Dauvergne Jérôme E, Bruyneel Arnaud, Caillet Anaëlle, Caillet Pascal, Keriven-Dessomme Brigitte, Tack Jérôme, Rozec Bertrand, Poiroux Laurent
Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care, Laënnec Hospital, F-44000 Nantes, France; Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, F-44000 Nantes, France.
Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
Intensive Crit Care Nurs. 2025 Apr;87:103866. doi: 10.1016/j.iccn.2024.103866. Epub 2024 Oct 30.
Within French intensive care units (ICUs), patients are treated with two levels of care (intensive or intermediate) with different nurse-to-patient ratios legally defined.
We aimed to compare the nursing workload associated with these two levels of care.
A nationwide prospective observational study was conducted in France between April and July 2023. Each ICU was allowed to choose its own two-week period of data collection during which the Nursing Activities Score was collected by nurses at patients' bedside, during each shift. The Nursing Activities Score ranges from 20 to 177% and a 100% score represents a nurse per shift. The number of patients per nurse was collected and the Nursing Activities Score per nurse was assessed.
One hundred and five ICUs participated. Overall, 21,665 measurements of Nursing Activities Score per patient and 9,885 Nursing Activities Score per nurse were collected. ICUs were composed by 2083 beds distributed into 1520 (73 %) intensive care beds and 563 (27 %) intermediate care beds. Among the participating units, 93 (89 %) of the teams worked in 2 shifts. Median [p25-p75] Nursing Activities Score per adult patient was 61 % [49-80] for intensive care patients and 47 % [38-61] for intermediate care patients (p < 0.001). Median Nursing Activities Score per nurse for adult population was 127 % [92-167], 143 % [92-198], and 164 % [126-213] for nurses only providing intensive care, only intermediate care or both levels of care, respectively (p < 0.001). A Nursing Activities Score per nurse value >100 % was observed in 71.4 %.
Nurses' workload was high in the ICU, especially when providing intermediate or mixed levels of care.
In order to reduce nurses' workload, a review of the nurse-to-patient ratios is expected. Physically separating the two levels of care may be a valuable option.
在法国重症监护病房（ICU）中，患者接受两种护理级别（重症或中级）的治疗，法律规定了不同的护士与患者配比。
我们旨在比较这两种护理级别相关的护理工作量。
2023年4月至7月在法国进行了一项全国性前瞻性观察研究。每个ICU可自行选择为期两周的数据收集期，在此期间，护士在每个班次于患者床边收集护理活动评分。护理活动评分范围为20%至177%，100%的评分代表每班一名护士。收集了每位护士护理的患者数量，并评估了每位护士的护理活动评分。
105个ICU参与了研究。总体而言，共收集了21665次每位患者的护理活动评分测量值以及9885次每位护士的护理活动评分。ICU共有2083张床位，其中1520张（73%）为重症监护床位，563张（27%）为中级护理床位。在参与的单位中，93个（89%）团队实行两班制。重症监护患者每位成年患者的护理活动评分中位数[p25 - p75]为61%[49 - 80]，中级护理患者为47%[38 - 61]（p < 0.001）。仅提供重症护理、仅提供中级护理或提供两种护理级别的护士，其护理成年患者的护理活动评分中位数分别为127%[92 - 167]、143%[92 - 198]和164%[126 - 213]（p < 0.001）。71.4%的护士护理活动评分值>100%。
ICU护士的工作量很大，尤其是在提供中级护理或混合护理级别时。
为了减轻护士的工作量，预计需要对护士与患者配比进行审查。将两种护理级别进行物理分隔可能是一个有价值的选择。
