[The assessment of nursing workload]

Area of Science:

• Critical Care Medicine
• Nursing Management
• Health Services Research

Background:

• Nursing workload measurement evolved significantly since the 1970s, driven by the need for accurate patient acuity and cost-effectiveness in ICUs.
• Early systems like TISS focused on illness severity, while later developments aimed to capture specific nursing activities more precisely.

Purpose of the Study:

• To provide a comprehensive review of validated nursing workload scoring systems developed from 1974 onwards.
• To analyze the evolution of these tools, from early severity-based measures to contemporary activity-focused assessments.

Main Methods:

• Systematic review of historical and contemporary nursing workload scoring systems.
• Analysis of the development, validation, and application of key scoring systems including TISS, TISS 28, NEMS, and NAS.

Main Results:

• Multiple scoring systems have been developed, including TISS (1974), TISS update (1983), PRN (1980-1987), OMEGA (1986), TOSS (1991), TISS 28 (1996), NEMS (1997), and NAS (2003).
• These systems vary in their approach, with some focusing on therapeutic interventions and illness severity (TISS, NEMS) and others on direct nursing activities (TOSS, PRN, NAS).
• Validated tools like TOSS and NAS offer more direct and comprehensive measures of nursing workload and time utilization.

Conclusions:

• A variety of scoring systems exist to measure nursing workload, reflecting a shift towards more specific activity-based assessments.
• These instruments are crucial for evaluating ICU resource utilization and ensuring appropriate nurse-patient ratios.