How much time do nurses have for patients? a longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals

Abstract

BackgroundTime nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks. We aimed to quantify how nurses distribute their time across tasks, with patients, in individual tasks, and engagement with other health care providers; and how work patterns changed over a two year period.MethodsProspective observational study of 57 nurses for 191.3 hours (109.8 hours in 2005/2006 and 81.5 in 2008), on two wards in a teaching hospital in Australia. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied. Proportions of time in 10 categories of work, average time per task, time with patients and others, information tools used, and rates of interruptions and multi-tasking were calculated.ResultsNurses spent 37.0%[95%CI: 34.5, 39.3] of their time with patients, which did not change in year 3 [35.7%; 95%CI: 33.3, 38.0]. Direct care, indirect care, medication tasks and professional communication together consumed 76.4% of nurses' time in year 1 and 81.0% in year 3. Time on direct and indirect care increased significantly (respectively 20.4% to 24.8%, P < 0.01;13.0% to 16.1%, P < 0.01). Proportion of time on medication tasks (19.0%) did not change. Time in professional communication declined (24.0% to 19.2%, P < 0.05). Nurses completed an average of 72.3 tasks per hour, with a mean task length of 55 seconds. Interruptions arose at an average rate of two per hour, but medication tasks incurred 27% of all interruptions. In 25% of medication tasks nurses multi-tasked. Between years 1 and 3 nurses spent more time alone, from 27.5%[95%CI 24.5, 30.6] to 39.4%[34.9, 43.9]. Time with health professionals other than nurses was low and did not change.ConclusionsNurses spent around 37% of their time with patients which did not change. Work patterns were increasingly fragmented with rapid changes between tasks of short length. Interruptions were modest but their substantial over-representation among medication tasks raises potential safety concerns. There was no evidence of an increase in team-based, multi-disciplinary care. Over time nurses spent significantly less time talking with colleagues and more time alone.

Workload of nurses: observational study of indirect care activities/interventions

“…An Australian study (26) showed that the time spent in transit by nurses (time between activities and patient care), over a three-year investigation, showed a reduction from 7.4% to 4.6%, after optimization strategies. (22) , 11.3% (8) , 11.5% (5) and 18.4% (20) .…”

Therapeutic relationship: Is it still heart of nursing?

“…Several reports and studies showed that the vast majority of nurses are too busy to talk to patients because they are over-worked. Westbrook et al (2011) indicated that time in professional relationship is around 37% of nurses' time. It's worth mentioning that almost 25% of this figure belongs to direct care such as bathing, applying dressings and …, so it may be concluded that only a few hours may remain for therapeutic relationship.…”

“…It's worth mentioning that almost 25% of this figure belongs to direct care such as bathing, applying dressings and …, so it may be concluded that only a few hours may remain for therapeutic relationship. 43 Disproportion between the nurses' working time with the time needed for therapeutic relationship causes the therapeutic relationship not to be formed and so it causes that nurses do not priorize the visit to patients among their routine activities. 25,44 In this regard, studies have also shown that noncompliance with nurse-to-patient staffing ratios brings about adverse effects on the health condition of patients.…”

Comparing the cost-effectiveness and clinical effectiveness of a new community in-reach rehabilitation service with the cost-effectiveness and clinical effectiveness of an established hospital-based rehabilitation service for older people: a pragmatic randomised controlled trial with microcost and qualitative analysis – the Community In-reach Rehabilitation And Care Transition (CIRACT) study

“…Of these, 142 papers were excluded based on the title and abstract, leaving 93 full-text papers to be screened for eligibility. Of these, 75 papers were excluded as they did not fit the inclusion criteria and two papers were unobtainable, even though interlibrary requests were submitted and the authors were contacted, leaving 16 papers [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] included in the review ( Table 9). …”