March 17, 2006

Study tracks how nurses spend time

Featured Image

Venus Manuel, R.N., a Medical Surgical nurse on 8 South, wears radio frequency identification tags that track her activity every two seconds as part of the Robert Wood Johnson Time & Motion study. Personal digital assistants (PDAs), below, are also being used by nurses taking part in the study.
Photos by Dana Johnson

Study tracks how nurses spend time

Nurses in VUMC's Medical Surgical Department are participating in a national study tracking how much time they spend performing the many duties required of them.

This effort is part of a Robert Wood Johnson “Time and Motion Study” taking place at more than two dozen clinically diverse health care systems across the country, and is aimed at helping to identify an ideal, evidence-based nursing unit.

At issue is how much time nurses spend in a variety of duties. Previous studies have shown that often less than 20 percent to 30 percent of the hours budgeted per patient per day is time spent delivering direct care. Typically, nurses spend up to 50 percent of their time doing paperwork and often travel miles during their shift.

“This study isn't just about the design of the unit. It is about how we do our work differently,” said Marilyn Dubree, M.S.N., Vanderbilt's chief nursing officer. “We are all the time trying to look at ways — either individually or as teams — to take better care of our patients. The ways that we've done that in the past are not going to be the ways we need to do it in the future because of changes in patients and technology. As leaders, we need to live in that space of innovation.”

This study hopes to identify specific environmental variables that can be altered to have a positive impact on direct care and, ultimately, patient safety. The study is designed to provide information about the amount of time nurses spend doing specific activities, the movements of nurses through the unit during a typical shift and the physical impact of nursing workload and stress.

“So far, researchers have spent more time looking at emergency departments, operating rooms or ICUs,” said JoAnne Immesberger, the study's project manager. “But if Med Surge isn't working right, chances are that a number of those other areas are impacted.”

Data will be collected over seven consecutive days for 24 hours each day. The 23 different nurses taking part in the study will be monitored using a combination of personal digital assistants (PDAs), radio frequency tags and armbands.

To get a baseline for electronic health record implementation, some of the nurses will simply turn on their PDA when they start charting and select which type of document they are working on. To measure how nurses spend time, other nurses will carry a PDA that will vibrate randomly throughout the day, which is a cue to enter their location and activity. Each of the participating nurses is wearing four radio frequency tags that emit to 42 receivers placed through the 18,000-square-foot unit to measure the distance traveled in the nursing unit.

Nine of the nurses in the study are also wearing a BodyMedia armband for 23 hours a day (at work and at home) to measure the physiological variables associated with stress such as heat flux, galvanic skin response, skin temperature and calories burned per minute at peak activity levels.

Venus Manuel is a registered nurse participating in the study, using the PDA that vibrates as well as the radio frequency tags.

“I want to take part in helping provide better nursing care. It doesn't take a whole lot of time, just two clicks on the PDA and I'm done. I don't even feel like the frequency tags are there,” she said.

“We feel an obligation to affect nursing across the nation,” said Robin Steaban, administrative director of both cardiovascular and inpatient medicine. “It's been an incredible couple of months, with so many new things introduced on the unit, but our Med Surge nurses are amazing and resilient.”

This is the second phase of the three-phase study. The entire study is scheduled for completion by the end of the year.