Abstract
Continuous non-invasive cardiac monitoring (CNICM) is increasingly deployed on medical-surgical units to detect patient deterioration early, yet it introduces significant clinical alarm volumes. This cross-sectional observational study evaluated the relationships among perceived subjective workload, alarm fatigue, and reported patient safety incident rates among medical-surgical registered nurses (N = 284) across three regional tertiary care hospitals. Data were collected using the NASA Task Load Index (NASA-TLX), the Alarm Fatigue Assessment Questionnaire for Nurses (AFAQ-N), and validated institutional safety incident logs over a six-month period. Multiple linear regression and structural equation modeling demonstrated that high subjective workload (beta = 0.42, p < 0.001) and elevated alarm fatigue (beta = 0.38, p < 0.001) were significant positive predictors of patient safety incidents, including delayed alarm response times and missed physiological desaturation events. Furthermore, alarm fatigue partially mediated the relationship between perceived nursing workload and safety incidents (indirect effect beta = 0.21, 95% CI [0.14, 0.29], p < 0.001). Nuisance alarms and sensory overload significantly diminished clinical alarm responsiveness. These findings highlight the critical need for unit-level alarm management protocols, customized physiological parameter thresholding, and nurse-driven telemetry deselect criteria to mitigate cognitive overburden, enhance patient safety, and optimize healthcare delivery in acute care medical-surgical environments.
