Nursing staff resources in direct patient care: comparison of TISS and ICNSS

The aim was to study the variation in the nursing workload and nursing staff resources in direct patient care.

Nursing staff resources and the patient-nurse ratio (P/N) were compared between postoperative and mixed-type intensive care units (ICUs) using the Therapeutic Intervention Scoring System (TISS) and the Intensive Care Nursing Scoring System (ICNSS) during a 4-month period.

A total of 832 patients were treated. In the postoperative ICU, the mean daily TISS score per nurse was 41.1, corresponding to a P/N of 1:1, and the mean ICNSS score was 33.8, corresponding to a P/N of 1:1.5. In the mixed-type ICU, the mean TISS score per nurse was 34.7, corresponding to a P/N of 2:1, and the mean ICNSS score was 27.7, corresponding to a P/N of 1:1. In the postoperative unit, 50.4% of the patients would have required a 1:1 P/N ratio based on their TISS scores and 47.5% would have required 1.5 or two nurses as estimated by the ICNSS score. In the mixed ICU 57.1% of the patients would have required a P/N ratio of 1:1 based on TISS scores and 61.3% a ratio of 1:1.5 or 1:2 according to the ICNSS score.

Intensive Care Nursing Scoring System gives additional information about the nursing staff resources and yields a higher number of nurses needed in direct patient care even when TISS scores show the number of nurses to be adequate.