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Nurses' working time divided into major nursing categories, includ- ing subcategories and nursing activities (N = 11 029)
Source publication
AimTo investigate registered nurses' (RN) and licensed practical nurses' (LPN) working time use in adult inpatient units.Background
There is only scarce information about value-adding patient care. Nursing care can be divided into three major categories: value-adding care (direct care, indirect care, patient documentation), necessary activities (in...
Contexts in source publication
Context 1
... total of 11 029 nursing activities were reported (see Table 2). Nursing occupational groups reported 10 936 nursing activities, of which RNs reported 9135 nursing activities while LPNs reported 1801 nursing activities (see Table 3). ...Context 2
... which the nurses had reported in 10-minute time-slots, are presented in Table 2 in the major nursing categories, including subcategories and nursing activities. A total of 11 029 nursing activities were reported, accounting for 1838 hours of nursing work [(11 029 9 10 minutes): 60 minutes = 1838 hours). ...Citations
... Common in nursing job analysis is using either observational or self-report methods, or a combination (see for example Antinaho et al., 2017). In the psychiatric-mental health nursing literature, selfreport (Antinaho et al., 2015;Tenkanen et al., 2016) and observational (Abt et al., 2021;Glantz et al., 2019) methods are equally common. There has only been one job analysis of school nurses, excluding mental health nurses (Morse et al., 2022), and it used a survey and not observation or self-report methods. ...
While schools have become settings for the delivery of mental health supports to students, mental health nursing has not yet described its practice in schools. In the absence of this mental health nursing literature, a quantitative self- reporting job analysis methodology was used to describe the tasks of mental health nursing in a specialist school as an observant–participator in a single- case holistic case study. Additional aims were to compare the results with the general school nursing and the disability nursing literatures and interpret these findings for mental health nursing. Categories of tasks from general school nursing were used to deductively interpret the results. Tasks were recorded across all categories of school nursing. The greatest number of tasks were recorded in the professional performance category, followed by planning, then personnel. The least number of tasks were recorded in the health education and promotion category, followed by practice and treatments, assessment and diagnosis, and management. These results differ from tasks in general school nursing but share similarities with intellectual and developmental disability nursing, particularly related to relationships and communication. Practising effectively as a mental health nurse in a specialist school requires capabilities for working with people with disability, particularly communicating and establishing relationships, in addition to clinical mental health skills. Mental health nursing in schools is an area of practice that requires further exploration to capitalise on emerging policy developments to support student mental health.
... As mentioned above, standard time includes some additional time, called the adjustment time: (i) personal needs such as rest, eating, drinking, etc; (ii) fatigue, due to physical movement (traveling), acuity of patient and mental stress, and (iii) unavoidable delays due to interruption by others, or delays due to searching for missing or out-of-stock items, assigned to new admission, etc. Although in the current study personal needs, fatigue and unavoidable delay represented 12%, 14 and 19%, respectively, our calculation demanded only 7% for personal needs, 5% for fatigue delay, making a total of 12% (around 1 h) [16]. However, unavoidable delay adjustment is known to be set based on the actual study results [22,38,39]. ...
... The results are in accordance with previously published studies [21]. Indeed, the percentage was almost similar to that found by Upenieks et al. [40], but slightly less than in a study by Antinaho et al. [16]. The much-larger proportions of time were devoted to both documentation and unit/room-related activities, making a total of 36% compared to 31% devoted to direct and indirect patient care activities. ...
... Numerous motion studies have integrated communication and documentation within indirect patient care activities category [15,16], while others classified them as a separate activity category [21,41]. Categorizations in the current study were developed based on a time and motion study of nurses by Hossny [21]. ...
(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities––which are often not taken into account while estimating nurse-to-patient care time allocation––that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses’ overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time–motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.
