The Nursing Activities Score Per Nurse Ratio Is Associated With In-Hospital Mortality, Whereas the Patients Per Nurse Ratio Is Not* (original) (raw)

2020, Critical Care Medicine

Objectives: Studies have shown contradicting results on the association of nursing workload and mortality. Most of these studies expressed workload as patients per nurse ratios; however, this does not take into account that some patients require more nursing time than others. Nursing time can be quantified by tools like the Nursing Activities Score. We investigated the association of the Nursing Activities Score per nurse ratio, respectively, the patients per nurse ratio with in-hospital mortality in ICUs. Design: Retrospective analysis of the National Intensive Care Evaluation database. Setting: Fifteen Dutch ICUs. Patients: All ICU patients admitted to and registered ICU nurses working at 15 Dutch ICUs between January 1, 2016, and Jan-uary 1, 2018, were included. The association of mean or day 1 patients per nurse ratio and Nursing Activities Score per nurse ratio with in-hospital mortality was analyzed using logistic regression models. Interventions: None. Measurements and Main Results: Nursing Activities Score per nurse ratio greater than 41 for both mean Nursing Activities Score per nurse ratio as well as Nursing Activities Score per nurse ratio on day 1 were associated with a higher in-hospital mortality (odds ratios, 1.19 and 1.17, respectively). After case-mix adjustment the association between a Nursing Activities Score per nurse ratio greater than 61 for both mean Nursing Activities Score per nurse ratio as well as Nursing Activities Score per nurse ratio on day 1 and in-hospital mortality remained significant (odds ratios, 1.29 and 1.26, respectively). Patients per nurse ratio was not associated with in-hospital mortality. Conclusions: A higher Nursing Activities Score per nurse ratio was associated with higher in-hospital mortality. In contrast, no association was found between patients per nurse ratios and inhospital mortality in the Netherlands. Therefore, we conclude that it is more important to focus on the nursing workload that the patients generate rather than on the number of patients the nurse has to take care of in the ICU. (Crit Care Med 2019; XX:00-00) Key Words: in-hospital mortality; intensive care; nurse-to-patientratio; Nursing Activities Score-to-nurse ratio; nursing activity score; nursing workload C ritically ill patients in ICUs require intensive nursing care and monitoring (1). This is one of the main reasons why ICU care is expensive. In Europe, the costs of ICUs represent approximately 20% of total hospital costs (2). On average, 50% of the budget of the ICU is spend on nursing staff (3). Hence, taking a critical evaluation on how many nurses are actually needed is of great importance from an economical point of view. On the other hand, reducing the number of nurses working at the ICU due to budgetary cuts will increase nursing workload which may have a negative