Cerela-Boltunova Olga, Millere Inga
Department of Nursing and Midwifery, Riga Stradiņš University, LV-1067 Riga, Latvia.
Int J Environ Res Public Health. 2025 Sep 17;22(9):1442. doi: 10.3390/ijerph22091442.
Latvia faces one of the lowest nurse-to-population ratios in the EU, resulting in critical staff shortages in intensive care units (ICUs). Nurses frequently care for more patients than recommended, which not only compromises patient safety but also places heavy psycho-emotional burdens on staff. The aim of this study was to examine organizational-level relationships between objectively measured ICU nursing workload and subjectively reported psycho-emotional outcomes, including moral distress, burnout, and intention to leave one's job. A secondary analysis combined data from two cross-sectional studies conducted in 2025. Workload was measured using 3420 Nursing Activities Score (NAS) protocols from three hospitals, while 155 ICU nurses from 16 units completed validated instruments assessing moral distress, burnout, and turnover intentions. The findings revealed persistent nurse shortages, with one ICU showing deficits exceeding 70% and mean NASs above 100 points per nurse per shift. Nurses reported moderate moral distress, particularly in situations of unsafe patient ratios and aggressive treatment, while burnout levels were moderate to high, especially in personal and work-related dimensions. About one-quarter of respondents were actively considering leaving their jobs. Moral distress significantly correlated with burnout (r = 0.357, < 0.001), and organizational-level comparison indicated that higher workload was associated with greater emotional strain. These results not only highlight urgent national challenges but also resonate with international evidence on the link between unsafe staffing, moral distress, and workforce sustainability. Implementing systematic workload monitoring, safe staffing ratios, and structured support mechanisms is essential to safeguard ICU nurses' well-being, reduce turnover, and protect patient safety in both Latvian and global contexts.
拉脱维亚面临着欧盟中护士与人口比例最低的情况之一，这导致重症监护病房（ICU）严重缺乏工作人员。护士经常护理的患者数量超过建议数量，这不仅危及患者安全，还给工作人员带来沉重的心理情感负担。本研究的目的是探讨客观测量的ICU护理工作量与主观报告的心理情感结果之间的组织层面关系，包括道德困扰、职业倦怠和离职意愿。二次分析结合了2025年进行的两项横断面研究的数据。使用来自三家医院的3420份护理活动评分（NAS）协议来测量工作量，而来自16个科室的155名ICU护士完成了评估道德困扰、职业倦怠和离职意愿的有效工具。研究结果显示护士持续短缺，一个ICU的短缺率超过70%，每位护士每班的平均NAS超过100分。护士报告了中度的道德困扰，特别是在患者比例不安全和积极治疗的情况下，而职业倦怠水平为中度到高度，尤其是在个人和与工作相关的方面。约四分之一的受访者正在积极考虑离职。道德困扰与职业倦怠显著相关（r = 0.357，<0.001），组织层面的比较表明，工作量越大，情感压力越大。这些结果不仅凸显了拉脱维亚面临的紧迫挑战，也与关于不安全人员配备、道德困扰和劳动力可持续性之间联系的国际证据相呼应。实施系统的工作量监测、安全的人员配备比例和结构化的支持机制对于保障拉脱维亚和全球背景下ICU护士的福祉、减少人员流失以及保护患者安全至关重要。
