence NNP workload. Findings can inform workflow redesign and system efficiency to enhance support for NNPs and improve safety and care quality in NICU environments