Research study nurses sit time-The Role of the Clinical Research Nurse

We spoke to nurses about their experience of working in this exciting space and the variety of roles our clinical research nurses undertake. All speak of having started their research careers with an uninformed view of what a research role could bring them. All speak of their surprise at the autonomy of the role, the skills they have developed and the variety of work they undertake. All speak of working in great teams, the career opportunities that have opened for them and the importance of their relationships with the clinical research nursing community. All speak of the challenges they have faced and overcome in research.

Research study nurses sit time

Research study nurses sit time

Research study nurses sit time

The research nurse is very much responsible for that relocation, as the Research study nurses sit time with Shop maidenhead services or sponsors, ensuring bank accounts are in place, other children are getting educated. Excludes medication related discussion communication. When I began in the Cancer Research Network my personal Research study nurses sit time was about approaching patients to join a study. National Center for Tlme InformationU. It was noted that most of them were first seen in labour when they were admitted to give birth. She believes that nurses are well positioned to contribute to research on the health risks associated with prolonged sitting - and the most effective nursees for reducing tiime risks. I have seen huge changes in almost every aspect of research sinceexcept for the fundamental of how we care for the patient.

Big ass cheeks. In this article

Motivation is a force which helps the people to Skirt camera their goals and creates eagerness and more readiness to do their tasks. Television viewing and television in bedroom associated with overweight risk among low-income preschool children. Mansoureh A. Med Educ. Results: The major theme extracted in this study was the inappropriate organizational culture which includes eight categories listed as follows: Not putting value on education, non-professional activities, physician-oriented atmosphere, conflict and lack of coherence in education, inappropriate communication skills, ignoring patient's right in education, lack of motivation, rewarding system in the organization, and poor supervision and control. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Following signed consent, nurses were assigned a study identification number, and demographic information regarding their age, nurse classification, and length of experience was collected. Keywords: Research nurse, Teamwork, Patient advocacy This article has been double-blind peer reviewed. Observers randomly allocated participating nurses to a list for each observation session according to the sampling strategy. Over time nurses experienced a shortening of the average length of key tasks such Research study nurses sit time professional communication and documentation. That kind of critical thinking means filtering tine before passing it on to patients. Obesity Prevention Source expand child menu. Effects of decreasing sedentary behavior and increasing activity sut weight change in obese children. Article Google Scholar 3.

Research nurses play a vital role in ensuring clinical research studies run smoothly and that participants are safe and fully informed.

  • Several studies indicate that patients, while getting discharged from hospitals, receive insufficient information about their illness and self-care.
  • Metrics details.
  • Research conducted at Harvard first linked TV watching to obesity more than 25 years ago.
  • Research nurses play a vital role in ensuring clinical research studies run smoothly and that participants are safe and fully informed.

Research nurses play a vital role in ensuring clinical research studies run smoothly and that participants are safe and fully informed. Pick A et al Getting started in clinical research: the role of the research nurse.

Nursing Times; online edition, 26 April. Clinical research is essential for continually improving standards of patient care. Research nurses have played a pivotal role in this initiative. Research is an indispensable part of a modern, effective health service and essential to the provision of effective and safe health and social care Royal College of Nursing, ; Department of Health, Experience at Bradford Teaching Hospitals Foundation Trust has shown us that without dedicated research nursing staff it is difficult to succeed in clinical research.

By developing a team with research nurses at the core we have substantially increased recruitment to clinical trials recruitment and obtained a phase 3 clinical trial grant from Cancer Research UK.

This article discusses our experience of developing a new clinical research team. Treatment for these cancers is often intensive and may involve major surgery, radiotherapy and chemotherapy. Research is essential to continue improving every aspect of their care, from earlier diagnosis to increased survival and from developing more effective treatments to helping patients with all their physical, social, psychological and emotional needs afterwards.

Until recently, the unit undertook little research activity. However, in a new consultant surgeon with an interest in clinical research was appointed, and since then the number of clinical trials has increased, as has the number of patients recruited into trials. Within two years, four studies were opened and patients enrolled. We now have five trials open and are hosting a new Cancer Research UK-funded multicentre trial.

