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The reality of nursing time: how nurses spend their shifts

07 November 2024
Volume 33 · Issue 20

Abstract

Background:

Nurse staffing levels are increasingly challenged while pressures on healthcare systems are rising. There is a clear need to optimise efficiency in healthcare delivery in order to deliver safe, effective and quality health care.

Aim:

To understand how nurses working shifts spend their time and explore opportunities to improve efficiency in care delivery.

Method:

A time-motion study was conducted on three acute care wards in a district general hospital in West Wales; 13 nurses were observed over 14 shifts, each activity undertaken was recorded in real time.

Findings:

In all, 109 hours were observed. Approximately half of nurses’ time is spent delivering direct patient care, with medications administration taking the majority of time.

Conclusion:

A number of recommendations are made involving processes and workforce modelling with the aim of improving efficiency and safety. Further research would be required to assess the impact of their introduction.

In the next decade, healthcare services across the UK and elsewhere in the world are expected to face significant workforce challenges in delivering quality health care. It is predicted that patient outcomes and staff experiences will be affected (Beech et al, 2019). Nurse vacancy rates have reached record levels, while nursing absences have increased (Hunter, 2022). Demands on the system, such as waiting times in emergency departments, for diagnostic testing, and routine treatments, have also increased (Royal College of Nursing (RCN) Wales, 2022). In Wales, the RCN estimated 2900 nursing vacancies in September 2022, and increasing reliance on agency nurses (RCN Wales, 2022).

Providing safe, effective patient care depends on adequate staffing levels, and is not always achieved when deploying temporary nursing solutions; these have been shown to be associated with patient mortality (Dall’Ora et al, 2020). To achieve good quality efficient care nursing roles must be carefully balanced to avoid either overstaffing or understaffing wards, and consequent inefficacies, staff burnout (van den Oetelaar et al, 2018) and poor patient care.

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