Last update:
15-Jul-2026

OBJECTIVE Το investigate the nursing workload in intensive care units (ICUs) and its impact on the quality of care, patient safety, and the physical and psychological health of nurses.

METHOD In a sample of 68 ICU patients admitted to a general hospital, workload was measured using the TISS-28 scale. Disease severity and patient outcomes were assessed with APACHE II and IV scores. Additionally, semi-structured interviews were conducted with nurses regarding their workload.

RESULTS The mean APACHE II score was 23.41 (standard deviation [SD]=8.72), and APACHE IV was 73.94 (SD=23.64). The predicted length of stay (APACHE IV) was 6.4 days, while the actual stay ranged from 1 to 143 days, with a mean of 10.85 (SD=20.12). The mean TISS-28 scores were 46.15 for the morning shift (7:00–15:00), 43.33 for the evening shift (15:00–23:00), and 41.94 for the night shift (23:00–7:00), with statistically significant differences (p<0.001). These findings showed that patients were critically ill, with high APACHE scores and correspondingly increased nursing workload. The heaviest burden occurred during the morning shift, highlighting the need for improved staffing planning and reinforcement during peak hours. Regression analysis indicated that patients with higher APACHE II and IV scores had higher workload (TISS-28), greater estimated mortality, and longer ICU stays. Qualitative data revealed that increased workload negatively affected nurses' performance, raised the risk of errors, and had a negative impact on their psychological well-being.

CONCLUSIONS Higher APACHE and TISS-28 scores were associated with increased mortality rates and prolonged ICU stays. Factors such as age, pathophysiology, need for mechanical ventilation, and albumin and creatinine levels significantly influenced these indices.

Key words: APACHE II, ICU, Nurses, TISS-28, Workload.