Marga Hoogendoorn

143 positive associations. This should be considered in planning the nursing staff; both a too low and a too high nursing workload should be avoided to keep the job position of an ICU nurse attractive. Chapter 6 focuses on the nursing workload during the COVID-19 pandemic. Data of 3,994 patients and 36,827 different shifts in 6 different hospitals from the nursing capacity module of the National Intensive Care Evaluation (NICE) registry were used to describe differences in the planning of nursing staff on the ICU in the COVID-period compared to a recent non-COVID-period. Patient data and NAS-data from this registry were used to describe differences in nursing workload in COVID-19 patients, non-COVID pneumonia patients and other patients in Intensive Care. The results of this study showed both a significant higher number of patients per nurse and a significant higher NAS per nurse in the COVID-period compared to the non-COVID period. The higher workload per nurse could be explained by the higher workload of COVID-19 patients, the increase of the proportion of COVID-19 patients and their long length of stay on the ICU. The significant higher NAS of COVID-19 patients compared to non-COVID patients with pneumonia or other non-COVID patients was mainly caused by more intense hygienic procedures, mobilization and positioning, support and care for relatives and respiratory care. This study also showed the opportunities of deployment of other nurses in daily care on the ICU nursing workload. Further research should focus on both the possibilities and the impact of deployment of other staff on the nursing workload. The NAS is currently the most used system for measuring nursing workload and planning of nursing staff. However, the NAS is somewhat outdated and overestimates the nursing workload. For this reason, we recommend further recalibration of the NAS. Further research should also focus on finding the optimal nursing workload per nurse. It is therefore important to collect data in a capacity registry of a national database to benchmark data about nursing workload and capacity between different ICUs. Those data could also be used for further validation of an optimum nursing workload and the development of national guidelines about nursing capacity and workload per nurse.