Fig 1 shows the increase in clinical research activity. Setting up and running a clinical trial is a complex process that takes time, planning and resources. Getting started in research is both exciting and challenging. One of the most valuable lessons we have learned is that teamwork is crucial.

All members of our team have their own unique skills and expertise to contribute; this includes participants themselves, whose first-hand knowledge of being a patient can give researchers better insight into important issues to address that may be overlooked by clinicians. The NIHR has set up a portfolio of high-quality studies adopted by the institute. Recruitment into these studies is one way by which research teams are assessed and funding is awarded.

Shortly after the new consultant was appointed, he set about building a clinical research team for the specialty. This core group of one consultant surgeon and 1. Our own CRUK funded multicentre trial will recruit a clinical trial coordinator and we are shortly to appoint a clinical research fellow.

Coming into the world of clinical research from hands-on care provision involved a steep learning curve for the nurses. A solid foundation based on years of experience in nursing is vital to the role, but it requires a wide range of additional skills and knowledge. Although the principal investigator PI has ultimate responsibility for any study, it is often research nurses who coordinate its day-to-day management.

This means leadership and organisational skills and a flexible and adaptable approach are vital. Since the nurses may at times work alone, they also need to be able to prioritise and to make decisions. As Poston and Buescher explain, research nurses are at the fulcrum of clinical trials.

They not only need a comprehensive understanding of the specialty in which they are working, but also an extensive knowledge of the research process and research-related legislation. In addition, they need a variety of computer-based skills, especially in the use of word processing, spreadsheets, database and presentation software, and the ability to undertake internet searches. The many duties of a research nurse include preparing trial protocols and other trial-related documentation, submitting study proposals for regulatory approval, and coordinating the initiation, management and completion of the research.

Ensuring patients give fully informed consent before being enrolled to trials is fundamental to the role. This encapsulates screening for potential participants at outpatients clinics and multidisciplinary team meetings, making sure patients are given all the information they need and that they fully understand the purpose of the study, any potential risks and benefits and what will happen to them if they agree to participate.

It must also be made clear to patients that they do not have to participate and are free to withdraw at any time without it affecting their treatment or care in any way. For this, nurses need an ability to give clear explanations, along with excellent communication and interpersonal skills. Once patients are enrolled to a trial, the research nurse may be responsible for randomisation, and for collecting and recording data.

Quality and reproducibility of data are two of the key principles of ethically sound research. All data must be accurate and complete for the results of the study to be valid, and research nurses often have responsibility for this aspect whether it be entering data themselves or checking that all records are correct and up to date.

This requires attention to detail, a meticulous approach and a high level of integrity. Prompt reporting of adverse events is fundamental to patient protection and a responsibility of the research nurse. These may be any unfavourable change in health or suspected side-effect experienced by a participant, which does not necessarily have to have a causal relationship with the treatment they are receiving European Medicines Agency, In the event of a patient suffering any untoward occurrence such as significant disability, incapacity or death, any life-threatening event, hospitalisation or prolongation of hospital stay or any form of congenital abnormality, a serious adverse event must be declared within 24 hours of the researchers becoming aware of it.

If there is any possibility of harm being done to participants as a result of being in a trial, it is essential to identify it quickly and take appropriate action, which may even mean closing the trial prematurely. Finally, research nurses may also act as teachers, mentors and advisors to other health professionals, or to give presentations at conferences and other meetings.

The International Conference Harmonisation Good Clinical Practice ICH GCP guide emphases the protection, safety and wellbeing of trial participants must be a priority - no one taking part in clinical trials should be harmed.

GCP training must be maintained on a two-yearly basis either by attending a one-day course, or through an online e-learning course with assessment. From a position whereby there was a dearth of research, the Bradford Head and Neck Department has steadily built up an increasing portfolio of clinical trials.

