Subtypes of nurses’ mental workload and interaction patterns with fatigue and work engagement during coronavirus disease 2019 (COVID-19) outbreak: A latent class analysis

BACKGROUND: Nurses play critical roles when providing health care in high-risk situations, such as during the COVID-19 outbreak. However, no previous study had systematically assessed nurses’ mental workloads and its interaction patterns with fatigue, work engagement and COVID-19 exposure risk. METHODS: A cross-sectional study was conducted via online questionnaire. The NASA Task Load Index, Fatigue Scale-14, and Utrecht Work Engagement Scale were used to assess nurses’ mental workload, fatigue and work engagement, respectively. A total of 1337 valid questionnaires were received and analyzed. Nurses were categorized into different subgroups of mental workload via latent class analysis (LCA). Cross-sectional comparisons, analysis of covariance (ANCOVA), and multivariate (or logistic) regression were subsequently performed to examine how demographic variables, fatigue and work engagement differ among nurses belonging to different subgroups. RESULTS: Three latent classes were identified based on the responses to mental workload assessment: Class 1 – low workload perception & high self-evaluation group (n = 41, 3.1%); Class 2 – medium workload perception & medium self-evaluation group (n = 455, 34.0%); and Class 3 – high workload perception & low self-evaluation group (n = 841, `62.9%). Nurses belonging into class 3 were most likely to be older and have longer professional years, and displayed higher scores of fatigue and work engagement compared with the other latent classes (p < 0.05). Multivariate analysis showed that high cognitive workload increased subjective fatigue, and mental workload may be positively associated with work engagement. Group comparison results indicated that COVID-19 exposure contributed to significantly higher mental workload levels. CONCLUSIONS: The complex scenario for the care of patients with infectious diseases, especially during an epidemic, raises the need for improved consideration of nurses’ perceived workload, as well as their physical fatigue, work engagement and personal safety when working in public health emergencies.