Comparison of scoring systems for measuring nursing workload in intensive care units (ICUs)

In the last decade, there has been an increasing interest in ICUs in using scoring systems for the measurement of nursing workload in order to improve the quality of care. Aim: This paper aims to a comparative literature review study of four widely applied scoring systems for the measurement of nursing workload: [TISS­28 (Therapeutic Intervention Scoring System­28), NEMS (Nine Equivalents of nursing Manpower use Score), NAS (Nursing Activities Score), CNIS (Comprehensive Nursing Intervention Score)]. TISS­28, comprised by 28 nursing activities, scores nursing workload in ICU in relation to the severity on illness of patients, describing a selected set of nursing activities in relation to therapeutic intervention. NEMS, based on TISS­28, itemizes only nine nursing activities, and is considered as a suitable, valid and reliable therapeutic index to measure nursing workload, as TISS­28. NAS, enhanced with items that relate to patient care but not included in TISS­28, takes into consideration the time consumption of nursing activities, independently of the severity of illness of the recipients of care. CNIS, as a measure of the comprehensive nursing workload, takes into consideration time consumption, number of nurses required, job intensity (or concentration), mental stress, muscular exertion and special skills required. Conclusions: The study showed that all scoring systems measure nursing workload in a satisfied way, as well as, could be used for ICU’s staffing. CNIS seems more comprehensive, possesses a much higher potential, and assesses the multifaceted nursing workload optimizing job schedule or staff assignment. The application of these four scoring systems in Greek Health System could be feasible, only if nursing interventions are officially computerized and hospital informative systems are placed in operation.