The key lesson learnt from building our portfolio of clinical trials has been the importance of teamwork, which is vital to the success of clinical research. Every member of the team has a significant part to play but research nurses are the lynchpin of our team. The role is extremely interesting, dynamic and challenging but demands a wide range of skills. London: DH. London: EMA. Kmietowicz Z Regulations on medical research need to be reinterpreted not rewritten.

BMJ; , Urologic Nursing; 1, London: RCN. Giving aspirant student nurses frontline care experience as healthcare assistants can increase…. Sign in or Register a new account to join the discussion.

You are here: Nurse educators. The role of the research nurse. In this article How research nurses can help to increase clinical research activity Skills needed by research nurses What the role involves. Abstract Pick A et al Getting started in clinical research: the role of the research nurse. Keywords: Research nurse, Teamwork, Patient advocacy This article has been double-blind peer reviewed. Research nurses are at the forefront of this process.

Research nurses need a thorough understanding of the research process and terminology, and in-depth knowledge of the specialty under investigation. Research nurses need a wide range of skills including management and organisational skills, teaching and mentoring, communication and IT.

Collaboration and cooperation with other researchers and members of the multidisciplinary team is crucial for successful research. NT Contributor. Share Facebook Twitter LinkedIn. The value of providing pre-nursing care experience for aspirant nurses Giving aspirant student nurses frontline care experience as healthcare assistants can increase…. Preparing students to care for patients at the end of life Are student nurses adequately prepared for their first encounter with death and….

An education programme for junior nurses working in acute medicine It is hard to recruit and retain junior nurses in acute medicine. Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions.

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Even she may see the nurse looks pale and tired, but only considers the bed sheet of patient! Experimental studies demonstrate that task-switching leads to increased errors and slower task performance [ 19 , 27 — 29 ]. Kmietowicz Z Regulations on medical research need to be reinterpreted not rewritten. Healthcare workers need to understand which alarms they have and how to monitor them appropriately to reduce false alarms. Arch Pediatr Adolesc Med. Prospective observational study of 57 nurses for Of course, the aim is to reduce mortality and get patients healthy again.

Research study nurses sit time

Research study nurses sit time

Research study nurses sit time

Research study nurses sit time

Research study nurses sit time. Childhood Obesity

Shortly after the new consultant was appointed, he set about building a clinical research team for the specialty. This core group of one consultant surgeon and 1. Our own CRUK funded multicentre trial will recruit a clinical trial coordinator and we are shortly to appoint a clinical research fellow.

Coming into the world of clinical research from hands-on care provision involved a steep learning curve for the nurses. A solid foundation based on years of experience in nursing is vital to the role, but it requires a wide range of additional skills and knowledge. Although the principal investigator PI has ultimate responsibility for any study, it is often research nurses who coordinate its day-to-day management. This means leadership and organisational skills and a flexible and adaptable approach are vital.

Since the nurses may at times work alone, they also need to be able to prioritise and to make decisions.

As Poston and Buescher explain, research nurses are at the fulcrum of clinical trials. They not only need a comprehensive understanding of the specialty in which they are working, but also an extensive knowledge of the research process and research-related legislation. In addition, they need a variety of computer-based skills, especially in the use of word processing, spreadsheets, database and presentation software, and the ability to undertake internet searches. The many duties of a research nurse include preparing trial protocols and other trial-related documentation, submitting study proposals for regulatory approval, and coordinating the initiation, management and completion of the research.

Ensuring patients give fully informed consent before being enrolled to trials is fundamental to the role. This encapsulates screening for potential participants at outpatients clinics and multidisciplinary team meetings, making sure patients are given all the information they need and that they fully understand the purpose of the study, any potential risks and benefits and what will happen to them if they agree to participate.

It must also be made clear to patients that they do not have to participate and are free to withdraw at any time without it affecting their treatment or care in any way. For this, nurses need an ability to give clear explanations, along with excellent communication and interpersonal skills.

Once patients are enrolled to a trial, the research nurse may be responsible for randomisation, and for collecting and recording data. Quality and reproducibility of data are two of the key principles of ethically sound research.

