Marga Hoogendoorn

133 Nursing workload systems are not only important for the daily scheduling of ICU nurses but also for the strategic planning over the year. This strategic planning is also based on the Dutch Guideline for Intensive Care, mentioning a nursing formation requirement between 3.5 and 4.2 FTE per bed. For this strategic planning of nursing staff, it is also important to substantiate the formation based on the workload per nurse, for which the NAS per nurse is a good indicator. In the current practice the number of beds and the number of nurses is generally compared among ICUs but based on the findings in our research this should be accompanied with the NAS per nurse. It is important to realize that non-patient related tasks such as resuscitation of patients outside the ICU, coordination tasks or bedside education are not included in the NAS. How and by whom these tasks are performed is different for every hospital and should be considered when using the NAS for strategic planning of the number of full-time equivalent nurses per ICU bed. By assigning patients to the nurses during a shift, it is important to focus on more than only the objective workload as measured with NAS. The perceived workload is influenced by other factors that are worth to consider. Although the NAS should be an important tool for the patient allocation there should also be a focus on the perceived workload, for instance on both the severity of illness of the patient and the presence of student nurses during that shift. By allocating a patient to a student nurse it is important to focus on the patient workload for both the student and the accompanying graduate ICU nurse. Finally, our research has shown that there is an optimum point in the workload from the point of view of nursing satisfaction about the workload. This should be considered when adapting the NAS in the current practice of daily and strategic planning. Insight in nurses’ satisfaction with workload can support decision making regarding planning of nursing staff. In case of a too high or too low nursing workload, the use of NAS enables the ICU- management to adapt to the circumstances. When the workload is too high, additional staff can be deployed in the next shift or, if not available, the number of available beds can be reduced. A low nursing workload gives room for additional tasks or to open more operational beds. Adaptation of the planning to the circumstances also contributes to the retention of highly educated ICU nurse, which is important in a situation of scarcity. The COVID-19 period has shown that in emergency situations with an extreme demand on ICU beds and nursing capacity there is a limit to this flexibility. On the other hand, the COVID-pandemic has also opened doors to new opportunities like the deployment of non-ICU trained staff on the ICU. However, the impact of other tasks like coordination or bedside teaching and the impact of the deployment of other staff on the nursing workload of ICU nurses is still unknown and are not part of the current workload scoring systems.