Association Between Nurse-Perceived Patient-Level Workload and Subsequent Nursing Care Time: A Multicenter Prospective Study Across Mixed Inpatient Wards

Background Accurate assessment of nursing care requirements is important for staffing and resource allocation. Available measures capture different dimensions of nursing care, including patient dependency, care complexity, and performed activities. Whether nurses’ prospective patient-specific workload judgments are associated with subsequently recorded nursing care time remains unclear. Methods We conducted a prospective, multicenter, cross-sectional study in 12 wards across five hospitals of the South Tyrol Health Authority, Italy, from September to December 2025. During the morning ward round, a nurse rated the expected workload associated with each enrolled patient using a five-level ordinal scale. Nursing activities delivered to the same patient over the subsequent 24 h were recorded by the nurses providing care. The primary outcome was patient-level recorded nursing care time. High recorded nursing care time was the secondary outcome. Results Among 463 patient-day observations, median recorded nursing care time was 155 min. After adjustment, moderate, high, and extremely high perceived workload were associated with greater nursing care time than the reference category “none.” Each one-category increase in perceived workload was associated with a 38% higher probability of high recorded nursing care time (adjusted risk ratio = 1.38; p = 0.005). However, high perceived workload identified patients above the 75th percentile with a sensitivity of only 45.0% (95% confidence interval 35.4–54.8). Conclusions Nurse-perceived patient-level workload was associated with subsequently recorded nursing care time but had limited sensitivity for identifying patients with the highest care-time requirements. Subjective judgment may therefore provide useful information but should not be used alone for workload estimation or staffing decisions.