All data must be accurate and complete for the results of the study to be valid, and research nurses often have responsibility for this aspect whether it be entering data themselves or checking that all records are correct and up to date. This requires attention to detail, a meticulous approach and a high level of integrity.

Prompt reporting of adverse events is fundamental to patient protection and a responsibility of the research nurse. These may be any unfavourable change in health or suspected side-effect experienced by a participant, which does not necessarily have to have a causal relationship with the treatment they are receiving European Medicines Agency, In the event of a patient suffering any untoward occurrence such as significant disability, incapacity or death, any life-threatening event, hospitalisation or prolongation of hospital stay or any form of congenital abnormality, a serious adverse event must be declared within 24 hours of the researchers becoming aware of it.

If there is any possibility of harm being done to participants as a result of being in a trial, it is essential to identify it quickly and take appropriate action, which may even mean closing the trial prematurely. Finally, research nurses may also act as teachers, mentors and advisors to other health professionals, or to give presentations at conferences and other meetings.

The International Conference Harmonisation Good Clinical Practice ICH GCP guide emphases the protection, safety and wellbeing of trial participants must be a priority - no one taking part in clinical trials should be harmed. GCP training must be maintained on a two-yearly basis either by attending a one-day course, or through an online e-learning course with assessment.

From a position whereby there was a dearth of research, the Bradford Head and Neck Department has steadily built up an increasing portfolio of clinical trials. The key lesson learnt from building our portfolio of clinical trials has been the importance of teamwork, which is vital to the success of clinical research.

Every member of the team has a significant part to play but research nurses are the lynchpin of our team. The role is extremely interesting, dynamic and challenging but demands a wide range of skills. London: DH. London: EMA. Kmietowicz Z Regulations on medical research need to be reinterpreted not rewritten. BMJ; , Urologic Nursing; 1, London: RCN. Giving aspirant student nurses frontline care experience as healthcare assistants can increase….

Sign in or Register a new account to join the discussion. You are here: Nurse educators. Inter-rater reliability tests were performed with two data collectors simultaneously, but independently, observing a nurse and comparing data.

Descriptive statistics were calculated for average task length, number of tasks per hour and proportion of nurses' time the task consumed.

Rates of interruptions and proportion of time multi-tasking were calculated. Data were analysed using SAS version 9. In year 1 nurses spent During an average 8. Overall, nurses completed Figure 1 shows the number and type of different tasks undertaken in an average hour. Professional communication and medication tasks were the most frequent. In the two year period the proportion of time spent on direct The proportion of time spent on medication tasks did not change, and that spent in professional communication Time spent in transit was the only other task type which significantly changed, falling from 7.

Task time distribution was similar for different nurse classifications with the exception of enrolled nurses who spent more time in direct care and less time in medication tasks and ward-related activities and no time supervising staff Figure 3. This is consistent with their reduced clinical role compared to registered nurses. Proportions of time spent in different tasks by nurse classification in Year 1 and Year 3. The average length of individual tasks ranged from 23 seconds in transit to 8.

In total, nurses changed tasks on average every 55 seconds. The mean length of tasks did not significantly differ by nurse classification for different tasks, and there was no evidence that less experienced nurses spent longer on tasks than experienced nurses Figure 4.

This change was also associated with a significant decrease in collaborative task completion by nurses Table 2. Use of computers to complete tasks significantly increased over time from 1.

This equated to around 1 task in every completed involved the use of a computer Table 4. Tasks completed with informal pieces of paper eg post-it notes and a phone did not significantly change over time. There was limited variation in the proportions of time spent on different tasks by day of the week Figure 5. The increases in time spent in direct and indirect care found in year 3 were distributed across the days of the week.

One exception was medication tasks, which in year 1 consumed significantly more time on Mondays and less on Fridays. This position was reversed in year 3 Figure 5. In total the 57 nurses were observed for For 5. There were interruptions recorded, a rate of one every 32 minutes.

