Journal Review

Hobgood C, Villani J, Quattlebaum R. Impact of emergency department volume on registered nurse time at the bedside. Ann Emerg Med 2005; 46:481-489.

ED nurses spend most of their time on indirect patient care — but they spend very little time on tasks that could be performed by ancillary staff, says this study from the Department of Emergency Medicine at the University of North Carolina in Chapel Hill.

During 2000 to 2002, researchers used direct observation of 49 nurses at one-minute intervals during 63 shifts, and they documented the amount of time nurses spend on direct patient care (25.6%), indirect patient care (48.4%), non-nursing care (6.8%), and personal time (19.1%). To see how volumes and acuity affected how nurses spend their time, researchers also collected staffing data, patient census, and patient triage scores every half-hour, but the results remained steady regardless of these variables.

"The study demonstrates that as nurse workload increases, nurses change their task allocation predictably, with direct patient care and indirect patient care rising in lockstep at the expense of nurse personal time," the researchers wrote.

The fact that ED nurses spent almost twice the amount of time on indirect patient care "should partially dispel the myth that the primary role of the skilled nurse is as a bedside care provider," say the researchers. Based on these findings, the researchers concluded that adding nonlicensed personnel such as nursing assistants, respiratory therapists, or phlebotomists to handle some tasks "might not be cost-effective, given the high costs of ancillary staff."

According to the researchers, more effective solutions include computerized documentation systems, more time-efficient charting, and automated dispensing systems.