# A Six-Month Observational Study of Nursing Workload in 14 Latvian Intensive Care Units Using the Nursing Activities Score

## TL;DR

This study found that nursing workload in Latvian ICUs is consistently high and unevenly distributed, with staffing shortages closely linked to workload rather than shift or unit level.

## Contribution

The study provides the first systematic national data on ICU nursing workload in Latvia using the Nursing Activities Score.

## Key findings

- The mean Nursing Activities Score (NAS) was 65.45, equivalent to 15.71 nursing care hours per patient per day.
- Nursing shortages were strongly predicted by NAS values, not by shift type or ICU level.
- Level 2 ICUs showed the highest workload, and staffing levels were inadequate relative to actual care demands.

## Abstract

What are the main findings?
Nursing workload in Latvian ICUs is consistently high, with a mean Nursing Activities Score (NAS) of 65.45 points, corresponding to approximately 15.7 h of nursing care per patient per day.Significant interunit and interlevel variability was identified, with nursing shortages strongly associated with NAS-based workload rather than shift type or ICU level.

Nursing workload in Latvian ICUs is consistently high, with a mean Nursing Activities Score (NAS) of 65.45 points, corresponding to approximately 15.7 h of nursing care per patient per day.

Significant interunit and interlevel variability was identified, with nursing shortages strongly associated with NAS-based workload rather than shift type or ICU level.

What are the implications of the main findings?
Fixed nurse-to-patient ratios are insufficient to reflect real care demands; NAS-based workload measurement should be integrated into routine staffing and workforce planning.Objective workload data provide a robust evidence base for national ICU staffing reforms aimed at improving patient safety and nurse well-being.

Fixed nurse-to-patient ratios are insufficient to reflect real care demands; NAS-based workload measurement should be integrated into routine staffing and workforce planning.

Objective workload data provide a robust evidence base for national ICU staffing reforms aimed at improving patient safety and nurse well-being.

Objectives: Intensive care units (ICUs) are characterised by high care complexity and nursing workload, which directly affects patient safety and staff sustainability. Latvia faces a chronic shortage of nurses, particularly in intensive care, yet systematic national data on nursing workload have been lacking. This study aimed to quantitatively assess nursing workload in Latvian ICUs using the Nursing Activities Score (NAS) and to evaluate its relationship with staffing adequacy. Methods: A prospective, multicentre observational study was conducted over six months (May–November 2025) in 14 Latvian ICUs representing all three levels of intensive care. Nursing workload was measured using the NAS during each 12 h shift. A total of 28,079 complete NAS observations were analysed using descriptive statistics, inferential tests (t-tests, ANOVA), mixed-effects modelling, regression analysis, and time-series forecasting. Results: The mean NAS was 65.45 (SD = 25.76), equivalent to an average of 15.71 nursing care hours per patient per day. Workload remained similarly high during day and night shifts. Significant differences were observed between ICUs and care levels, with level 2 units showing the highest workload. The average nursing shortage rate was 42.6% and was strongly predicted by NAS values (R2 = 0.115), whereas shift type and unit level had minimal explanatory power. Conclusions: ICU nursing workload in Latvia is persistently high and unevenly distributed across units. Staffing levels are not adequately adjusted to actual care demands. Integrating NAS-based workload monitoring into staffing models is essential for evidence-based workforce planning, improving patient safety, and reducing nurse overburdening.