The highest proportion of interruptions occurred when nurses were undertaking medication tasks In In year 1, nurses spent Two years later nurses spent Thus, as Table 2 shows, the amount of time spent completing tasks alone increased overtime from This was predominantly due to a decrease in time nurses spent undertaking tasks with other nurses from In year 3, when nurses completed tasks with others, they did so more quickly than in year 1.

For example, the average time per task completed with another nurse in year 1 was There was no significant change in the percentage of tasks completed with others. As Table 2 shows, the proportion of time that nurses spent with colleagues other than nurses was modest. For example, nurses spent 3. During an average nurse's shift of 8. Nurses spent approximately one third of their time with patients and this did not change over time.

There are surprisingly few studies which have sought to quantify the amount of time nurses spend in direct care activities with patients and we have identified no study which has examined changes over time.

Hendrich et al [ 24 ] in a study of multiple units at Kaiser Permanente in the United States reported an average of In year 3 the nurses in our study had moved to allocation of patients to nursing teams, but this appears to have had no effect on proportion of time spent with patients.

A central question is the extent to which this amount of time ensures safe care. Surveillance of patients by nurses has been identified as important to detect patients who are deteriorating.

Research by Aiken and colleagues [ 1 ] has highlighted the relationship between nurse surveillance and patient safety. Surveillance relies on frequent interactions to be able to constantly monitor patients' conditions and provide opportunities to respond. On average we found each direct care task consumed approximately 80 seconds, and in an average hour nurses performed approximately 10 direct care tasks. However we were unable to assess how these tasks were distributed and this is likely to make a substantial difference to patient care.

For example, 10 direct care tasks completed in quick succession leaves patients with no nurse contact for the remainder of the hour. However 10 tasks distributed evenly across the hour would provide much greater opportunity for surveillance. Further work is underway to develop methods to assess the sequencing of task distribution. Few researchers have reported the amount of time which nurses spend on individual tasks. Nurses' work was characterised by a pattern of rapidly changing short tasks.

Our findings are consistent with available evidence and suggest a general trend in the nature of nursing work on hospital wards. On average nurses in our study changed tasks every 55 seconds. Cornell et al[ 26 ] examined time spent in 29 task categories in a direct observational study on two wards and reported a similar high rate of task-switching with an average of 88 tasks per hour.

We grouped work into 10 broad tasks and found a rate of 72 tasks per hour. The implications of this rapid task changing activity in real-world settings have been underexplored. Experimental studies demonstrate that task-switching leads to increased errors and slower task performance [ 19 , 27 — 29 ]. One of the posited reasons for the slower performance when task-switching occurs is the cognitive effort required in reconfiguring the taskset which can involve both shifting attention to the new task while also inhibiting attention to a previous task [ 30 ].

Importantly these 'switch costs' have been shown to occur regardless of the participant's familiarity or training in the tasks performed [ 28 ]. The availability of preparation time prior to a task-switch has been shown in some cases to reduce switch costs [ 28 , 31 ]. The rapidity of task-switching found in the present study suggests nurses receive limited time to prepare for new tasks. Our results demonstrate the reliance that nurses have on formal information sources to complete their work.

This was not due to greater demands on nurses to document information, as time spent in documentation did not increase over the two year period. The increased reliance on formal information sources may be a response to a decrease in access to information from other sources given that there was a significant fall in face to face professional communication and an increase in time nurses spent completing tasks alone.

Use of computers constituted a very small amount of nurses' overall work, but increased over time. It is likely that with the introduction of greater computerisation, for example with computerised medication management and clinical documentation systems, time spent completing tasks with a computer will increase substantially. A significant decline in time spent in transit was found. This may be related to greater access to computerised information sources and a decrease in seeking information face to face as evidenced by the reduction in professional communication both of which reduce the need to travel to obtain information.

However without a focused study it is not possible to confirm the role of these factors in this result. The majority of multi-tasking involved communication with patients or other health professionals and is a required feature of health care work which has rarely been quantified. Along with the results about interruptions it adds further evidence of the non-linear nature of clinical work.

