Factors associated with nursing workload in three intensive care units

An analytical cross-sectional study was carried out in three ICUs in Bucaramanga, Colombia, between February 2018 and February 2020. The nursing workload was estimated based on the NAS. A descriptive and bivariate analysis stratified by ICU was performed using a robust multiple linear regression model, and the factors associated with the nursing workload (p < 0.05) were estimated.

Results:

In this study, 362 records were included. The median NAS was 68.1 points (Q1:47.2–Q3:116.7). APACHE II (β = 3.13, CI: 95% 2.28; 3.98), days of stay in ICU ≥3 (β = 16.78, CI: 95% 6.15; 27.41), surgery provenance service (β = 22.31, CI: 95% 9.76; 34.86), and traumatology and emergencies diagnostic category (β = 33.72, CI 95%: 9.90; 57.53) were associated with high NAS scores.

Conclusion:

The nursing staff spend approximately 70% of their time on a single patient, and administrative work takes up most of their time. Hospital stays of longer than 3 days, high APACHE II score, coming from the surgery department, and having a diagnosis of trauma and emergency were associated with a high workload.

DESCRIPTORS
Workload; Critical Care Nursing; Intensive Care Units

Characteristics	All		ICU 1		ICU 2		ICU 3		p-value¥
Characteristics	n	% or Median (Q1–Q3)	n	% or Median (Q1–Q3)	n	% or Median (Q1–Q3)	n	% or Median (Q1–Q3)	p-value¥
Age, years	362	64.50(53.00–73.00)	234	64.00(53.00–73.00)	81	68.00(57.00–77.00)	47	59.00(45.00–72.00)	0.029
Gender
Female	136	37.99	85	36.48	34	43.59	17	36.17	0.514
Male	222	62.01	148	63.52	44	56.42	30	63.83
Marital status
Single	89	24.93	63	27.04	7	9.09	19	40.43
Married	149	41.74	92	39.48	39	50.65	18	38.30
Cohabiting	48	13.45	42	18.03	3	3.90	3	6.38	<0.001
Divorced	24	6.72	10	4.49	13	16.88	1	2.13
Widowed	47	13.17	26	11.16	15	19.48	6	12.77
Socioeconomic level
Low	191	53.06	146	62.39	34	42.50	11	23.91
Medium	165	45.83	88	37.61	46	57.50	31	67.39	<0.001
High	4	1.11	0	0.00	0	0.00	4	8.70
Occupation
None	139	39.04	74	31.90	42	54.55	23	48.94
Student	6	1.69	5	2.16	1	1.30	0	0.00
Employee	106	29.78	87	37.50	11	14.29	8	17.02
Self-employed	67	18.82	46	19.83	11	14.29	10	21.28	<0.001
Unemployed	7	1.97	4	1.72	0	0.00	3	6.38
Pensioner/Retiree	31	8.71	16	6.90	12	15.58	3	6.38
Service of origin
Emergencies	145	40.17	95	40.77	40	49.38	10	21.28
Surgery	83	22.99	73	31.33	8	9.88	2	4.26
Hospitalization	45	12.47	30	12.88	5	6.17	10	21.28	<0.001
Remission	56	15.51	16	6.87	22	27.16	18	38.83
Others	32	8.86	19	8.15	6	7.41	7	14.89
Patient discharge destination
Morgue	71	20.47	45	20.83	10	12.50	16	34.78
Home	35	10.53	15	6.94	19	23.75	1	2.17
Hospitalization	224	65.50	149	68.98	49	61.25	26	56.52	<0.001
Transfer	12	3.51	7	3.24	2	2.50	3	6.52
Disease category
Circulatory	152	41.99	98	41.88	47	58.02	7	14.89
Respiratory	62	17.23	49	20.94	3	3.70	10	21.28
Central Nervous System	45	12.43	32	13.68	6	7.41	7	14.89
Infectious	42	11.60	19	8.12	13	16.05	10	21.28	<0.001
Gastrointestinal	18	4.97	11	4.70	4	4.94	3	6.38
Metabolic	18	4.97	8	3.42	7	8.64	3	6.38
Renal	8	2.21	8	3.42	0	0.00	0	0.00
Connective tissue	7	1.93	6	2.56	0	0.00	1	2.13
Trauma	5	1.38	0	0.00	0	0.00	5	10.64
Psychiatric	2	0.55	1	0.43	1	1.23	0	0.00
Obstetrics	2	0.55	2	0.85	0	0.00	0	0.00
Intoxication	1	0.28	0	0.00	0	0.00	1	2.13
Days of stay in ICU	357	3.00(2.00–7.00)	234	2.00(2.00–4.00)	77	5.00(3.00–9.00)	46	11.50(7.00–17.00)	<0.001
Mortality, YES	66	21.93	46	21.30	4	10.53	16	34.04	0.031
APACHE II SOFA	307	16.00 (10.00–22.00)	234	16.00 (16.00–20.00)	73	17 (12.00–24.00)	0		0.017
Total patients	361	10.00 (8.00–11.00)	234	9.00 (8.00–11.00)	80	11.00 (10.00–15.50)	47	14.00 (13.00–14.00)	<0.001
Nurses at the time of assessment	361	4.00 (3.00–5.00)	234	4.00 (3.00–5.00)	80	3.00 (2.00–4.00)	47	4.00 (4.00–4.00)	<0.001
Percentage of occupancy	319	0.90 (0.75–1.00)	234	0.91 (0.73–1.00)	38	0.90 (0.82–1.00)	47	1.00 (0.85–1.00)	0.208

