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Accepted Manuscript

Title: Nurses' Perceptions Of Multitasking In The Emergency Department:Effective, Fun And Unproblematic (At Least For Me) – A Qualitative Study

Author: Helena Hvitfeldt Forsberg, Åsa Muntlin Athlin, Ulrica Thiele Schwarz

PII: S1755-599X(14)00032-9DOI: http://dx.doi.org/doi:10.1016/j.ienj.2014.05.002Reference: IENJ 349

To appear in: International Emergency Nursing

Received date: 7-1-2014Revised date: 18-5-2014Accepted date: 19-5-2014

Please cite this article as: Helena Hvitfeldt Forsberg, Åsa Muntlin Athlin, Ulrica Thiele Schwarz, Nurses' Perceptions Of Multitasking In The Emergency Department: Effective, Fun AndUnproblematic (At Least For Me) – A Qualitative Study, International Emergency Nursing (2014), http://dx.doi.org/doi:10.1016/j.ienj.2014.05.002.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a serviceto our customers we are providing this early version of the manuscript. The manuscript willundergo copyediting, typesetting, and review of the resulting proof before it is published in itsfinal form. Please note that during the production process errors may be discovered which couldaffect the content, and all legal disclaimers that apply to the journal pertain.

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NURSES’ PERCEPTIONS OF MULTITASKING IN THE EMERGENCY1

DEPARTMENT: EFFECTIVE, FUN AND UNPROBLEMATIC (AT LEAST FOR ME)2

– A QUALITATIVE STUDY 3

Authors:4

Helena Hvitfeldt Forsberg (PhD)1 5

Åsa Muntlin Athlin (PhD, Adj Senior Lecturer, RN, CNS (Emerg Care)2-5 6

Ulrica von Thiele Schwarz (PhD, Associate Professor, Reg. Psychologist)1,6 7

8

1Department of Learning, Informatics, Management and Ethics (LIME); Medical9

Management Center (MMC), Karolinska Institutet, Stockholm, Sweden10

2Department of Medical Sciences, Uppsala University, Uppsala, Sweden11

3Department of Public Health and Caring Sciences, Uppsala University, Uppsala,12

Sweden13

4Department of Emergency Care, Uppsala University Hospital, Uppsala, Sweden14

5School of Nursing, University of Adelaide, Adelaide, Australia15

6Department of Psychology, Stockholm University, Stockholm, Sweden16

17

Correspondence:18

Helena Hvitfeldt Forsberg19

Karolinska Institutet, LIME, Dept. of Learning, Informatics, Management and Ethics20

MMC, Medical Management Center21

S- 171 77 Stockholm, Tomtebodavägen 18 A floor 522

[email protected] 23

+46 8 524 837 8324

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mailto:[email protected]



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25

ACKNOWLEDGMENT 26

The authors wish to thank the participating respondents for taking their time to share their27

work experiences. Also, the authors kindly acknowledge Erik Peters for his help with the data28

collection.29

30

31

Highlights32

The findings from this study showed registered nurses’ positive perceptions33

regarding their work, where multitasking was seen as an attractive prerequisite,34

implying efficiency and not stressful.35

Respondents didn’t perceive multitasking as related to an increase risk of error.36

However, the participants expressed their worries about new inexperienced37

colleagues and other colleagues not managing stressful multitasking situations.38

The results from this study show that from the nurses’ perspective, multitasking39

is perceived as a main characteristic of work in the ED.40

This study shows how the patient load and the unreflected multitasking that41

follows relates to nurses’ perceived efficiency and job satisfaction. 42

43

44

45

INTRODUCTION46

47

The emergency department (ED) is a setting of unpredictable, uncontrolled48

workload and high information intensity. Adding complex and time critical tasks, work49

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in the ED is prone to interruptions and requires the simultaneous management of50

multiple tasks, i.e. multitasking (Laxmisan et al. 2006; Chisholm et al. 2001; Chisholm.51

CD, Collison. EK, Nelson. RD 2000). Interruptions can be defined as an event that52

diverts a person’s attention from the task at hand (Chisholm et al. 2001). Thus, although53

interruptions are not the same as multitasking they are important antecedents for it; so54

much so that interruptions and multitasking are often discussed in an intertwined55

manner as something inherent to the ED environment (Chisholm et al. 2001). However,56

despite its frequency in the ED it can be argued that, in fact, the simultaneous57

management of multiple tasks is impossible (Clyne 2012; Stephens & Fairbanks 2012).58