Kosit et al [ 32 ], in a study of interruptions in an emergency department, reported nurses were interrupted on average of 3. Interruptions during medication tasks have been shown to be directly associated with the rate and severity of medication administration errors by nurses [ 33 ].

While nurses experienced rates of interruptions lower than their medical colleagues[ 15 , 19 ], their concentration during medication tasks suggests this task is at specific risk and interventions to reduce interruptions during this process are required [ 34 , 35 ]. No previous studies have followed nurses' work patterns over time.

Both these changes in the shortening of communication activities may be related to an increased reliance upon electronic communication and the greater use of clinical information systems reducing both the level of verbal communication required and the amount of documentation. This may reflect the increased complexity of medication management among hospitalised patients requiring additional time, particularly in administration of medications.

However whether this is an adequate amount of time is unclear. Research conducted by our team at this site on several wards, including the study wards, demonstrated high medication administration error rates and poor compliance with some medication administration procedures[ 33 , 36 ]. The extent to which this reflects intentional deviation of practice or a response to time pressures is unknown.

However there is good evidence that current practice is resulting in a high rate of medication administration errors [ 33 , 36 ]. The results provide little support for an increase in the amount of inter-disciplinary care or communication over time.

Interestingly, the results suggest that the requirement that certain tasks be completed with a colleague the number of tasks completed with others did not change may have led to nurses in year 3 completing joint tasks in significantly shorter times than in year 1. The average time for collaborative tasks with another nurse fell from For example, the move to team based allocation of patients may have led to nurses having a smaller pool of colleagues ie those in their team from whom to seek assistance in year 3.

The amount of time nurses spent in professional communication significantly declined. There was little change in collaboration or communication with other health professionals which remained at very low levels. Cornell [ 26 ] also reported low levels of interactions between nurses and non-nursing colleagues making up around 2.

On average nurses in our study spent approximately 3. Thus while the literature on the value of improved inter-disciplinary communication expands[ 37 ], our results suggest no evidence of increased interaction.

Nurses on our study wards did not increase their level of engagement with other professionals. Further, the amount of time they worked collaboratively with other nurses substantially declined. This occurred in the context of both wards moving to a team-based nursing model. The impact of decreased collaborative task completion on care provision in terms of quality or efficiency is unknown and is worthy of consideration in future studies.

While our study did not measure the content or quality of communication, the finding that the average length of a professional communication task almost halved between years 1 and 3 from 59 seconds to 33 suggests little time is available for detailed information exchange about patient care. The results reflect work patterns on two wards at one hospital and thus may not generalise to other hospitals with very different nursing practices.

Our study examined weekday work. The results may not be representative of evenings or weekends. We used a direct observational approach, and while nurses may have changed their behaviours because they were being observed, the likelihood of dramatic change is low due to the extended length of the study, reducing the chance of sustained behavioural change on busy hospital wards. Observational studies of clinicians in-situ have suggested that the extent of behaviour change is minimal [ 17 , 38 , 39 ].

Strengths of our study include the longitudinal study design, consistency of methods and the data collection technique which accounted for multi-tasking, all of which have extended previous work in this area. The results present a picture of a fragmented pattern of work with increasingly rapid changes between tasks.

Over time nurses experienced a shortening of the average length of key tasks such as professional communication and documentation. Nurses spent a significantly greater proportion of time alone and had significantly reduced contact with other nurses, while interactions with other health professionals did not change and remained low.

While the interruption rate was modest, at an average of two per hour, their distribution across tasks was not even. Both these contextual factors are associated with increased risk of error.

Little is known regarding the relationship between nurses' patterns of work and the quality of patient care. These results provide an indication of the ways in which nurses' work patterns have changed over time. They provide a baseline to inform policy debate, and against which future interventions designed to change patterns of work might be measured. App Nurs Res. Staniszewska S, Ahmed L: Patient expectations and satisfaction with health care.

