The impact of COVID-19 on nursing workload and planning of nursing staff on the Intensive Care: A prospective descriptive multicenter study.
M E Hoogendoorn, S Brinkman, R J Bosman and 3 others
PMID 34273806WHAT IT FOUND
ICU nurses carried more patients and more total workload during the 2020 pandemic than in 2019.
COVID-19 patients needed far more time for hygiene, prone positioning, respiratory care and family support. Non-ICU nurses helped, but their hours were not counted.
Key findings
01The number of patients per ICU nurse rose in the COVID period (median 1.1 vs 1.0), and total Nursing Activities Score per nurse rose (median 69.8 vs 46.6), with April 2020 showing a 98% increase in workload per nurse.
02COVID-19 patients scored higher on the Nursing Activities Score than non-COVID pneumonia patients (median 55.2 vs 50), driven by hygiene procedures, mobilization with three or more nurses, respiratory care and family support.
03Non-ICU nurses supported ICU staff with basic care and procedures, but their hours were not recorded in the registry, so the true workload per ICU nurse is uncertain.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only six of eleven participating ICUs had complete data; five were excluded because nurses could not collect scores during the peak workload. Non-ICU nurses who helped were not included in the staffing count, so the workload per ICU nurse may be overestimated. The Nursing Activities Score relies on nurse estimates, which have variable reliability. The study population was not fully representative of all Dutch ICUs, with differences in patient mix and higher mortality in the study group. The study did not analyze the impact of the new supervisory role of ICU nurses over non-ICU staff.
Declared interests
Several authors are members of the board of NICE, the foundation that funded the registry and the study.
The easy way to misread this
Do not read the higher workload per nurse as solely due to more patients. The study shows the workload per patient was also higher, and the presence of non-ICU nurses was not accounted for in the denominator, so the true burden on the named ICU nurse is complex and likely underestimated in some aspects and overestimated in others.