Studies from the neuropsychological field suggest that rather than attending to several59

tasks simultaneously, at best humans are able to switch swiftly between the tasks at60

hand. At worse, their working memory and activity performance are negatively affected61

(Berg et al. 2012), causing cognitive overload (Coiera & Jayasuriya 2002) resulting in62

potential energy loss and stress. Even in the best cases, though, multitasking means that63

in every instance, tasks are not fully attended to and subsequently risk being forgotten64

and/or performed mindlessly (Kalisch & Aebersold 2010; Coiera & Jayasuriya 2002;65

Laxmisan et al. 2006). The negative effects of the combination of interruptions and66

multitasking are known to increase the risk of errors, and are a great threat to patient67

safety (Chisholm. CD, Collison. EK, Nelson. RD 2000; Laxmisan et al. 2006; Coiera &68

Jayasuriya 2002). Thus, it is not surprising that the ED, has a high frequency of69

preventable errors (Richardson et al. 2000).70

Most studies of multitasking in healthcare focus on physicians. An Australian71

observational study (Kee et al. 2012) identified that ED consultants perform an average72

of 100 tasks an hour, whereby each observed hour consisted of 17 minutes of73

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multitasking activity. According to Chisholm’s observational study, the emergency74

physician is interrupted an average of 9.7 times per hour, compared to 3.9 times for the75

primary care physician (Chisholm et al. 2001). Fewer studies have focused on the76

registered nurse’s (RN) work and interruptions (Schmitz 2012; Kalisch & Aebersold77

2010), despite suggestions that nurses’ work tasks are even more predisposed to being78

multitasked than those of physicians (Berg et al. 2012). In an observational study79

performed by Kalisch & Aebersold, nurses working in medical surgical units and in80

intensive care units all experienced interruptions (ranging from 4.4 to 18 times per hour)81

and multitasking (ranging from 23% to 42% of observed time) (Kalisch & Aebersold82

2010). A Swedish study (Berg et al. 2012) showed that the two most common activities83

in everyday ED practice, information exchange (40%) and information seeking (20%),84

are frequently performed simultaneously with other tasks, i.e. multitasking. The authors85

also conclude that RNs were the professional group who performed the majority of the86

multitasking activities (Berg et al. 2012). Thus, the phenomenon of multitasking is87

known in EDs. However, few studies go beyond examining the quantitative aspect of88

interruptions and multitasking and, thus, little is known about how working in an89

environment prone to interruptions and multitasking is perceived by staff (Kalisch &90

Aebersold 2010; Berg et al. 2012; Chisholm et al. 2001).91

The aim of this paper was to understand how multitasking is experienced by92

registered nurses and how it relates to their everyday practice in the emergency93

department.94

95

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METHODS96

Study design97

This study is part of a mixed-methods study investigating the effects of Teamwork98

on Efficiency, Patient safety, Patient satisfaction and Personnel work environment (the99

TEPPP study). The present study used an exploratory, qualitative approach.100

101

Setting102

The study was set in two different EDs in Sweden: one at a university hospital,103

with approximately 50,000 adult visits to the ED a year; and the other at a medium-104

sized county hospital with approximately 56,000 mixed children – adult visits to the ED105

a year. In Swedish EDs, RNs have important and varied roles, as for example, leading106

the care procedures, performing triage and carrying out medical directives from the107

physicians. They work closely with physicians and assistant nurses (carrying out108

practical basic nursing).109

110

Data collection and procedure111

The respondents were recruited through ED managers and were sent information112

about the study before the interviews took place. Only RNs were included in this call. A113

total of about 100 RNs are employed at the two settings, however at each ED there is a114

number of part-time employers. RNs who wanted to participate informed the manager,115

who contacted the researchers. Altogether nine (n=9) RNs participated and their ages116

varied between 30 and 57 years. The respondents’ had a minimum of 5-27 years’117

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experience of working in an ED and 5-38 years’ experience of working in healthcare.118

The number of respondents was spread amongst the two EDs.119

Before each interview the respondents were given information about the study,120

and gave informed consent. The interview used an exploratory approach with open-121

ended questions. Questions regarding work situation, what helps/hinders personal122

efficiency, and expectations regarding the professional role and multitasking were123

included in the interview guide. Two pilot interviews were conducted to test the124

interview guide, which was slightly altered after the first pilot interview to ease the125

transitions between the different interview questions. All interviews were carried out by126

a master student and the interview guide was developed in collaboration with the127

authors (two researchers and one researcher with clinical experience) and formed by the128

aim of the present study and the research questions for the TEPPP-study. Interviews129

lasted 44-68 minutes, and were conducted at the respondents’ workplace. All interviews130

were audio taped. The pilot interviews were included in the total number of interviews.131

