1. Laskowski-Jones, Linda MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN

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Think of nursing actions performed every day in patient care. Next consider how long an experienced nurse needs to perform each action properly under optimal conditions. Then try to remember the last time conditions were optimal.

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To place expectations in a purely mathematical framework, if a nurse is assigned a standard 8- or 12-hour shift, the cumulative time for all necessary work to be performed should approximate the time allocated in that nurse's schedule for the day. Unfortunately, optimal conditions are not the norm in most real-world clinical settings due to a multitude of patient variables, staffing challenges, supply and equipment issues, and technology glitches. Meeting all expectations in the manner required may exceed allocated time or resources. Staff then must make choices.


Some choices are very appropriate, such as requesting assistance from coworkers, reprioritizing work, and working overtime. However, not all choices are in patients' best interests, such as taking risky shortcuts, or neglecting some aspect of care to avoid relying on teammates for help or generating overtime. Leaders may be compelled to advocate for more positions if existing staff cannot consistently complete required work. But is all the work really value-added-or does it need to be intelligently pared down?


Letting go of nonvalue-added work is a skill we often do not do well and need to hone. It is essential to evaluate the additive cost of time for each expectation in our professional and even our personal lives. Magical thinking aside, we cannot create more hours in a day. To fit in an additional task, we need to make a decision to take something out.


For every new requirement, standard, form, or solution, consider how much time is necessary and how the new demand can be reasonably accomplished in the real world. What responsibility or aspect of work will be eliminated to fit new expectations into the time allocated without creating deleterious effects? Also consider the cost of time in analyzing systems and clinical services.


In an era of cost reduction where obtaining more resources is challenging or impossible, we need to intentionally engineer systems that are designed to function properly by the humans who are responsible. Otherwise, we add demands along with expectations that may not be realistic, fostering stress, burnout, and potentially unacceptable patient outcomes.


This holiday season, give yourself the gift of time!


Until next time,



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