Nurse Staffing Levels: Skill Mix and Nursing Care Hours Per Patient Day

  • Alberto LucchiniEmail author
  • Michele Pirovano
  • Christian De Felippis
  • Irene Comisso


There is evidence that nursing workload is associated with the quality of patient care and the health of workers. Workloads and resource allocation can be measured by scoring systems. To provide a real-time assessment of nurse allocation and workloads, the Nursing Activities Score (NAS) was developed as a means to measure patient care. The items examine specific activities: patient monitoring, medication, hygiene procedures, care of drains, patient mobilization and positioning, admission and discharge procedures, administrative and managerial tasks, research activity and renal, invasive and non invasive ventilation, cardiovascular, metabolic and nutritional support. There is also the possibility to weigh those specific interventions in intensive care which are the exclusive competence of nurses. The authors maintain that the score wholly reflects 81% of nursing time. The remaining 19% comes from nursing activities deriving from medical interventions, related exclusively to the severity of illness of the patient. NAS was created in order to better define nursing activities in relation to continuous patient monitoring, performing hygiene procedures, mobilization procedures, data handling and caring for relatives. The appropriate application of NAS will support the taking up of real measures in response to the working demands of nurses and will allow for improved investment in human and material resources at the ICU.


Nursing workload NAS Staffing ICU 



Accident & emergency department


Cardiosurgical intensive care unit


General intensive care unit


Medical intensive care unit


Nurse-to-patient ratio


Nursing activities score


Neurosurgical general intensive care unit


Pediatric intensive care unit


Simplified acute physiology score


Sequential organ dysfunction score


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alberto Lucchini
    • 1
    Email author
  • Michele Pirovano
    • 2
  • Christian De Felippis
    • 3
  • Irene Comisso
    • 4
  1. 1.General Intensive Care UnitSan Gerardo Hospital, ASST Monza, University of Milano-BicoccaMilanItaly
  2. 2.AREU Regional Emergency System-ITMilanItaly
  3. 3.Adult Intensive Care Unit, Glenfield HospitalUniversity Hospital of Leicester-NHS TrustLeicesterUK
  4. 4.University Anesthesia and Intensive Care Unit, University Hospital S. Maria della MisericordiaUdineItaly

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