How Do Nurses Spend Their Time?

Nurses often complain that they spend more time doing paperwork and other administrative tasks than they do caring for patients. As it turns out, they arent exaggerating.

Documentation consumes more than a third of nurses time, followed by care coordination at 20 percent, patient care activities at 19.3 percent, medication administration at 17.2 percent and patient assessment at 7.2 percent, according to a new time-motion study supported by the Robert Wood Johnson Foundation.

It wasnt what you would have hoped, said investigator Marilyn Chow, DNSc, FAAN, vice president of patient care services at Kaiser Permanente in Oakland, California, and program director of the Robert Wood Johnson (RWJ) Executive Nurse Fellows Program. It verified what the staff nurses knew. When nurses hear the findings, they say, Thank goodness someone has actually documented what we suspected.

Chow worked with co-investigator Ann Hendrich, RN, MSN, FAAN, vice president of clinical excellence operations for Ascension Health in St. Louis and a RWJ Executive Nurse Fellow, and colleagues to monitor 767 nurses movements and activities at 36 medical-surgical units in 15 states.

Nurses in the time study arm of the research project carried a PDA that vibrated at 25 random times during a 13-hour shift, reminding them to stop and record whatever activity they were doing. The nurses also wore radio frequency identification tags, tracking their movements. The investigators could watch on a screen where the nurses went.

The data showed that, on the day shift the nurses average distance traveled was 3.4 miles per 10 hours. At night the average was 2.2 miles per 10 hours.

The Robert Wood Johnson Foundation funded the study as part of its ongoing interest in improving quality of care and safety, said Sue Hassmiller, RN, PhD, senior program officer and team leader at the foundation.

This was an extraordinary quantitative study, the largest ever to determine how nurses spend time, Hassmiller said. Its a fascinating study and shows the inefficiencies and ineffectiveness in how we are trying to care for our patients. Its giving us an opportunity to step back and say, Nurses are right, they are not in the rooms as much as they want or need to be.

While not surprised to learn how nurses spend their time, Chow said she did not expect the variance in practice among nurses and how they moved about.

Chow observed a difference from nurse to nurse, not from unit to unit. She attributes it, at least in part, to nurses not learning about the most efficient ways to organize and prioritize while they were in nursing school. The study showed the design of the unit did not affect efficiency.

Nurses are extremely flexible and adaptable, Chow said. She added that, when given the opportunity, nurses can identify time-wasting activities.

Clinicians participating in the RWJF-supported Transforming Care at the Bedside program have already succeeded in suggesting and implementing new processes--such as placing a commode in each room--that resulted in more time with patients.

Kaiser has brought nurses together, along with consultants, to share their techniques for optimizing their time and have outlined a sequence for giving shift reports in the patients rooms.

We all want to find ways to increase time for nurses to care for patients, Chow said. This [study] provides baseline data on how they spend their time.

Chow and others will look for ways to eliminate inefficiencies--for instance, hunting and gathering supplies--so more time can be spent teaching and assessing. The study shows how much time nurses waste in these valueless activities.

This is providing hard data, Hassmiller said. We hope it is a wake-up call for the decision makers.

Sue Hassmiller, RN PhD, hopes nurse executives will use the time-motion study results to determine ways to cut down on inefficiencies.

2008. AMN Healthcare, Inc.