The number of interviews was carried out until data saturation was reached. The project132

was approved by the regional ethics committee (DNR 2010-170).133

134

Data analysis135

The data analysis was guided by Schilling’s structured model for qualitative136

content analysis. The model consists of five levels: from recordings to raw data, to137

condensed protocols, to preliminary category systems and finally to coded protocols.138

The last level includes concluding analysis and interpretations (Schilling 2006). During139

the process of going through the five levels, the 159 pages of transcribed text were140

transformed into nine preliminary categories: multitasking, stress, structure, efficiency,141

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prioritization, expectations, characteristics, polychronicty and monochronicity. This142

process was undertaken by the last author and the data collector. For inter-reliability143

purposes, the analysis and interpretation were reviewed by the second author. Concept144

maps were later created, according to Schilling’s model, to summarize the general terms145

and concepts found in the interviews. From these concept maps, three core concepts146

were extracted: multitasking, efficiency and stress. All three concepts connect to the aim147

of understanding how multitasking is experienced by RNs, and relate to everyday148

practice in the ED.149

150

RESULTS151

Findings are presented in relation to the three core concepts: ‘multitasking – an152

attractive prerequisite for ED care’; ‘multitasking implies efficiency’ and ‘multitasking153

is not stressful’. From these core concepts an overarching additional theme emerged: ‘...154

and does not cause errors – at least for me’, related to patient safety.155

156

Multitasking – an attractive prerequisite for ED care157

All nine respondents experienced several situations during each work shift in158

which they had to multitask, i.e. simultaneously manage multiple tasks. Often, the159

multitasking was triggered by a high influx of patients and tasks, and by interruptions160

by others. It was very common to start a new task without finishing the last one and161

working on several tasks in parallel. One respondent explains that there is a lack of162

cultural awareness of the importance of being fully focused on the task at hand:163

164

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”That culture [being fully focused on the task at hand] does not exist, and that165

results in a bunch of parallel tracks. People are interrupting each other all the time”166

167

The respondents viewed multitasking as something so natural at an ED that they168

did not think much about it and struggled giving very detailed descriptions of situations169

when they multitasked. They rather discussed having a lot to do and working with170

several tasks in parallel than multitasking. They regarded multitasking as an inherent171

part of work in an ED, something that cannot be separated from it. Interruptions and172

multitasking were not viewed as problematic; on the contrary, this was described as part173

of the attraction of working in the ED in relation to working at a ward:174

175

“Spontaneously I don’t think I could manage working at a ward, there’s too little176

action and the tasks are monotonous.”177

178

This illustrates how having a lot going on at the same time, which results in179

multitasking, was perceived as enjoyable, and also shows how important multitasking180

was from a job satisfaction perspective. In addition to perceiving multitasking as181

enjoyable, the respondents also expressed that they performed better when there was a182

lot going on, implying that these kinds of situations, where they described multitasking183

as something self-evident, is something they perceive that they have the capacity to184

manage:185

186

“ I work best when there’s a lot to do; if it gets too quiet I don’t feel like I can187

manage anything.”188

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189

Thus, multitasking is perceived as self-evident both in relation to the ED190

environment and how the respondents viewed themselves. This also spills over to how191

the respondents viewed the expectations on staff in the ED in general. They perceived192

that certain individuals like multitasking and thus seek work in the ED. Furthermore, the193

respondents described that they regarded being capable of multitasking and able to194

process high loads of information as a basic requirement for anyone wanting to work in195

the ED. In sum, multitasking is experienced as a prerequisite for ED care that attracts196

certain individuals who appreciate this kind of situation, and that makes working in the197

ED more enjoyable.198

199

Multitasking implies efficiency200

The respondents did not only go to work expecting to multitask, and enjoying it.201

They also expressed that they felt more efficient when there was a great deal to do,202

when patient volumes were high and they were involved in the care of many patients.203

