Nursing workload assessment in an intensive care unit: A retrospective observational study using the Nursing Activities Score

Abstract

Background: Nursing Activities Score (NAS) is a promising tool for calculating the nursing workload in intensive care units (ICU). However, data on intensive care nursing activities in Portugal are practically non-existent.Aim: To assess the nursing workload in a Portuguese ICU using the NAS.Study Design: Retrospective cohort study developed throughout the analysis of the electronic health record database from 56 adult patients admitted to a six-bed Portuguese ICU between 1 June-31 August 2020. The nursing workload was assessed by the Portuguese version of the NAS. The study was approved by the Hospital Council Board and Ethics Committee. The study report followed the STROBE guidelines. Results:The average occupancy rate was 73.55% (±16.60%). The average nursing workload per participant was 67.52 (±10.91) points. There was a correlation between the occupancy rate and the nursing workload. In 35.78% of the days, the nursing workload was higher than the available human resources, overloading nurse staffing/team.

Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit

“…However, the data showed that all the study participants needed at least basic care activities related to the care and prevention of pressure ulcers and daily dressing changes, while 26.1% needed frequent dressing changes (at least once per nursing shift) and/or extensive wound care. These data were consistent with other studies developed in intensive care units that highlight the need to preferentially assess the nursing workload that each participant generates [ 39 ] and the specificities of each shift [ 40 , 41 ] instead of calculating nursing ratios according to occupancy rates, average nursing workload per participant, and/or the total 24-h nursing workload in the intensive care unit [ 2 ]. Specifically, regarding the wound treatment, when the wound is complex, more time is needed, as well as more differentiated interventions by different health professionals aiming to choose the best dressing options [ 42 ].…”

“…Being admitted to a hospital is an important measure of frailty [ 21 ], whereby the patients admitted to intensive care units [ 22 ] are normally associated to higher levels of nursing workload [ 1 , 2 ].…”

“…Subsequently, it is essential to identify objective indicators that measure the real needs of the patients and of the nursing professionals, specifically in patients with wounds and injuries of different aetiologias, to ensure that all patients are offered consistently high-quality care in intensive care units [ 2 , 37 ].…”

“…Nowadays, nursing workload assessment is widely discussed and implemented to qualify, plan, and evaluate intensive care units (ICU) [ 1 , 2 ]. Nursing workload is defined as a product of the average daily number of patients seen, adjusted by the degree of dependence and type of care and the average time of assistance for each patient [ 3 ].…”

Management and leadership of intensive care units for the future

“…Conversely, negative workplace environments and unsustainable workloads can have deleterious impacts that compromise patient safety. 13 The challenge of heavy workloads and staff shortages is an important issue, which commonly arises in ICU settings and reflects a disquieting dichotomy between workload requirements versus expectations and workforce availability versus capability. Further to this it represents a very challenging situation when essential care is required, but the potential for further harm because of scarce human resources exists.…”