... Nurses care for their patients and want to have the time to connect with them, but the ever-changing and demanding healthcare environment is making it virtually impossible. It is estimated that only 20%-38% of nurses total work time is spent in direct contact with patients (Antinaho et al., 2015;Michel et al., 2021;Yen et al., 2018). Recent surveys of registered nurses in the United Kingdom and the United States have reported that 75% to 90% of respondents stated that they did not have sufficient time to comfort, speak with, or spend time with their patients (Kleebauer, 2016;Massachusetts Nurses Association, 2018). ...
Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.
... The same reasons were found by [97] who discovered that nurses spend 90 minutes of every 12.5-hour shift on tasks other than providing direct care to patients. Meanwhile, [98] found that nurses use 40% of their time for direct patient care and 20% for indirect care. [12] research yielded similar findings that nurses' lack of knowledge and skill in using evidence (such as research findings), poor time management, a lack of motivation, inadequate resources, and inadequate training were the most common reasons given for not adopting the evidence-based practice. ...
The study aimed to determine clinical nurses' beliefs, knowledge, organizational readiness, and evidence-based practice implementation levels and identify the perceived factors affecting evidence-based practice implementation. A descriptive-correlational in quantitative approach with triangulation was used. Data were gathered through the administration of adapted survey questionnaires along with structured interviews and personal observation to supplement the data. Forty-two voluntarily participated and completed the survey. Frequency, percent, mean, and standard deviation were used to analyze and interpret the participants' demographic profile and evidence- based practice-related variables. Regression analysis was used to identify the predictors from the list of variables. For facilitating and hindering factors in the evidence-based practice implementation of clinical nurses, an open- ended question was asked to triangulate the quantitative data. Most of the nurses are female in their middle adulthood, have completed a bachelor’s degree in nursing, and have worked in the hospital as a senior staff nurse for considerable time. The result shows that nurses somewhat truly believe in evidence-based practice, have acceptable evidence-based practice knowledge, probably consider the culture and organizational readiness, and are interested in implementing specific evidence-based practice tasks. Also, it was found that only knowledge of evidence-based practice is a highly significant predictor of evidence-based practice implementation. Perceived facilitating factors include supportive policies, training opportunities, management, and peer support. At the same time, lack of knowledge and insufficient time were recorded as barriers to implementing evidence-based practice. The salient findings were used in crafting the policy brief.
... Optimising the use of time and skills of nurses is critical to the future of the health care system. Paying increasingly more attention to and studying how nurses allocate their time provide opportunities for improvement (Antinaho et al. 2015;Michel et al. 2021). Guiding and supporting people through major transitions, including chronic illness, is a key component of care coordination (Luchsinger et al. 2019). ...
... 32 Participants also sought comfort from interactions with nurses and staff members since interactions with family were limited. A cross-sectional observational study of 188 nursing home residents identified an association between nurse-patient interaction and residents' loneliness, 33 supporting the value nurse interaction can have on patient comfort. 34 The provision of compassionate connected care by slowing down, being physically close to patients, and communicating openly can decrease patient suffering. ...
... The time nurses spend with patients is tied to better patient health outcomes, patient satisfaction, and nurse satisfaction. 6,33,34,38 Some participants felt that nurses were busy and that units were understaffed, which impacted their perception of care, relationships with the nurses, and their willingness to ask for help. Participants expressed discomfort due to delays in receiving pain medication, toileting, and bathing. ...
The purpose of this Qualitative Descriptive study was to describe the experience of hospitalized adults during the pandemic who did not have COVID-19. Semi-structured interviews were conducted with 20 English-speaking adults who were hospitalized on a medical or surgical floor after April 1, 2020 and were negative for COVID-19 throughout their entire hospital stay. The interview questions focused on the overall hospital experience, the nurse’s role in their experience, comfort needs, and the experience of having comfort needs met during the hospitalization. Conventional content analysis of the transcribed transcripts revealed five main themes related to the hospital experience: I don’t expect the hospital to be comfortable; I was always tense; Wanting human connection; Communication is important; and Nurses are busy. An unpleasant environment, longing for comfort from family and nurses, a perception that the nurses were too busy, feelings of being isolated from others and the world, and experiencing fear and anxiety were all elements of the hospital experience during the COVID-19 pandemic. These findings identified a need for targeted practice, research, and education to improve patient comfort in the physical, psycho-spiritual, sociocultural, and environmental contexts. This is important as we look toward improving the overall patient experience during hospitalization.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.
