Marga Hoogendoorn

98 Analyzing the subcategories of the NASA-TLX showed a significant increase of the chance of a nurse being satisfied with the workload in the highest quartiles of subcategories ‘mental demand’, ‘physical demand’ and ‘effort’. If the nurse scored a high mental demand (quartile 3) the odds ratio was 2.72 (CI 1.05 – 7.06). If the nurse scored a high physical demand the odds ratio was 5.40 (CI 1.53 – 19.15). In case of a high effort the OR was 2.73 (CI 1.03 – 7.24). D I SCUSS I ON With this study we showed an association between workload satisfaction and the objective and perceived workload of ICU nurses. The fourth quintile of the objective workload, measured by the Nursing Activities Score (between 74-84), was significantly associated with a higher workload satisfaction, this effect was absent in the other and hence also the fifth quintile. This confirms our hypothesis that regarding workload satisfaction there is an optimum in the Nursing Activities Score per nurse. However, the Nursing Activities Score is developed with the suggestion that 1 FTE ICU nurse corresponds with a Nursing Activities Score of 100 17 . This score per nurse was never validated as an optimum score per nurse. In most studies the mean Nursing Activities Score per nurse is lower than the 100 NAS-points per nurse. Moghadam et al. (2020) reported a mean Nursing Activities Score per nurse of 72,84 5 . Earlier research of our research group comparing the COVID-19 ICU patients with non-COVID ICU patients showed a mean Nursing Activities Score per nurse of 46.6 29 . In an observational study about the updated guidelines of the Nursing Activities Score from Padilha et al (2015) in 19 ICUs in seven different countries they found a mean Nursing Activities Score of 72.8 with the lowest mean Nursing Activities Score of 44.5 in Spain and the highest mean Nursing Activities Score of 101.8 in Norway 18 . Our research shows that regarding the workload satisfaction of ICU nurses an optimal Nursing Activities Score per nurse would be around 80. In an earlier study of our group we showed a significant increase in hospital mortality if the Nursing Activities Score per nurse exceeded 78 per nurse 30 . Based on those results we already suggested that one registered ICU nurse should provide no more than a Nursing Activities Score of 78 per shift. Our present results seem to fit with these observations. We also investigated the association of workload satisfaction with the perceived workload. The two highest quintiles of the perceived nursing workload measured by the NASA-TLX were associated with a higher workload satisfaction. This is also represented in 3 of the 6 subscales of the NASA-TLX; the mental and physical demand and the effort. In all three subcategories we found a higher workload satisfaction in the highest but one quintile (score 60 - 70). This implicates that both a perceived under- and over-prestation has an