title: SwissScoring--a nationwide survey of NEMS assessing practices and its accuracy.
abstract: BACKGROUND
  The nine equivalents of nursing manpower use score (NEMS) is used to evaluate critical care nursing workload and occasionally to define hospital reimbursements. Little is known about the caregivers' accuracy in scoring, about factors affecting this accuracy and how validity of scoring is assured.
  
  
  METHODS
  Accuracy in NEMS scoring of Swiss critical care nurses was assessed using case vignettes. An online survey was performed to assess training and quality control of NEMS scoring and to collect structural and organizational data of participating intensive care units (ICUs). Aggregated structural and procedural data of the Swiss ICU Minimal Data Set were used for matching.
  
  
  RESULTS
  Nursing staff from 64 (82%) of the 78 certified adult ICUs participated in this survey. Training and quality control of scoring shows large variability between ICUs. A total of 1378 nurses scored one out of 20 case vignettes: accuracy ranged from 63.7% (intravenous medications) to 99.1% (basic monitoring). Erroneous scoring (8.7% of all items) was more frequent than omitted scoring (3.2%). Mean NEMS per case was 28.0 ± 11.8 points (reference score: 25.7 ± 14.2 points). Mean bias was 2.8 points (95% confidence interval: 1.0-4.7); scores below 37.1 points were generally overestimated. Data from units with a greater nursing management staff showed a higher bias.
  
  
  CONCLUSIONS
  Overall, nurses assess the NEMS score within a clinically acceptable range. Lower scores are generally overestimated. Inaccurate assessment was associated with a greater size of the nursing management staff. Swiss head nurses consider themselves motivated to assure appropriate scoring and its validation.
authors.affiliation: Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale San Giovanni, Bellinzona, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Perren
authors.forename: B
authors.initials: B
authors.lastname: Cerutti
authors.forename: P
authors.initials: P
authors.lastname: Merlani
authors.forename: I
authors.initials: I
authors.lastname: Perren
authors.forename: M
authors.initials: M
authors.lastname: Previsdomini
authors.forename: P
authors.initials: P
authors.lastname: Massarotto
authors.forename: M
authors.initials: M
authors.lastname: Kaufmann
authors.forename: H U
authors.initials: HU
authors.lastname: Rothen
mesh_terms: D000328:Adult; D003422:Critical Care / Q000592:standards / Q000706:statistics & numerical data; D003625:Data Collection; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data / Q000600:supply & distribution*; D009741:Nursing Staff, Hospital; D011785:Quality Assurance, Health Care; D011786:Quality Control; D017678:Sex Distribution; D013557:Switzerland; D000078329:Workforce