Nursing workload in critical care unit during admission and discharge: A prospective study

Higher nursing workload (NW) is associated with a negative impact on patient-focused clinical outcomes in critical care units. Adjusting the nursing staffing to the individualized care needs of critically ill patients' using a validated scale could constitute an efficient care management strategy in these settings.

Assessing NW within 24 h of admission and discharge using the Nursing Activities Score (NAS) in 4 adult critical care units.

Prospective, observational, single-center study.

Patients admitted to the critical care units of a high-complexity hospital from October 2022 to February 2023. Descriptive analysis, Student's t-test, ANOVA, and multiple linear regression were performed using SPSS® v26.

A total of 236 patients were included, of which 143 (60.9%) were male and the mean age was 61.30 (15.79). The reason for admission was medical in 151 (64.3%) cases, unplanned in 184 (78.3%) cases, APACHE II 17.09 (7.31), Charlson index of 5 [3-8], number of devices 4 [3-6], invasive ventilation 97 (41.1%), length of stay 5 [3-10] days, on admission ratio 1:2 in 203 (86.0%) and care level 3 in 236 (100.0%), on discharge with ratio 1:2 in 232 (98.3%) and care level 2 in 195 (82.6%). The mean NAS 24 h on admission was 59.46 (5.19) and on discharge was 51.13 (7.55). The variables that predicted the 24-h NAS on admission were the unit (P = .001), number of devices (P < .001), and APACHE IIs (P < .001); while those predicting 24-h NAS at discharge were unit (P < .001), mortality (P < .001), care level (P < .001), number of devices (P = .011), and length of ICU stay (P = .037).

NW was high, both at admission and discharge, exceeding the 1:2 ratio. Higher rates were found in the afternoon shift. The variables that predict NW on admission are the unit, number of devices and severity of illness, and on discharge, also mortality, level of care, and length of ICU stay.