Impact of COVID-19 on nursing time in intensive care units in Belgium.
Arnaud Bruyneel, Maria-Cécillia Gallani, Jérôme Tack and 5 others
PMID 33162312WHAT IT FOUND
Belgian ICU patients with COVID-19 needed much more nursing time than non-COVID patients: mean workload score 92.0% versus 71.7%.
This points to near 1:1 nurse staffing, not the legal 1:3.
Key findings
01Mean nursing time was 92.0 ± 16.1% for COVID-19 patients and 71.7 ± 18.2% for non-COVID-19 patients.
02COVID-19 patients required more nursing time for monitoring, mobilisation, and hygiene care.
03The NAS suggests COVID-19 patients demand an ideal nurse-to-patient ratio close to 1:1, while the Belgian legal ICU ratio is 1:3.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 95 patients had COVID-19, and the study included five ICUs in one Belgian province, so it may not represent other units or countries. Patients needing ECMO were transferred out, and prone positioning sessions were not extracted, so some high-intensity nursing activities may be missing from the workload estimate. The COVID-19 and non-COVID-19 groups were studied at different times of year, and the authors note missing factors that could explain high NAS. This was an observational study of nursing time, not a randomised staffing intervention, so it cannot show that changing nurse numbers improves patient outcomes.
Declared interests
The authors declare no known competing financial interests or personal relationships that could have appeared to influence the work.
The easy way to misread this
Do not read the near 1:1 ratio as proof that assigning one nurse per patient will improve outcomes. This was an observational study of nursing time, not a staffing intervention, and patients with COVID-19 also had longer mechanical ventilation, more CVVH, and other supports whose separate contributions cannot be isolated.