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Intensive Crit Care Nurs. 2018 Jun;46:64-69. doi: 10.1016/j.iccn.2018.01.004. Epub 2018 Feb 12.

The NASA Task Load Index as a measure of overall workload among neonatal, paediatric and adult intensive care nurses.

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Cincinnati Children's Hospital Medical Center, Department of Patient Services, 3333 Burnet Avenue, ML 11016, Cincinnati, OH 45229, USA; The Ohio State University College of Nursing, Columbus, OH, USA. Electronic address:
Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH, USA.
Cincinnati Children's Hospital Medical Center, James M. Anderson Center for Health Systems Excellence, Cincinnati, OH, USA.
Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA.



The NASA Task Load Index (NASA-TLX) is a subjective workload assessment scale developed for use in aviation and increasingly applied to healthcare. The scale purports to measure overall workload as a single variable calculated by summing responses to six items. Since no data address the validity of this scoring approach in health care, we evaluated the single factor structure of the NASA-TLX as a measure of overall workload among intenisive care nurses.


Confirmatory factor analysis of data from two studies of nurse workload in neonatal, paediatric, and adult intensive care units. Study 1 data were obtained from 136 nurses in one neonatal intensive care unit. Study 2 data were collected from 300 nurses in 17 adult, paediatric and neonatal units. Nurses rated their workload using the NASA-TLX's paper version.


A single factor model testing whether all six items measured a single overall workload variable fit least well (RMSEA = 0.14; CFI = 0.91; TLI = 0.85). A second model that specified two items as outcomes of overall workload had acceptable fit (RMSEA = 0.08; CFI = 0.97; TLI = 0.95) while a third model of four items fit best (RMSEA = 0.06; CFI > 0.99; TLI = 0.99).


A summed score from four of six NASA-TLX items appears to most reliably measure a single overall workload variable among intensive care nurses.


Factor analysis; ICU; NASA; Neonatal; Nurse; Paediatric; Workload

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