Abstract:
Abstract
Context: Nurses are the primary hospital caregivers. Increasing
the effi ciency and effectiveness of nursing care is essential to
hospital function and the delivery of safe patient care.
Objective: We undertook a time and motion study to document
how nurses spend their time. The goal was to identify drivers of
ineffi ciency in nursing work processes and nursing unit design.
Design: Nurses from 36 medical-surgical units were invited to
participate in research protocols designed to assess how nurses
spend their time, nurse location and movement, and nurse physiologic
response.
Main Outcome Measures: Nurses’ time was divided into
categories of activities (nursing practice, unit-related functions,
nonclinical activities, and waste) and locations (patient room,
nurse station, on-unit, off-unit). Total distance traveled and energy
expenditure were assessed. Distance traveled was evaluated
across types of unit design.
Results: A total of 767 nurses participated. More than threequarters
of all reported time was devoted to nursing practice.
Three subcategories accounted for most of nursing practice time:
documentation (35.3%; 147.5 minutes), medication administration
(17.2%; 72 minutes), and care coordination (20.6%; 86
minutes). Patient care activities accounted for 19.3% (81 minutes)
of nursing practice time, and only 7.2% (31 minutes) of nursing
practice time was considered to be used for patient assessment
and reading of vital signs.
Conclusion: The time and motion study identifi ed three main
targets for improving the effi ciency of nursing care: documentation,
medication administration, and care coordination. Changes
in technology, work processes, and unit organization and design
may allow for substantial improvements in the use of nurses
