How do ED nurses and physicians spend their time?

ED time study highlights staffing issues, finds surprising differences in duties

A study published in the January 1998 issues of Annals of Emergency Medicine examined the way nurses and physicians spent their time in the ED at Methodist Hospital in Indianapolis, IN.1 "There has been very little research in this area, and we felt that this would help managers to evaluate staffing patterns, determine how many nurses it takes to staff an ED, and increase productivity," explains Beverly Giles, RN, research nurse for the ED and one of the study's researchers.

A single investigator followed nurses and physicians for 180-minute periods, and recorded time spent on various activities, type and number of activities, and distance walked. Only one provider was studied for each observation period.

Since the study was done in a central city teaching hospital with a 36-bed ED, its results are mainly relevant to similar facilities. "We see 80,000 patients a year, so it would be interesting to do a similar study in a smaller community hospital to see if there is a significant difference," notes Giles. Here are some of the study's findings:

Physicians spent more time on indirect patient care than nurses. While physicians spent more than half their time on indirect care, such as charting, nurses spent approximately 40%. "With that in mind, nurses might consider finding ways to increase the time actually spent at the bedside with patients, instead of on paperwork," says Giles.

Nurses spent more time comforting patients. Nurses spent more than 2% of their time on comfort measures such as providing pillows or getting a glass of water, whereas physicians spent 0.5%.

Nurses walked further than physicians. "The actual amount of mileage that everyone walked surprised us," says Giles. An observer wore a pedometer and followed the staff member, at a discreet distance, to mimic their steps.

Nurses walked an average of 5.6 miles during a 12-hour shift (faculty physicians walked 2.4 miles and residents walked 4.5 miles). "We have to walk from room to room to gather supplies and medicines, often going from one side of the department to the other," Giles says. ED physicians often have physician extenders to do legwork, she notes.


1. Hollingsworth JC, Chisholm CD, Giles BK, et al. How do physicians and nurses spend their time in the emergency department? Ann Emerg Med 1998;31:87-91.