Complexity of care, adequate staffing levels, and workflow are key factors affecting nurses' workloads. There remain notable gaps in the current evidence regarding clinical complexity classification and related staffing adjustment, limiting the capacity for optimal staffing practices. This study aimed to adapt and validate the Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool (WANNNT-SC) for an Italian context to allow the assessment of newborns admitted to NICUs. This was a validation study. To evaluate the reliability of the tool among different professionals, a correlation test was performed using Pearson's correlation, which revealed a strong correlation (r = 0.967, = 0.01). In the test-retest phase, there was a significant correlation (r = 0.910 and = 0.01). Using an analysis of variance, we found that the higher the I-WANNNT-SC score was, the higher the predicted death rate (F = 13.05 and < 0.001). The Italian Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool represents the first tool available for an Italian context that aims to measure the nursing workload in neonatal intensive care. It could allow adjustments in nursing staffing based on NICU activities and patient needs. This study was prospectively approved by the local Ethics Committee "Palermo 1" (Protocol CI-NICU-00).
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