Reorganizing nursing work on surgical units: a time-and-motion study.

A time-and-motion study was conducted in response to perceptions that the surgical nursing staff at a Montreal hospital was spending an excessive amount of time on non-nursing care. A sample of 30 nurse shifts was observed by trained observers who timed nurses' activities for their entire working shift using a hand-held Personal Digital Assistant. Activities were grouped into four main categories: direct patient care, indirect patient care, non-nursing and personal activities. Break and meal times were excluded from the denominator of total worked hours. A total of 201 working hours were observed, an average of 6 hours, 42 minutes per nurse shift. The mean proportions of each nurse shift spent on the main activity categories were: direct care 32.8%, indirect care 55.7%, non-nursing tasks 9.0% and personal 2.5%. Three activities (communication among health professionals, medication verification/preparation and documentation) comprised 78.9% of indirect care time. Greater time on indirect care was associated with work on night shifts and on the short-stay surgical unit. Subsequent work reorganization focused on reducing time spent on communication and medications. The authors conclude that time-and-motion studies are a useful method of monitoring appropriate use of nursing staff, and may provide results that assist in restructuring nursing tasks.