Time and motion study: how do medical-surgical nurses spend their time?

Ann Hendrich: Permanente Journal

This study is the first hospital environmental study to quantify how nurses spend their time, in real-time and in real work contexts. tracking the movement and tasks of more than 760 medical-surgical nurses using hand-held computers and motion sensors. The findings demonstrate that nurses spent more than three-quarters of their time on nursing practice-related activities--but less than one-fifth of all nursing practice time on activities defined as patient care activities. Three other activities accounted for the majority of nursing practice time: documentation, care coordination, and medication administration. Only 7.2% (31 minutes) of nursing practice time was dedicated to patient assessment and recording of vital signs. Nurses spent the largest proportion of their time--38.6% (214.2 minutes)--at the nurse station, compared with less than one-third (171 minutes) in the patient room.

A picture emerges of the professional nurse who is constantly moving from patient room to room, nurse station to supply closet and back to room, spending a minority of time on patient care activities and a greater amount of time on documentation, coordination of care, medication administration, and movement around the unit. The motion findings of the study support this picture. Nurses walked significant distances while at work and walked farther while on shift (median, 3.0 miles) than when not at work (median, 2.1 miles). In previous studies, walking has been identified as a major time consumer for nurses, and evidence suggests that time saved walking translates into more time spent on patient-care activities. Documentation required the most time, about 2 1/2 hours during a 10-hour shift, according to results published in the Permanente Journal. Nurses spent another hour and a half coordinating care and 81 minutes on direct patient care. Medication administration absorbed 72 minutes. Roughly one half-hour went to patient assessment and tracking vital signs. Results did not vary significantly across three floor plans included in the study. The study identified 36 minutes of waste--waiting, delivering, searching--during a 10-hour shift

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.

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