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Think you spend more time on paperwork than caring for your patients? A new study funded by the Robert Wood Johnson Foundation confirms your impression. Involving 767 nurses from 36 medical/surgical units in 15 states, the study found that documentation takes up 35% of nurses' time, versus 19% of time devoted to patient-care activities.


Nurses were randomized into protocol A and protocol B. Those in protocol A (385 nurses) carried PDAs to record all documentation activities per shift. Those in protocol B (382 nurses) carried a PDA that vibrated randomly 25 times during a 13-hour shift. When the PDAs vibrated, nurses recorded whatever they were doing at that moment.


All the nurses wore radio-frequency identification tags that tracked their movements. Some nurses in the study (288) also volunteered to have their physiologic responses monitored continuously for 23 hours per day for 7 days by wearing special armbands.


During the study, researchers tracked where nurses went and what they did via an indoor positioning system installed in each unit for the study duration. On day shift, nurses walked an average of 3 miles per 10-hour shift; at night, 2.1 miles.


Here's a breakdown of how nurses spent their time by activity:


* Documentation, 35%.

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* Care coordination, 21%.


* Patient-care activities, 19%.


* Medication administration, 17%.


* Patient assessment/vital signs, 7%.



Researchers analyzed the amount of time nurses spend on "valueless" activities, such as hunting for supplies. They write, "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."


Researchers say differences in the way nurses spend time were more apparent between individual nurses than units. For example, a unit's design didn't affect efficiency. They believe their research provides a foundation for finding ways to eliminate wasted time and improve efficiency so nurses can get back to their real job: assessing, caring for, and teaching patients.




Hendrich A, et al., A 36-hospital time and motion study: How do medical-surgical nurses spend their time?, The Permanente Journal, Summer 2008.