One respondent explains how not having too much to do make her feel lazy.204

205

“So, I work best when there’s a lot to do. When it’s not on the verge of being too206

much, I think it’s boring when there’s little to do and then I get lazy.” 207

208

Being in a situation that the respondents describe forces them to perform many209

parallel tasks making them feel most efficient. Thus, respondents perceive that210

multitasking equals being efficient. When you do not multitask, job satisfaction is211

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reduced and work becomes less efficient, and several respondents expressed that they212

got lazy and less motivated to work when there was less to do. Other respondents213

described this as a sense of emptiness. One respondent described a feeling of not being214

useful during these times, and even though she reflected upon the need for quiet time to215

allow herself space to think, her first reaction was that she might as well go home:216

217

“ If there are enough of us nurses and if I’m not needed, I try to get away and go218

home because there’s an opportunity to.” 219

220

“ Most often I’m in a hurry; if I’ve had a lot to do during the day I feel good and221

in a rush when I get home…it’s worse if I had a slow day. Then I’m tired when I222

get home”.223

224

Figure 1 summarizes how high patient load and the unreflected multitasking that225

follows relate to perceived efficiency and job satisfaction.226

227

228

INSERT FIGURE 1 HERE.229

Figure 1: A conceptual model of how having a lot to do (high patient load) relates to230

unreflected multitasking and to perceived efficiency and job satisfaction.231

232

Multitasking is not stressful233

The respondents did not relate multitasking to stress related factors such as fatigue234

or cognitive overload and they did not perceive that a high cognitive demand for235

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multitasking would evoke feelings of pressure. Rather, working with many things in236

parallel and at a high tempo seldom appeared to be related to energy loss – rather the237

opposite. A respondent describes:238

239

”…..the fact that I have a lot of work to do never st resses me”. 240

241

The fact that parallel work tasks and interruptions were not perceived as stressful242

does not mean that working in the ED is stress-free, merely that stress was related to243

other things, such as when patients were not discharged to a ward in a timely manner,244

having to wait for a procedure or test, or working with less experienced colleagues.245

Overall, there was agreement among the respondents that the ED is a stressful246

environment. It was also very clear that they perceived themselves as stress-hardy247

individuals:248

249

“I perceive myself as very good at managing stressful situations. If I weren’t, I250

wouldn’t work at the ED; it wouldn’t work.” 251

252

Very few respondents described ever doubting their own way of managing stress,253

including the high cognitive load associated with multitasking. But when describing254

colleagues and other professions in stressful situations, is was clear that not all255

colleagues could live up to expectations:256

257

“Some are very sloooooow in their actions. Even in a non-stressful situation one258

has to be able to hurry up”.259

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260

So, being able to handle many things and work at a high tempo were highly261

valued. Also, colleagues who were not able to do so evoked feelings of frustration262

among the respondents, who felt that this slowed them down and caused interruptions in263

the work flow. This, in turn, caused the respondents to experience feelings of stress.264

Again, it was perceived as so important for a professional working in the ED to be able265

to handle multiple simultaneous and parallel tasks that many of the respondents shared266

the view that if you cannot manage this you would probably be better off working267

somewhere else.268

269

...and does not cause errors – at least for me270

Adding together that multitasking was perceived as inherent to working in the ED,271

and that having an individual capacity to multitask was a prerequisite for ED staff, it272

may not be surprising that the respondents did not perceive multitasking to affect work273

performance negatively, or to be related to an increased risk of error (for example by274

forgetting things or mixing things up). On the contrary, the general perception seemed275

to be that it is the lack of capacity to multitask that has a negative influence on work.276

Several of the respondents explained how being able to handle several concurrent on-277

going activities is a necessity in the ED. One respondent explains how it does not work278

out for nurses who do not appreciate having too much going on at the same time:279

280

“ W e have nurses coming here from wards who don’t like that it is like this here, it281

doesn’t work out”. 282

283

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They were very clear in stating that errors are unacceptable, and returned to the284

concept that those who cannot handle the demands are not suited to work in the ED. It285

was common to attribute the lack of ability to handle the demands to lack of experience.286

287

” I can get really frustrated if I am working with an unexperienced doctor who288

doesn´t understand that the patient is ill ”.289

290

When reflecting upon one’s ways of working and risk for errors associated with291

this, the respondents had to go back in time to when they were inexperienced to find an292

example. One respondent says:293

294

“ In the beginning I was afraid I would miss things. But I like having a lot to do all295

the time.” 296

297

In addition to illustrating how stimulating multitasking is perceived to be, this298

quote also illustrates the temporal process whereby the respondents might have viewed299

the demands of multitasking as problematic at one point in time, when they were new300

and inexperienced, but that this perception changed as they grew accustomed to the301

demands of multitasking. In relation to errors, there is a pattern by which the302

relationship between multitasking and errors in the ED differs depending on the actor.303

