IMPACT OF ALARM FATIGUE AMONG ONCOLOGY NURSES ON NURSING SHORTAGE IN PAKISTAN: THE MEDIATING ROLES OF WORKLOAD AND BURNOUT

Background: Alarm fatigue is increasingly recognized as a critical occupational hazard in healthcare, particularly in high-acuity units such as oncology wards. Repetitive exposure to non-actionable alarms leads to cognitive overload and desensitization, compromising nursing performance. In resource-limited settings like Pakistan, where nurses already face overwhelming workloads and systemic challenges, alarm fatigue may exacerbate professional burnout and contribute to missed nursing care. Understanding this interplay is essential to guide interventions for safer and more effective oncology care. Objective: To investigate the direct and indirect effects of alarm fatigue on nursing deficits among oncology nurses in Pakistan, with workload and burnout assessed as potential mediators through structural equation modeling. Methods: A cross-sectional survey was conducted in March 2025, involving 200 registered oncology nurses across tertiary care hospitals in Pakistan. Data were collected using standardized tools: the Oncology Nurse Alarm Fatigue Scale (Cronbach’s α = 0.865), Maslach Burnout Inventory (α = 0.907), and the Nurses' Self-Concept Questionnaire. Structural equation modeling (SEM) using AMOS 24.0 and bootstrapping with 5,000 resamples evaluated both direct and indirect effects. Model fitness was assessed using RMSEA and CFI indices. Results: Alarm fatigue showed strong correlations with workload (r = 0.492), burnout (r = 0.585), and nursing deficit (r = 0.613), all significant at p < 0.01. SEM indicated a significant direct effect of alarm fatigue on nursing deficits (β = 0.316, p < 0.05). Indirect effects were mediated by workload (β = 0.111; 14.61%), burnout (β = 0.187; 24.61%), and a sequential path through both (β = 0.159; 20.92%). Collectively, indirect effects accounted for 60.13% of the total effect, while the direct path accounted for 39.87%. Model fit indices confirmed robustness (RMSEA = 0.056; CFI = 0.965). Conclusion: Alarm fatigue substantially contributes to nursing care deficits in oncology settings, with workload and burnout acting as significant mediators. Targeted strategies addressing alarm burden, nurse workload, and psychological well-being are imperative to safeguard care quality and workforce sustainability.