NEMS (Nine Equivalents of Nursing Manpower Use)
NEMS, the Nine Equivalents of Nursing Manpower Use Score (Reis Miranda and colleagues 1997), scoring 0 to 56.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Ventilatory support
- Mechanical ventilatory support: any form of mechanical or assisted…
- Vasoactive or inotropic support
- A single vasoactive or inotropic drug, continuously intravenous
- Basic monitoring
- Yes
- Intravenous medication
- Yes
- Dialysis techniques
- No
- Specific interventions IN the ICU
- No
- Specific interventions OUTSIDE the ICU
- No
Result: NEMS 34 of 56.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Exclusive pairs
- Mechanical ventilation excludes supplementary care; multiple vasoactive replaces single. Each is one choice, not two items.
- Maximum 56
- Reachable only by taking one item from each exclusive pair. A naive sum of all nine gives 66.
- Routine care
- Interventions in the ICU exclude routine radiographs, echocardiograms, ECGs, dressings, and line insertion.
- Axis
- Nursing workload consumed, not illness severity. Not a mortality predictor and not a nurse-to-patient ratio.
What you enter
- Ventilatory support - ONE choice, because mechanical support and supplementary care are mutually exclusive
- Vasoactive or inotropic support - ONE choice, because multiple replaces single rather than adding to it
- Basic monitoring: hourly vital signs, regular record and calculation of fluid balance
- Intravenous medication, bolus or continuous — NOT including vasoactive or inotropic drugs, which are scored separately
- Dialysis techniques (all)
- Specific interventions IN the ICU: intubation, pacemaker insertion, cardioversion, endoscopy, emergency operation in the past 24 hours, gastric lavage.
- Specific interventions OUTSIDE the ICU: a surgical or diagnostic procedure related to the severity of illness, making extra demand on ICU manpower
Full field descriptions
- Ventilatory support - ONE choice, because mechanical support and supplementary care are mutually exclusive [none = Neither (0); supplementary = Supplementary ventilatory care: breathing spontaneously through an endotracheal tube, or supplementary oxygen by any method (3); mechanical = Mechanical ventilatory support: any form of mechanical or assisted ventilation for 2 hours or more in the shift. This EXCLUDES supplementary ventilatory care rather than adding to it. (12)]
- Vasoactive or inotropic support - ONE choice, because multiple replaces single rather than adding to it [none = None (0); single = A single vasoactive or inotropic drug, continuously intravenous (7); multiple = More than one vasoactive or inotropic drug, regardless of type and dose, continuously intravenous. This REPLACES the single-drug score rather than adding to it. (12)]
- Basic monitoring: hourly vital signs, regular record and calculation of fluid balance [yes = 9; no = 0]
- Intravenous medication, bolus or continuous — NOT including vasoactive or inotropic drugs, which are scored separately [yes = 6; no = 0]
- Dialysis techniques (all) [yes = 6; no = 0]
- Specific interventions IN the ICU: intubation, pacemaker insertion, cardioversion, endoscopy, emergency operation in the past 24 hours, gastric lavage. Routine radiographs, echocardiograms, ECGs, dressings, and venous or arterial line insertion do NOT count. [yes = 5; no = 0]
- Specific interventions OUTSIDE the ICU: a surgical or diagnostic procedure related to the severity of illness, making extra demand on ICU manpower [yes = 6; no = 0]
How this is calculated
- Weights
- Basic monitoring 9, IV medication 6, mechanical ventilation 12, supplementary ventilatory care 3, single vasoactive 7, multiple vasoactive 12, dialysis 6, interventions in ICU 5, outside ICU 6.
Reis Miranda D, Moreno R, Iapichino G. Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med. 1997;23(7):760-765. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.