Development of a comprehensive scoring system to measure multifaceted nursing workloads in ICU.

A new scoring system, the comprehensive nursing intervention score (CNIS), was developed to quantify the overall workload of diverse nursing activities in the intensive care unit (ICU). A total of 88 nursing items were listed. With the cooperation of 20 skilled ICU nurses, a three-round Delphi survey was conducted to assign a four-grade workload score to each item from five aspects: number of nurses required, muscular exertion, mental stress, skill, and intensity. After the survey, 15 unnecessary items were deleted. Appropriateness of the assigned scores was confirmed by surveying 118 nurses in other ICU. Within-individual reproducibility, examined in 44 nurses, was summarized as a mean kappa-coefficient of 0.65. Time required for each job was recorded and added as the sixth aspect of the workload. Thus, final CNIS gave six subscores (0-3) plus one overall score (3-18) to each of the 73 job items. The CNIS was confirmed as truly representing overall nursing workload by applying it to the daily care of 107 patients.