Measuring the nursing workload per shift in the ICU

Abstract

Purpose: In the intensive care unit (ICU) different strategies and workload measurement tools exist to indicate the number of nurses needed. The gathered information is always focused on manpower needed per 24 h. However, a day consists of several shifts, which may be unequal in nursing workload. The aim of this study was to evaluate if differences in nursing workload between consecutive shifts can be identified by a nursing workload measurement tool. Methods: The nursing activities score (NAS) was registered per patient for every shift during a 4-week period in a prospective, observational research project in the surgical-pediatric ICU (SICU-PICU) and medical ICU (MICU) of an academic hospital. Results: The NAS was influenced by the patient characteristics and the type of shift. Furthermore, the scores were lower during night shifts, in weekends and in MICU patients. Overall, the mean NAS per nurse per shift was 85.5 %, and the NAS per 24 h was 54.7 %. Conclusion: This study has shown that the nursing workload can be measured per working shift. In the ICU, the NAS differentiates the nursing workload between shifts, patients and units.

Nursing Activities Score: an updated guideline for its application in the Intensive Care Unit

“…However, the NAS measures showed a great degree of variation between countries with a minimum of 44.5% (Spain) and a maximum of 101.8% (Norway), as well as average values of 83.0% (Poland), 64.59% (Greece) and 57.1%, 54.0% and 51.0% (Egypt, Brazil and the Netherlands, respectively). Although similar values have been reported by other researchers (20)(21)(25)(26) , it is possible to attribute these differences to the type of ICU, as well as to the characteristics of the patients.…”

“…Results indicated that the NAS accounts for 81% of the nursing time, whereas TISS-28 accounts for only 43% (14) . Thus, NAS has been translated into many languages and is in use in 12 countries including Norway and Finland in the global north, and Brazil in the south (15)(16)(17)(18)(19)(20)(21)(22) .…”

Interrater reliability of Nursing Activities Score among Intensive Care Unit health professionals

“…It is of interest to know whether ICU managers precisely assess the ICU-CCNs workload (1,3) . A widely used and validated instrument to assess ICU-CCN workload is the Nursing Activities Score (NAS) (10)(11)(12)(13)(14) . Assessed at the individual patient level, the NAS measures the average time spent by nurses in performing activities related to therapeutic procedures; medical interventions and nursing activities.…”

The continuing imperative to measure workload in ICU: impact on patient safety and staff well-being

“…This approach is driven by increasing effectiveness and efficiency, with the goal of decreasing unnecessary nursing costs. Debergh and colleagues [18] report on the use of NAS to delineate between the workload of different shifts; in an increasingly cost-conscious environment, this is an important further piece of the workload puzzle, with shift work potentially impacting on patient safety and staff well-being, as well as the more obvious financial costs. However, the ability to take account of unit-based factors influencing workload remains unsolved and is necessary before these data can be used for comparison across units, a key consideration in an increasingly 'benchmark-orientated' health-care environment.…”

“…The paper by Debergh and colleagues [18] sheds light on a previously ignored but important aspect of workload-comparison across shifts; the usefulness of this approach will only be evident when units replace a global nurse to patient ratio with some form of workload tool to plan staffing.…”