Marga Hoogendoorn

132 showed for example that a NAS per nurse >61 was associated with an increased mortality risk of the patient 10 . When using an optimum NAS per nurse for planning of nursing staff, it is necessary to develop an evidence-based recommendation on broader knowledge than only the satisfaction of nurses but also take outcome of the patient and health care budgets into account. Further research should therefore focus on the association between an optimum NAS per nurse and quality of patient care. 7. 3 IMPL I CAT I ONS OF THE F I ND I NGS The findings of our research are important for planning ICU nursing staff. By using the NAS, it is possible to weigh the combined workload that the patients compose in NAS- points against the available number of nurses per shift in NAS-points. This enables the ICU management to substantiate the workload per nurse on an ICU. Until nowNAS has shown to be the best available and most used instrument for measuring nursing workload and the translation to the need for nursing staff. Considerations about the reliability of the items in NAS with an estimation of time can be overcome by recalibration and adaptation of NAS to the current practice to improve the performance. Therefore, we still recommend the use of (an improved) NAS for measuring nursing workload and planning of nursing staff. The use of NAS per nurse leads to a more objective weighed comparison of both the nursing capacity and the average amount of work required for patient care. The findings of our research are therefore important for the daily practice of patient allocation to the nurses on the ICU at the start of a shift. Looking at the current practice of planning nursing staff, the focus is usually on the number of patients per nurse. The Dutch Guideline for Intensive Care mentions a maximum number of 1.5 to 2 patients per nurse depending on day shift, evening shift, or night shift 11 . However, in this guideline the workload required for a patient is not considered when assigning the number of patients per nurse. Previous research showed that it is more important to focus on the workload per nurse than on the number of patients per nurse 10 . It is therefore recommended to base the patient allocation not only on the number of patients but also on the total NAS per nurse. Subsequently, it can lead to a deviation from the maximum number of patients per nurse as mentioned in the guidelines in case of a very low nursing workload. Based on a very high nursing workload the ICU-management can substantiate decisions regarding reducing bed capacity or extra nursing staff.