... Illustrating the scope of nursing practice requires a clear description of nurses' work and responsibilities and suggests the need to explore how they truly allocate their time. Studies oriented towards general care have sought to define the scope of nursing practice in relation to the concept of "added value," from which patients benefit directly (Antinaho et al., 2015), and then to describe nurses' various tasks (Cornell et al., 2010;Farquharson et al., 2013;Westbrook et al., 2011). Few studies to date have examined the scope of practice of mental health nurses (MHNs) in psychiatric units. ...
... Finally, the miscellaneous/non-healthcare domain of activities was among those to which MHNs devoted the most time, with means of 180 min and 150 min on day and evening shifts, respectively. Among the activities included in this category, simply waiting took up the most time, followed by administrative tasks, with significantly longer durations than observed in previous studies (Antinaho et al., 2015;Whittington & McLaughlin, 2000). ...
... There is a great deal of variability among studies that have analysed the distribution of psychiatric nurses' activities (Hodek et al., 2011;Antinaho et al., 2015Antinaho et al., , 2017Goulter et al., 2015;McAllister & McCrae, 2017). Only one study used a time and motion method (Glantz et al, 2019). ...
Introduction:
The evaluation of nursing care practices poses many challenges, including identifying all the aspects of the care given. However, few studies have examined the scope of nursing practice in psychiatry.
Aim:
The aim of this study was to describe the intensity of nursing activities on a psychiatric unit based on the adaptation of Déry and D'Amour's (2017) Scope of Nursing Practice Model.
Method:
This 56-day descriptive observational study used the time and motion method to follow eight nurses.
Results:
500 hours of observations were carried out. The greatest lengths of time were allocated to communication and coordination of care activities and to "non-healthcare" domains. Less time was devoted to activities related to clinical evaluation and therapeutic education.
Discussion:
Findings demonstrated that MHNs do not perform all the possible functions in the domains of their scope of practice in the same way, and time spent with patients was short. Several factors contributed to this, including the fact that nurses are working in increasingly demanding care settings that keep them under constant pressure.
Relevance for clinical practice:
It is essential to describe concretely what is expected of nurses, to help them allocate their time effectively and to identify opportunities for improvement.
... Indirect care involves paperwork and work related to the ward (Lavander et al., 2016). Some studies estimated the proportion of indirect care to take up from 11% to 25% of the working day (Antinaho et al., 2015;Farquharson et al., 2013;Westbrook et al., 2011), whereas Walker et al., (2007) reported a proportion of 40%. These results show that much nursing work is invisible to patients (Lavander et al., 2016). ...
... Two studies chose to analyse nursing activities in relation to the concept of 'added value', distinguishing three categories: activities with added value from which patients benefit directly; necessary activities from which they benefit indirectly and activities with no added value (Antinaho et al., 2015;Upenieks et al., 2007). Valueadded activities occupied from 54% to 71% of work time, necessary tasks from 14% to 25% and activities with no added value from 15% to 21% (Upenieks et al., 2007). ...
... Clear descriptions of the hospital work expected of nurses and exploring how they allocate their time are essential steps in identifying opportunities for improvement (Bodenheimer & Sinsky, 2014;Hendrich et al., 2008). This information would help to initiate indepth reflections on nursing care, work organization, the allocation of professional or financial resources, the division of tasks and staffing levels (Antinaho et al., 2015;Cornell et al., 2010;Desjardins et al., 2008;Farquharson et al., 2013;Lavander et al., 2016). ...
Aim
To describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward.
Design
A single-centre observational descriptive study.
Method
Using a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre-registered list of 42 activities classified into 13 dimensions.