Nurs Stand. Mechanic D: Physician discontent: challenges and opportunities. J Nurs Care Qual. Med Educ. Prescott P: Changing how nurses spend their time. Health and Welfare Expenditure Series. Int J Med Inform.

Med J Aust. J Hlth Serv Res Policy. Medinfo Qual Saf Hlth Care. J Pharm Pract Res.

Yes, nurses do research, and it’s improving patient care

Time nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks.

We aimed to quantify how nurses distribute their time across tasks, with patients, in individual tasks, and engagement with other health care providers; and how work patterns changed over a two year period. Prospective observational study of 57 nurses for Proportions of time in 10 categories of work, average time per task, time with patients and others, information tools used, and rates of interruptions and multi-tasking were calculated.

Nurses spent Direct care, indirect care, medication tasks and professional communication together consumed Time on direct and indirect care increased significantly respectively Proportion of time on medication tasks Time in professional communication declined Nurses completed an average of Between years 1 and 3 nurses spent more time alone, from Time with health professionals other than nurses was low and did not change.

Work patterns were increasingly fragmented with rapid changes between tasks of short length. Interruptions were modest but their substantial over-representation among medication tasks raises potential safety concerns. There was no evidence of an increase in team-based, multi-disciplinary care.

Over time nurses spent significantly less time talking with colleagues and more time alone. Central to the care of patients and the satisfaction of nurses is the amount of time they are able to spend with patients.

Time nurses spend in direct care activities has been identified as a determinant of better patient outcomes and fewer errors [ 1 - 3 ]. Patient satisfaction is also related to the amount of direct care received [ 4 ].

Qualitative studies reveal clinicians' satisfaction is associated with time spent in clinical work [ 5 ] and that clinicians are dissatisfied with the amounts of 'excessive paperwork' and 'wasted time' spent locating other professionals [ 6 ], documents or equipment [ 7 ]. Thus initiatives which are effective in allowing clinicians to shift their time to direct care are likely to produce improvements in health outcomes, and patient and health professionals' satisfaction, which may also impact upon improved staff retention [ 3 , 8 ].

Two priority areas of health reform internationally are to improve the productivity of the workforce to address growing service demands[ 9 - 11 ]; and increase the level of inter-disciplinary care and communication to enhance the quality and safety of services[ 12 , 13 ]. Ratios of nurses to patients on general wards is a frequently applied metric, yet reveals little about the ways in which this nurse time resource is deployed to support patient care.

If a primary objective is to ensure nurses spend sufficient time with patients in direct care and are engaged in inter-disciplinary care provision, then direct measures of these are required. There are surprisingly few baseline data about how nurses distribute their time, or the extent to which nurses engage with other health professionals in care provision against which the effectiveness of strategies can be tested.

This absence of evidence also hinders debate about what are the most appropriate and effective levels of direct care provision. We aimed to quantify how different classifications of nurses on hospital wards distribute their time across tasks, their time in individual tasks, and the extent to which they engage with other health care providers.

We then assessed how these patterns of work changed over a two year period. Both wards used paper medical records and medication charts, but the hospital had a computerised order entry system for ordering of diagnostic tests and viewing of results as well as ordering of diets, transport, porters and allied health consultations.

Ward nurses included in the study worked shifts of 8. In year 1 both wards used a patient allocation model where each nurse was assigned patients. In year 3 both wards used a team allocation model where a team of three nurses were assigned patients. We used a prospective observational study design to identify changes in patterns of nurses' work on two general medical and surgical wards. The study was conducted over 41 months with data collected between July and March and between August and December All nurses on the two wards were invited to participate in the study via information sessions followed by a direct approach.

Twenty-seven nurses were observed for Representative sampling was used to determine the number of minutes that participants needed to be observed for each hour of the day for each classification of nurse. Following signed consent, nurses were assigned a study identification number, and demographic information regarding their age, nurse classification, and length of experience was collected. Nurses were given no prior warning of observation periods. Observers randomly allocated participating nurses to a list for each observation session according to the sampling strategy.

