Nursing Workload and Nursing Staff in Intensive Care With the Nursing Activities Score in 10 Countries

Background: Adequate nursing staff to meet the demands of patient care in intensive care units (ICUs) is a goal pursued by all health care systems in the world. Purpose: The purpose of this study was to describe the nursing workload, the quantity and composition of nursing staff, and the patient-to-nurse ratio in ICUs from different countries considering the application of the Nursing Activities Score (NAS) for the adequacy of the nursing staff to the nursing workload. Methods: This was an observational, descriptive study with data from 15 ICUs in 10 different countries, comprising 941 patients and 666 nursing professionals. NAS was used to measure the nursing workload. Data about nursing workload and nursing staff were assessed daily during November 2017. Descriptive statistics were used for the data analysis. Results: The majority of patients were male (61%) with a mean age of 61.9 (SD, 16.9) years and a risk of mortality of 26.2%. The mean age of the nursing staff was 41.3 (SD, 10.5) years with 10.8 (SD, 8.9) years of experience in the ICU. Almost 40% were critical care nurses, and 35.7% were registered nurses. The mean NAS (3691 measures) was 67.7 (SD, 27.7). The patient-to-nursing staff ratio varied from 0.8:1 to 1.9:1. There were exceeding nursing staff hours in relation to the nursing hours required by the patients measured by NAS in 70% of the countries. Conclusions: The majority of the ICUs presented a high nursing workload and experienced nursing staff and were exceeding nursing staff hours according to the nursing workload in most countries. However, the diversity of nursing care contexts must be considered for estimating the number of professionals required to provide nursing care according to NAS in the ICUs.