Work pattern of neurology nurses in a Chinese hospital: A time and motion study

Abstract

Aim To investigate nursing work patterns in a neurology department in a Chinese hospital. Background Knowledge of nursing work patterns is important for nursing management and work design, and for the evaluation of organizational process change associated with the introduction of an innovation. Methods A time‐and‐motion method was used to observe 14 registered nurses’ (RNs’) work patterns in a neurology department in a Chinese hospital. Results There were 147 hr of observation. Overall, the most time‐consuming activities were verbal communication (28.5%) and documentation (28.3%), followed by indirect care (14.6%) and direct care (14%). Compared to support RNs, charge RNs spent 20% more time on documentation and 11% more time on verbal communication. Two‐thirds of the observed activities had a duration of less than 40 s. Conclusions Communication, in verbal and written forms, consumed more than half of the nursing time. Conversely, nurses only spent about a quarter of their worktime on preparation for care provision and direct care provision. This reflects the significant role and resource‐consuming nature of communication to provide safe and quality care. Implications for Nursing Management Communication methods need to be enhanced to improve nursing productivity. This may be achieved through the introduction of more effective nursing documentation methods.

Development and content validation of the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey

“…Most time and motion studies collect data for short blocks of time which may lead to an under or over representation of certain tasks. Only Yu et al, (2019) collected data on the work pattern of nurses for entire shifts reporting that documentation took up 28.3% It is evident from the literature that there is a need to measure nurses and midwives perception of the burden of documentation with a valid and reliable tool. Such a tool will provide information on how documentation has an impact on nurses and midwives workload and how they perceive it influences the care they provide to patients.…”

“…Time and motion studies exploring the work patterns of clinical nurses have included measures of time spent on clinical documentation (Antinaho, Kivinen, Turunen, & Partanen, ; Ballermann, Shaw, Mayes, Gibney, & Westbrook, ; Hendrich, Chow, Skierczynski, & Lu, ; Westbrook, Duffield, Li, & Creswick, ; Yen et al, ; Yu et al, ). There is considerable variation in the amount of time these studies have reported nurses spend on documentation from as low as 7.3% (Westbrook et al, ) to as high as 28.3% (Yu et al, ).…”

“…Time and motion studies exploring the work patterns of clinical nurses have included measures of time spent on clinical documentation (Antinaho, Kivinen, Turunen, & Partanen, ; Ballermann, Shaw, Mayes, Gibney, & Westbrook, ; Hendrich, Chow, Skierczynski, & Lu, ; Westbrook, Duffield, Li, & Creswick, ; Yen et al, ; Yu et al, ). There is considerable variation in the amount of time these studies have reported nurses spend on documentation from as low as 7.3% (Westbrook et al, ) to as high as 28.3% (Yu et al, ). There are various factors which could influence these differences including variations in health care systems and clinical areas, whether data were directly observed (Ballermann et al, ; Westbrook et al, ; Yen et al, ; Yu et al, ) or self‐reported (Antinaho et al, ; Hendrich et al, ), the time and length of data collection and differences in task categorisation.…”

“…There is considerable variation in the amount of time these studies have reported nurses spend on documentation from as low as 7.3% (Westbrook et al, ) to as high as 28.3% (Yu et al, ). There are various factors which could influence these differences including variations in health care systems and clinical areas, whether data were directly observed (Ballermann et al, ; Westbrook et al, ; Yen et al, ; Yu et al, ) or self‐reported (Antinaho et al, ; Hendrich et al, ), the time and length of data collection and differences in task categorisation. Most time and motion studies collect data for short blocks of time which may lead to an under or over representation of certain tasks.…”

“…Most time and motion studies collect data for short blocks of time which may lead to an under or over representation of certain tasks. Only Yu et al, () collected data on the work pattern of nurses for entire shifts reporting that documentation took up 28.3% of nurses time while only 14% of their time was on direct care. In the context of community substance abuse treatment (Carise, Love, Zur, McLellan, & Kemp, ) a state‐wide evaluation of documentation burden was conducted measuring the approximate time taken to complete different types of documentation before and after an intervention.…”