Finding more time for direct patient care during a nurse’s shift is no easy feat. Ask any nurse why s/he wanted to become a nurse, and the response is likely to be: to help those who are suffering. But studies show that nurses lose about 3 hours of patient care every 12-hour shift to non-direct care tasks. Nurses are spending a majority of their day performing tasks that offer the least benefit to their patient. Hunting for equipment, tracking down medications, waiting in line for supplies, filling out paperwork, searching for missing test results – all of these tasks take nurses away from direct care.
Further research has revealed that direct patient care accounts for less than 50% of a nurse’s working hours. So how can nurses ensure more direct patient care time?
On a primary level, clinical workflow represents a sequence of duties, such as a nurse’s activities related to patient care on a given day, on a given unit. Elevating workflow to a higher level, however, is a pattern of processes for information processing. Sounds complicated, because it is. Let’s simplify by looking at time as a resource much like money, technology, energy, and most of all, people - other members of the health care team.
Some nurses spend energy walking as many as 5 miles around the hospital in a single shift. So for every mile walked, here are 5 tips to finding time for the patient:
1. Hourly rounding: Studies have shown the benefits of an hourly rounding system, where nurses visit each patient at specified times, which reduces call-bells. Patients feel assured knowing their nurse will be in to see them regularly, so they don't use the call bell as often. This increases nurses' ability to complete their tasks without constant interruption.
2. Electronic medication administration records: eMARs can save time for all caregivers by making it easy to access a list of the patient’s medications while simplifying medication administration for bedside nurses.
3. Bedside reporting/medication administration/documentation: Bedside shift reporting saves time, strengthens communications between shifts, and improves patient safety. Charting at the bedside improves patient safety, but it's also been shown to save time, notably with available technology such as computer carts that can be wheeled to patients' beds. When implementing EHRs, involve bedside caregivers in the process to ensure that it's user-friendly and avoids duplicating efforts. Similar to eMARs, bedside medication administration removes inefficiencies and improves patient safety. Using standardized tools, such as SBAR, provide communication checklists and ensure appropriate information is conveyed.
4. Keep supplies in close reach: Nurses spend hours hunting and gathering all the supplies they need during a shift, and often walk miles in the process. Maximize storage space by stocking patient rooms with the items needed during a shift, such as commonly-used pre-filled syringes for flushing IV lines and extra linens. Situating supply closets and nurses stations in central locations is another time saver.
5. Improve teamwork by improving communications: Collaborating as a team while maximizing available resources fosters communication within the integrated health care team. Redirecting more routine tasks to an LVN or CNA is a win-win. Knowing when to delegate is key to building teamwork as well as effectively managing time and maximizing resources. Building nurse-physician teamwork by seeking physician input allows nurses to work in collaboration, which can be critical to utilizing time efficiently and effectively. Doing more together ultimately benefits the patient while maximizing direct patient care.
Tell us what you do to streamline clinical workflow. What ideas do you have for finding more time to spend on direct patient care? Comment below!