Workload in ICU nurses: A systematic review and meta-analysis of the Nursing Activities Score

Intensive care units (ICUs) are high-demand environments where nurse workload management is critical for ensuring quality patient care and nurse well-being. The Nursing Activities Score (NAS) is widely used to quantify nursing workload, yet individual studies report heterogeneous findings. This systematic review and meta-analysis aimed to synthesize global data on ICU nursing workload using the NAS.

A comprehensive literature search was conducted in multiple databases without language restrictions, identifying studies reporting mean NAS scores. Data were extracted by two independent reviewers, and a random-effects meta-analysis was performed to pool NAS values. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity.

A total of 70 observational studies, encompassing data from 56,042 ICU patients, were included. The meta-analysis revealed a pooled mean NAS of 66.2% (95% CI: 62.6-69.8%), indicating that, on average, ICU nurses spend nearly two-thirds of their shift on direct patient care for a single patient. Higher NAS values were observed during patient admission and the morning shift, with a significant increase during the COVID-19 period compared to pre-pandemic levels.

Our analysis revealed that ICU nurses spend a substantial part of their shift on direct patient care, especially during high-demand periods. These findings challenge traditional nurse-to-patient ratios, suggesting the need for flexible staffing models.

The current nursing staff level within ICU settings may not be adequate for the average nursing workload in some countries. Consideration should be given to dynamic staffing models that can consider increased nursing workload.