Document Type : Original Article


1 College of Nursing, AIIMS, Rishikesh, Uttarakhand, India

2 College of Nursing, AIIMS, Jodhpur, Rajasthan, India


BACKGROUND: The safety of patients remain at risk due to a higher workload and lower
nurse‑to‑patient ratio. However, in India, most hospitals still adhere to long‑known nurse staffing
norms set by their statutory or accreditation bodies. Therefore, the present study was undertaken
to recommend a standard workload‑based estimation of nursing manpower requirement in the ICU
of a tertiary care teaching hospital.
MATERIALS AND METHODS: It was a descriptive, observational, time and motion study was
conducted in the medicine ICU of a tertiary care teaching hospital. Data collection was done by using
demographic and clinical profile sheet of patients, NPDS‑H dependency assessment scale, time and
activities record sheet, and WHO WISN tool. The nurses’ activities were observed by nonparticipatory and
non‑concealment technique. Data analysis was done using descriptive statistics and the WHO WISN tool.
RESULTS: The bed occupancy rate and the average length of stay in the medicine ICU were 93.23%
and 7.18 days respectively. Distribution of dependency level of the medical ICU patients was very
high (41.67%), low‑high (33.33%), and medium‑high (25.0%) dependency level. Considering available
resources and workload in tertiary care hospitals in India, the study recommended a nurse‑to‑patient
ratio of 1:1.2 in each shift for the medicine ICU of a tertiary care hospital.
CONCLUSION: The study suggested minimum nurse-to-patient ratio in medical ICU should be
1:1.2 with provision of power to ICU incharge nurse to allocate nurses according to the workload in
different shifts. Also, nurse staffing norms in hospitals need to be estimated or selected with serious
consideration of health care demands when employing nurse staffing norms.


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