Only when thinking back on when they were new in the ED were they able to consider304

that there may be risks associated with multitasking and interruptions. They were,305

however, able to describe how their colleagues from time to time were in over their306

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heads. Figure 2 shows how the relationship between multitasking and errors is307

perceived to be mediated by whom the actor is, and his or her level of experience.308

309

INSERT FIGURE 2 HERE.310

Figure 2. The relationship between multitasking and errors as described by the311

respondents.312

313

DISCUSSION314

The findings from this study showed registered nurses’ positive perceptions315

regarding their work, where multitasking was seen as an attractive prerequisite,316

implying efficiency and not stressful. They didn’t perceive multitasking as related to an317

increase risk of error. However, the participants expressed their worries about new318

inexperienced colleagues and other colleagues not managing stressful multitasking319

situations.320

The results from this study show that from the nurses’ perspective, multitasking is321

perceived as a main characteristic of work in the ED. This is in line with previous322

studies describing multitasking as something very common in the ED (Laxmisan et al.323

2006; Chisholm et al. 2001; Chisholm. CD, Collison. EK, Nelson. RD 2000, (Kalisch &324

Aebersold 2010). It also adds to the literature on multitasking among nurses by325

investigating how multitasking is experienced by nurses specifically, something that326

few previous studies have done (Berg et al. 2012). More specifically, it shows that in327

contrast to most previous research describing the challenges, stress and risks of328

multitasking, the results from this study suggest that for the nurses in the ED,329

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multitasking may rather be perceived as something positive, related to both perceptions330

of efficiency and enjoyment.331

332

Our findings suggest that many, if not all, of the respondents could be described333

as polychrone. Polychronicty is defined as an individual preference for shifting one’s334

attention among ongoing tasks, rather than handling them in a serial fashion (Poposki &335

Oswald 2010). Other definitions underscore that polychrone people not only perceive336

multitasking as a preferred activity, but also believe it is a superior way of handling337

tasks (Konig & Waller 2010). This is in line with findings in this study, which indicate338

that many of the respondents perceive that multitasking is a natural behavior in the ED.339

However, they also perceive that they are better at multitasking than others. Previous340

studies have shown that this may not be the case, as polychronicty is not a predictor of341

multitasking (rather, working memory, attention and fluid intelligence are) (Konig et al.342

2009). Thus, there is a misconception that being polychrone makes people better at343

multitasking. Furthermore, it could be suggested that this misconception contributes to344

the discrepancies in the descriptions of the risks of multitasking between self-345

descriptions (no risk) and descriptions of colleagues (greater risk).346

Concurrently with self-descriptions that imply polychronicty as a rather stable347

personality trait, the findings also suggest that there is a temporal development in the348

experiences of multitasking over time, from being new at the ED and being stressed by349

and feeling uncomfortable with the complexity that calls for multitasking, to a later350

stage of experience when this is no longer seen as problematic but rather something351

inherent in the work. These findings offer support to theories suggesting that the352

preference for multitasking is a result of working in an environment and culture that353

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value multitasking (Konig & Waller 2010). There is no doubt that ED is an environment354

where multitasking is perceived as something inherent to the setting: for example, it has355

been suggested that multitasking should be part of the training for physicians and nurses356

(Stephens & Fairbanks 2012; Laxmisan et al. 2006). Thus, this study adds to the357

literature by suggesting that multitasking and polychronicty may be related both to358

stable, personal preferences and to a cultural adaptation process whereby the view on359

multitasking changes in response to the environment.360

Several studies from fields other than health care have investigated the361

relationship between multitasking and performance, with very heterogeneous results,362

but often interpreted as related to whether or not the performance requires multitasking363

and whether the person doing the performance is polychrone or monochrone (Konig &364

Waller 2010). However, fewer have investigated the relationship between multitasking365

and quality and errors, and how multitasking might affect the patient safety. Although366

the findings from this study do not refer to the effects of multitasking on patient safety367

per se, it does raise some important issues for future research and practice. For example,368

the potential risk for multitasking should be further investigated. For practice, this369

knowledge is of great importance for clarifying how multitasking should be managed.370

