A 36-hospital time and motion study: how do medical-surgical nurses spend their time?

Abstract

Context: Nurses are the primary hospital caregivers. Increasing the efficiency 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 inefficiency 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 three-quarters 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 identified three main targets for improving the efficiency 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' time and the safe delivery of care.

Figure 1

Reported nurse time by location. In protocol B, location was selected by the nurse from four categories: patient room, nurse station, on the unit, and off the unit. Data were normalized to a 10-hour shift (600 minutes). Of this total, 45 minutes (7.5% of total) were not accounted for by participants (data not shown). Data in chart are percentages of all reported time (555 minutes).

Figure 2

Reported nurse time spent by care category. In protocol B, activity category was selected by the nurse from the following: nursing practice, nonclinical, unit-related functions, or waste. Data were normalized to 10-hour shift (600 minutes). Of this total, 63.5 minutes (10.6% of total) were not accounted for by participants (data not shown). Data in chart are percentages of all reported time (536.4 minutes). Nursing practice accounts for over three-quarters of all nursing time.

Figure 3

Reported nurse time in each activity category by location. Activity category data from protocol B were examined by each of the four nurse locations: patient room (3A), nurse station (3B), on the unit (3C), and off the unit (3D). Unreported time is categorized as “other.” Nursing practice accounted for most time in the patient room and at the nurse station and a majority of time on the unit. Time off the unit was fragmented into multiple categories.

Figure 4

Nursing practice by location and by subcategory. Analysis of nursing practice time by location revealed that the largest proportion of nursing practice was done at the nurse station (4A). Three subcategories of nursing practice (4B) consumed most nursing practice time not accounted for by patient care activities: documentation, medication administration, and care coordination.

Figure 5

Care coordination and documentation subcategories by location. Analysis of nursing practice subcategories by location found that care coordination was performed primarily at the nurse station (69.2%) and documentation was also performed primarily at the nurse station (80.6%).