Results
A total of 507.5 work hours were observed. Less than one third of registered nurses’ work time was spent with patients. They allocated the most time to the dimensions of ‘communication and care coordination’ and ‘care planning’, whereas ‘optimizing the quality and safety of care’, ‘integrating and supervising staff’ and ‘client education’ were allocated the least time.
Conclusion
This study provided a reliable description of nurses’ time use at work. It highlighted suboptimal use of the full scope of nursing practice.
Impact
Both work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses’ skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses’ knowledge.
... Surgical ward nurses have to work with new technological equipment and keep up with new invasive techniques [9], modern wound care and disinfection measures [10]. Compared to other somatic and mental health fields, nurses in surgical care spend more time on patient monitoring, performing treatment procedures, preparing treatments and organising outpatient care [11]. Nurses are responsible for preparing a patient before surgery, administering post-surgical care, and educating patients on follow-up plans. ...
... The responsibility of each profession is to keep a certain range of work to reduce overload, job dissatisfaction and the risk of burnout, but nurse managers play an even more important role in task clarification. Nurse managers should deal with the division of labour [11] and, where appropriate, direct non-nursing activities to other, suitably competent personnel. Nurse managers task is to clarify the scope of practice for nurses and other professions and avoid the overlapping of roles. ...
Background:
Care left undone is a worldwide problem for both the quality of health care and the safety of patients. In surgical nursing, care left undone is a critical issue arising from the intensive pace of work, invasive procedures and the pressure for efficiency. Previous knowledge about care left undone in surgical contexts is missing.
Objective:
To describe care left undone and its relationship to nursing and organisational characteristics in the surgical wards of regional and central hospitals in Estonia.
Methods:
A cross-sectional study with an online questionnaire took place from June to October of 2018. The target population (N = 570) consisted of nurses working in the surgical wards of two regional and three central hospitals at the time of the study. The data were analysed using descriptive statistics and Fisher's exact test. The open-ended questions were analysed with deductive content analysis.
Results:
Nursing care in the surgical wards was reported as having been left undone sometimes or often by 88% of the nurses. Most often, the documentation and evaluation of care plans (33%) were reported as undone and most rarely, disinfection measures were left undone (5%). Nurses with a shorter employment history left care undone more frequently, and when the number of patients per nurse increased, the amount of care left undone increased as well. More than half of the participants (59%) considered work organisation to be the cause of care left undone.
Conclusions:
Work organisation and staffing in surgical wards require more attention at the management level, as nursing care left undone occurred to a significant degree in the investigated wards, and more than half of the nurses considered work organisation to be the reason for care left undone.
... The aim of this time-motion study was to describe the nature and duration of the activities performed by nurses and nursing assis- (Antinaho et al., 2015;Cornell et al., 2010;Desjardins et al., 2008;Farquharson et al., 2013;Furåker, 2009;Hendrich et al., 2008;Lavander et al., 2016;McNair et al., 2016;Schenk et al., 2017;Upenieks et al., 2008;Westbrook et al., 2011) Mean duraƟon in minutes for each of the 13 dimensions by professional group and shiŌ type ...
Aim
To log the activities of registered nurses and nursing assistants on a visceral surgery ward.
Background
By prioritizing their activities, nurses fail to exercise their full scope of practice even though this is essential for healthcare systems to function effectively and efficiently.
Method
A descriptive observational time‐motion study was conducted over a period of 48 days. The activities of nurses (n=24) and nursing assistants (n=9) were logged over the course of their entire work shifts, both in the day and at night.
Results
In all, 499 hours of observation were logged. Tasks that fell under the categories of care activities and of communication and care coordination, which cover documentation, non‐care activities and delegated medical tasks, were the ones that took up most of the nurse work time. Patient assessment, relational care, therapeutic teaching/coaching, and knowledge updating and utilization were categories that nurses were under‐engaged in.
Conclusion
The study shows that the scope of nursing practice was not optimal.
Implication for nursing management
The results can serve to improve the work environment of carers, optimize the use of human resources, and increase the visibility and efficiency of nursing work.
