A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time

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