In particular, the discrepancy between knowledge about the limits of the human371

capability for multitasking and the lack of corresponding descriptions from the372

respondents in our sample merits further attention. Are there situations in the ED373

environment that exceed the human capacity for multitasking? If so, how can these374

situations be recognized, and how can awareness of these limitations be spread among375

ED staff, who, based on the results from our study, are less likely to perceive376

multitasking as problematic?377

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Previous research has shown that task interruptions, and multitasking, may be378

particularly challenging in complex dynamic contexts like the ED, since the situation is379

not static and hence involves switching between evolving situations and tasks380

(Tremblay et al. 2011). This supports the results of our study, which clearly show that381

multitasking and interruptions are viewed as unavoidable parts of the ED environment.382

However, still, the way work is organized is likely to influence how much multitasking383

is required. For example, working in small teams has been suggested as a promising384

method for making it easier to recover from the interruptions that multitasking involves385

(Tremblay et al. 2011). These suggestions are confirmed by a Swedish study386

investigating how the introduction of teamwork in the ED affected work procedures,387

work environment and patient perceptions of the quality of care (Muntlin Athlin et al388

2013). Teamwork, i.e. handling a limited number of patients within a multi-professional389

team, reduced multitasking processes, which in turn improved the staff’s work390

environment. However, the staff initially felt ineffective due to the work changes391

(Mazzocato et al. 2011; von Thiele Schwarz, U. Hasson, H. Muntlin Athlin 2012). Also,392

this introduction of teamwork lead to several improvements in patients’ perceptions of393

the quality of the ED care including an increase in the number of patients reporting a394

positive atmosphere at the ED (Muntlin Athlin et al. 2014). Some of the respondents in395

our study worked at the ED mentioned above. Surprisingly, the respondents did not396

further reflect on organization and processes in relation to multitasking. This might397

mirror that their perceptions of multitasking are an inherent part of the ED work.398

Lastly, but no less important: we do not know how multitasking affects the actual399

patient care and how it is (or even if it is) perceived by patients. Previous studies have400

indicated that clinicians spend less time in their work on direct patient care (Kee et al.401

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2012; Hollingsworth et al. 1998). Working in a multitasking and time-pressured402

environment and culture such as the ED may negatively affect the time spent on direct403

patient care, in which attention is paid to patients’ care needs and not only life-saving404

medical technical procedures. This may also negatively affect the quality of the405

communication, as nurses describe having less time to communicate with patients;406

however, the feeling of time pressure and stress could also be used as a prevarication to407

avoid more in-depth communication in a busy setting (Elmqvist et al. 2012). Further408

research studying how multitasking is perceived by patients and how it affects direct409

patient care is required.410

411

Limitations and strengths412

This study took place in two different Swedish EDs, but was limited to only nine413

respondents. Therefore, the findings have limited transferability. However, our results414

add important aspects to the discussion on multitasking in the ED. To our knowledge,415

this is the first study to investigate how multitasking is experienced by registered nurses416

and how it relates to their everyday practice in the ED. Previous studies have only417

focused on the quantitative side of multitasking, rather than on understanding the418

phenomenon itself. The qualitative design was used to deepen our understanding of419

multitasking in the ED. To manage trustworthiness, the research team included420

researchers familiar with qualitative data analysis. One of the researchers is also an RN421

with long experience of working in the ED. During the different steps of the data422

analysis procedure, data were reviewed by two to three researchers to ensure inter-423

reliability.424

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The included respondents showed a variety in age and work experience. However,425

none of them could be classified as ‘inexperienced’, which may raise questions426

regarding recall of their experiences about being new at the workplace. It is427

recommended that future studies include a larger sample, as well as those with less428

experience of ED work, to verify the experiences of multitasking and interruptions429

when one is new at work.430

431

CONCLUSIONS432

This study shows how high patient load and the unreflected multitasking that follows433

relate to nurses’ perceived efficiency and job satisfaction. It also shows how the434

relationship between multitasking and errors is perceived to be mediated by whom the435

actor is, and his or her level of experience. Findings from this study can add value to the436

discourse on multitasking and the emergency department context, as few studies go437

beyond examining the quantitative aspect of interruptions and multitasking and, thus,438

little is known about how working in an environment prone to interruptions and439

multitasking is perceived by staff.440

441

FUNDING442

The TEPPP project was funded by AFA Insurance, Sweden.443

444

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445

446

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