If a nurse at the top of the list was not working that day, observers selected the next one on the list. This comprises a modified time and motion approach which includes a multi-dimensional work task classification system incorporated into a handheld computer personal digital assistant-PDA. The method collects information about 10 broad, mutually exclusive work categories. This classification was developed following extensive observations and pilot testing described previously [ 17 , 18 ].

The method has been applied in Australian studies of doctors on hospital wards [ 15 ], in an emergency department [ 19 ], and hospital pharmacists [ 20 ]. Most recently the technique was validated in Canadian studies of intensive care clinicians [ 16 , 21 ]. The observers shadowed nurse participants for an average of one hour blocks, recording data on all work tasks performed using the PDA. For each task the data collector recorded with whom the nurse completed the task, the information tools used and any interruptions to work defined as ceasing a task in order to respond to an external stimuli or tasks completed in parallel multi-tasking.

Each task is automatically time and date stamped when entered into the PDA. When the participant nurse engaged with patients, visitors, or other health professionals, the nurse was asked to introduce the observer and seek permission to continue.

Alternatively, the observer would identify themselves. Several dummy observation sessions were undertaken as part of the observer training process. This also allowed nurses to become accustomed to being observed.

The study was approved by the human research ethics committees of the University of New South Wales and the study hospital. All observers were clinically experienced registered nurses or medical doctors. Inter-rater reliability tests were performed with two data collectors simultaneously, but independently, observing a nurse and comparing data. Descriptive statistics were calculated for average task length, number of tasks per hour and proportion of nurses' time the task consumed.

Rates of interruptions and proportion of time multi-tasking were calculated. Data were analysed using SAS version 9. In year 1 nurses spent During an average 8. The categories of with who are not mutually exclusive with the exception of 'alone'. Overall, nurses completed Professional communication and medication tasks were the most frequent.

In the two year period the proportion of time spent on direct The proportion of time spent on medication tasks did not change, and that spent in professional communication Time spent in transit was the only other task type which significantly changed, falling from 7.

This is consistent with their reduced clinical role compared to registered nurses. Proportions of time spent in different tasks by nurse classification in Year 1 and Year 3. The average length of individual tasks ranged from 23 seconds in transit to 8. In total, nurses changed tasks on average every 55 seconds.

Average length of tasks by nurse classification in Year 1 and Year 3. Use of computers to complete tasks significantly increased over time from 1. Tasks completed with informal pieces of paper eg post-it notes and a phone did not significantly change over time. Number, average task length and overall percentage of tasks completed using specific information tools. The increases in time spent in direct and indirect care found in year 3 were distributed across the days of the week. One exception was medication tasks, which in year 1 consumed significantly more time on Mondays and less on Fridays.

In total the 57 nurses were observed for For 5. There were interruptions recorded, a rate of one every 32 minutes. The highest proportion of interruptions occurred when nurses were undertaking medication tasks In In year 1, nurses spent Two years later nurses spent This was predominantly due to a decrease in time nurses spent undertaking tasks with other nurses from In year 3, when nurses completed tasks with others, they did so more quickly than in year 1.

For example, the average time per task completed with another nurse in year 1 was There was no significant change in the percentage of tasks completed with others. For example, nurses spent 3. During an average nurse's shift of 8. Nurses spent approximately one third of their time with patients and this did not change over time.

There are surprisingly few studies which have sought to quantify the amount of time nurses spend in direct care activities with patients and we have identified no study which has examined changes over time. Hendrich et al [ 24 ] in a study of multiple units at Kaiser Permanente in the United States reported an average of In year 3 the nurses in our study had moved to allocation of patients to nursing teams, but this appears to have had no effect on proportion of time spent with patients.

A central question is the extent to which this amount of time ensures safe care. Surveillance of patients by nurses has been identified as important to detect patients who are deteriorating. Research by Aiken and colleagues [ 1 ] has highlighted the relationship between nurse surveillance and patient safety.

Surveillance relies on frequent interactions to be able to constantly monitor patients' conditions and provide opportunities to respond.

Research study nurses sit time