Marga Hoogendoorn

108 Margadant et al (2020) stated the importance of the nursing workload per ICU nurse; a higher Nursing Activities Score per nurse ratio was associated with a higher in-hospital mortality 9 . Therefore, it is important to look both at the number of patients per nurse and the nursing workload per nurse. The primary aim of this study was to describe differences in the planning of nursing staff, expressed as the patient per nurse ratio on the ICU, and the impact of those differences on nursing workload in the COVID-period versus a recent non-COVID-period. The secondary aim of this study was to describe differences in ICU nursing workload according to the Nursing Activities Score of COVID-19 ICU patients and other ICU patients. We compared the workload of COVID-19 ICU patients with the workload of pneumonia patients from a recent non-COVID period. We also compared the workload of non-COVID patients during the COVID-period versus non-pneumonia patients in a recent non-COVID period. Lastly, we compared the workload of COVID-19 ICU patients with other ICU patients during the COVID-period. We finally wanted to assess the cause of possible differences in Nursing Activities Score between the different groups. METHODS Setting We used data from the Dutch National Intensive Care Evaluation (NICE) quality registry. Since 2016 all 80 Dutch ICUs participate in NICE 10 . The NICE quality registry contains a minimal dataset with demographic, physiological and diagnostic patient data, and in- hospital mortality of all admitted ICU patients in all Dutch hospitals. One of the optional modules in the NICE registry is the nursing capacity module with data about nursing workload and the number of fulltime-equivalent nurses per shift. This capacity module is available since 2017. Among the 80 Dutch ICUs participating in the NICE quality registry, eleven Dutch ICUs of eleven distinct hospitals participate in the nursing capacity module since the start in 2017. From the eleven participating ICUs in the capacity module, we included the data of six ICUs as we had to exclude five ICUs due to missing Nursing Activities Score; the nurses in those five ICUs were not able to collect the Nursing Activities Score during the COVID-19 period due to the high workload.