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Seasonal and Regional Variations in Nursing Workload in French Intensive Care Units: A National Study Using the Nursing Activities Score

par Poiroux, Laurent;Blanchard, Pierre‐Yves;Caillet, Anaelle;Bruyneel, Arnaud ;Dauvergne, Jerome E
Référence Journal of nursing management, 2026, 1
Publication Publié, 2026-01

Article révisé par les pairs

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Résumé :

Aim To compare intensive care unit (ICU) nursing workload between spring–summer and winter and to examine factors associated with workload variation across French regions. Background Critical care nursing workload is high and may fluctuate with seasonal demand and regional ICU bed capacity, challenging fixed‐staffing models. Methods Secondary analysis of two nationwide prospective cross‐sectional surveys in French ICUs (April–July 2023; January–March 2024). Workload was measured using the Nursing Activities Score (NAS). Outcomes were NAS per patient, NAS per nurse, and NAS per nurse > 100%. ICU‐level linear mixed models assessed associations with season and regional ICU bed availability (below, versus, at, or above the national mean), adjusting for ICU characteristics. Results Forty‐three ICUs contributed 2703 nurses and 18,772 patient NAS assessments (8759 NAS per‐nurse observations). At the individual level, median NAS per nurse was lower in spring−summer than in winter (124.3% vs. 127.1%; p value = 0.043), whereas NAS per patient was higher in spring−summer (61.3% vs. 59.4%; p < 0.001). The proportion of shifts with NAS per nurse > 100% was higher in winter (69.3% vs. 67.3%; p  = 0.044), and the patient‐to‐nurse ratio was higher (2.06 ± 0.7 vs. 1.96 ± 0.7; p < 0.001). ICUs in regions with fewer ICU beds consistently showed higher NAS per nurse across seasons. In multivariable models, winter (β = 4.5, 95% CI: 2.3–6.7) and residence in under‐resourced regions (β = 19.2, 95% CI: 5.9–32.5) were associated with higher NAS per nurse. Conclusions ICU nursing workload varies by season and regional ICU bed capacity; baseline workload frequently exceeds 100%, limiting surge adaptability and exposing limits of fixed‐staffing ratios. Implications for Nursing Management Nurse managers may rely on objective and longitudinal workload information to support sustainable decision‐making in intensive care. Embedding indicators such as the NAS into staffing policies may facilitate anticipatory planning, reduce reactive staffing responses, and support patient safety and workforce stability.