“…Their influence on patient safety has been demonstrated reproducibly (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Aiken, Sloane, & Sochalski, 1998; Rafferty et al, 2007). However, multiple investigators—not to mention nurses themselves—report that only a minority of nursing time is dedicated to direct patient care (Hendrich, Chow, Skierczynski, & Lu, 2008; Hendrickson, Doddato, & Kovner, 1990; Linden & English, 1994; Upenieks, Akhavan, Kotlerman, Esser, & Ngo, 2007; Watson, Lower, Wells, Farrah, & Jarrell, 1991). A central goal of quality improvement in healthcare is to return direct care time to nurses.…”