Characteristic	All	ICU 1	ICU 2	ICU 3	p-valueⱡ
Characteristic	Median (Q1–Q3)	Median (Q1–Q3)	Median (Q1–Q3)	Median (Q1–Q3)	p-valueⱡ
General NAS	68.1 (47.2–116.7)	64.2 (46–115.3)	102.0 (60.90–152.7)	60.85 (51.8–68.25)	0.001
Administrative and organizational tasks	27.40 (4.20–27.4.0)	27.40 (27.40–27.40)	4.20 (4.20–27.40)	4.20 (4.20–4.20)	0.001
Monitoring and control	16.60 (0–16.6)	4.50 (0.00–16.60)	16.60 (16.60–36.20)	16.60 (16.60–20.15)	0.001
Mobilization and postural changes	12.40 (0.00–17.90)	5.50 (0.00–17.90)	17.90 (5.50–34.90)	12.40 (5.50–12.40)	0.001
Renal support	7.00 (0.00–7.00)	0.00 (0.00–7.00)	7.00 (0.00–7.00)	7.00 (7.00–7.30)	0.001
Medication administration	5.6.0 (5.60–5.60)	5.60 (5.60–5.60)	5.60 (5.60–5.60)	5.60 (5.60–5.60)	0.001
Laboratory procedure	4.30 (4.30–4.30)	4.30 (4.30–4.30)	4.30 (4.30–4.30)	2.15 (2.10–4.30)	0.001
Hygiene interventions	4.10 (0.00–20.60)	4.10 (0.00–20.60)	20.60 (4.10–20.60)	4.10 (2.05–4.10)	0.001
Support and care of family members or patients	4.00 (0.00–4.00)	4.00 (0.00–4.00)	4.00 (4.00–4.00)	0.00 (0.00–2.00)	0.001
Specific interventions	1.90 (0.00–2.80)	1.90 (0.00–2.80)	1.90 (0.00–2.80)	0.00 (0.00–0.90)	0.001
Ventilatory support	1.40 (0.00–7.60)	1.40 (0.00–5.80)	4.40 (0.00–7.60)	2.30 (1.40–5.40)	0.002
Cardiovascular support	1.20 (0.00–3.70)	1.20 (0.00–2.50)	2.50 (0.00–3.70)	1.20 (0.60–2.45)	0.003
Drainage care	0.00 (0.00–0.00)	0.00 (0.00–1.80)	0.00 (0.00–0.00)	0.00 (0.00–0.90)	0.429
Neurological support	0.00 (0.00–0.00)	0.00 (0.00–000)	0.00 (0.00–0.00)	0.00 (0.00–0.00)	0.265
Metabolic support	0.00 (0.00–1.30)	0.00 (0.0–1.3)	0.00 (0.0–1.30)	1.30 (1.30–2.80)	0.001

Nursing Activities Score (NAS)	Simple models: Raw effects			Final model (R2: 42.48) (n:297) ¥¥
Nursing Activities Score (NAS)	β	CI 95%	p¥ Value	β	CI 95%	p Value*
Age, years	0.01	(–0.32; 0.34)	0.995	–0.31	(–0.64; 0.025)	0.070
β0: 86.42	R2 = 50.19ⱡ	(65.32; 107.52)	0.000
Gender	Reference: Female
Gender (male)	0.65	(–10.38; 11.68)	0.908	6.98	(–3.06; 17.04)	0.172
β0: 86.44	R2 = 50.30	(77.44; 95.44)	0.000
Service of provenance	Reference: Emergency Department
Surgery	13.59	(–0.08; 27.26)	0.051	22.31	(9.76; 34.86)	0.001
Hospitalization	8.24	(–8.65; 25.15)	0.338	11.65	(–8.37;31.68)	0.253
Remission	3.27	(–11.71; 18.27)	0.667	–4.10	(–18.41; 10.19)	0.572
Others	4.66	(–15.85; 25.18)	0.655	19.79	(–2.19; 41.78)	0.007
β0: 81.70	R2 = 49.93	(73.94; 89.46)	0.000
Diagnostic category	Reference: Metabolic–Infectious
Metabolic sphere	–11.70	(–32.25; 8.86)	0.264	–3.10	(–23.83; 17.63)	0.769
Cardiovascular	–19.41	(–34.22; –4.61)	0.010	–9.93	(–26:53; 6.60)	0.240
Gastrointestinal	12.60	(–17.51; 42.72)	0.411	15.02	(–12.12; 42.17)	0.277
Traumatology and emergencies	2.27	(–26.82; 31.38)	0.878	33.72	(9.90; 57.53)	0.006
β0: 99.71	R2 = 49.37	(86.22; 113.20)	0.000
APACHE II	3.17	(2.44; 3.89)	0.000	3.13	(2.28; 3.98)	0.000
β0: 37.72	R2 = 45.72	(25.69; 49.76)	0.000
Days of stay in ICU	Reference: Days of stay in ICU
≥3 Days of stay in ICU	17.99	(7.30; 28.70)	0.001	16.78	(6.15; 27.41)	0.002
β0: 75.99	R2 = 49.43	(67.39; 84.59)	0.000
Location IPS	Reference ICU 1
UCI 2	24.04	(10.38; 37:70)	0.001	19.27	(3.88; 34.66)	0.014
UCI 3	–23.72	(–30.99; –16.45)	0.000	–	–	–
β0: 84.70	R2 = 48.18	(78:26; 91.14)	0.000

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Diana Isabel Cáceres Rivera, Calle 30 A 33–51, dianai.caceres@ucc.edu.co