Marga Hoogendoorn

135 data due to the impact of the COVID-pandemic on those ICUs. The impact of the high workload on the registration shows the limitation of the current way of data collection on nursing workload in some ICUs. Especially when the workload is high the registration is too time consuming to be performed manually and of course subordinate to patient care. This shows the importance of automated extraction of data on nursing workload from the Electronic Patient Record. Automated extraction reduces the workload of the registration itself. This automated extraction can also increase the quality of the data, which is important given that some studies showed various and sometimes disappointing results of the interrater reliability of the NAS. However, NAS also contains items with an estimated time the nurse needed for that specific intervention, e.g. hours of bedside activities (hourly vital signs; present and active for 2 hours or more; present and active for 4 hours or more). The registration of the nursing workload should therefore always to a small extent be supplemented and validated or approved by the ICU nurse. Finally, our research showed that it is important to focus on both the objective nursing workload and the perceived nursing workload. However, the existing registry does not consist of items to measure the perceived nursing workload like the NASA-TLX. Keeping the workload of registration of extra items in mind, it should be considered to measure the perceived workload and the satisfaction of nurses about the workload not on daily basis, but on a regular basis, for instance, by one week of data collection once or twice a year or during extreme situations like the COVID-pandemic. 7. 5 RECOMMENDAT I ONS AND NEW RESEARCH QUEST I ONS It is important to focus on a continuous validation and recalibration of the NAS. Our research showed that the NAS is currently the best instrument for measuring nursing workload, but the findings of our validation also showed that a revision of the estimated time per intervention is necessary. Further validation of the NAS with time-and-motion techniques will give a more accurate insight in the objective nursing workload. This validation can also lead to broader adaptation of the NAS. We already made a first effort in this direction with a recalibrated version of existing scoring systems; the Nurse Operation Workload (NOW). The NOW includes a selection of items from NAS and TISS nursing activities and a recalibration of time per item 13 . Beside the validation of the NAS points per nurse it is also important to quantify and validate the necessary nursing time needed for indirect patient care or additional nursing tasks like resuscitation outside the ICU or coordinating tasks during a shift. It is worth considering the deployment of non-