Determinants of increased nursing workload in the COVID‐era: A retrospective analysis of prospectively collected data

Abstract

BackgroundCOVID‐19 is associated with increased nursing workload, therefore a high nurse‐to‐patient ratio would be required.AimTo analyse difference in nursing workload, as expressed with the Nursing Activities Score (NAS), between COVID‐19 patients versus control patients without COVID‐19 disease (NCOVID‐19 group) in an Italian Extracorporeal Membrane Oxygenation (ECMO) centre.Study DesignRetrospective analysis of prospectively collected data, enrolling consecutive patients admitted to a general Intensive Care Unit, between 1st May 2019 and 28th February 2021. A multivariate analysis was then performed to assess if COVID‐19 disease was an independent predictor of higher NAS and to assess which other factors and procedures are independently associated with increased workload.ResultsWe enrolled 574 patients, of which 135 (24%) were in the COVID‐19 group and 439 (76%) in the NCOVID‐19 group. The average NAS was higher in the COVID‐19 group (79 ± 11 vs. 65 ± 15, T = −10.026; p < 0.001). Prone positioning, continuous renal replacement therapy (CRRT) and ECMO were used more frequently in the COVID‐19 group. A higher fraction of patients in the COVID group showed colonization from multidrug resistant bacteria. COVID‐19 group had a higher duration of mechanical ventilation and longer ICU stay. The COVID‐19 diagnosis was independently associated with a higher NAS. Other independent predictors of higher NAS were the use of prone positioning and continuous renal replacement therapy (CRRT). Colonization from multidrug resistant bacteria and ECMO support were not independently associated with higher NAS.ConclusionsThe higher nursing workload in COVID‐19 patients is mainly due to specific procedures required to treat the most hypoxemic patients, such as prone positioning. Colonization with multidrug resistant bacteria and ECMO support were not independently associated with a higher NAS.Relevance to Clinical PracticeHigher workload in COVID‐19 patients was due to specific interventions, such as prone positioning and CRRT, with the related nursing activities, as continuous presence at patient's bed, mobilization, positioning and complex hygienic procedures.

Effects of closed loop ventilation on ventilator settings, patient outcomes and ICU staff workloads – a systematic review

“…While these studies all showed a reduction of these three aspects, it remains uncertain if this truly reflects a reduction in ICU staff workload, during different phases of mechanical ventilation: for example, the weaning phase in particular, is seen as a labour-intensive phase of mechanical ventilation 64 . We need better studies in the future that, for instance, capture nursing activities scores with metrics that encompass the majority of tasks of an ICU nurse, including those related to invasive ventilation 65,66 …”

“…64 We need better studies in the future that, for instance, capture nursing activities scores with metrics that encompass the majority of tasks of an ICU nurse, including those related to invasive ventilation. 65,66 Closed loop ventilation can facilitate rapid and precise adjustments to ventilator settings. In ICU subpopulations, such as traumatic brain injury patients, strict and precise titration of paCO 2 and paO 2 values are fundamental in order to optimise intracerebral physiology.…”

“… 64 We need better studies in the future that, for instance, capture nursing activities scores with metrics that encompass the majority of tasks of an ICU nurse, including those related to invasive ventilation. 65 , 66 …”

Weak Correlation Between Perceived and Measured Intensive Care Unit Nursing Workload

“…Increasing administrative responsibilities, broadening interprofessional communication, the introduction of integrative medicine such as hypnosis, and the inclusion of patients' family in their care undeniably contribute to modifications in the determinants of nursing workload in the ICU. 19 Hence, conducting a prospective evaluation that matches subjective perceptions with objective measures rather than solely relying on activity-or timebased assessments is essential for achieving a more reliable workload evaluation. Enhanced reliability in workload measurement is important for various aspects of nursing practice and health care delivery.…”

Introduction to the issue and goodbye as co‐editor in chief

“…As the number of our submissions and accepted papers has increased, so too must the number of papers published in our issues, with this issue featuring around 25 papers around a number of themes, such as sleep promotion, 1,2 the impact of COVID-19 on both patients' experiences and nurses, [3][4][5][6][7][8][9] technology use in the intensive care unit (ICU) 10,11 and quantitative research, involving statistics. 1,2,[12][13][14] Our statistical advisor Dr. Chao Huang, in collaboration with the editors, has written an informative guest editorial 15 around why it is so important that nurses can understand basic statistics to be able to read and interpret papers such as these. Many of the papers in this issue are primarily quantitative in nature and use some form of statistical analysis in their results.…”