Transforming nursing workflow, part 1: the chaotic nature of nurse activities

To quantitatively measure workflow and computer use, the activities of 27 medical-surgical RNs were recorded through direct observation.

Previous studies have shown how nurses spend their time but have not documented the pattern, duration, or frequency of activities. The absence of this information is problematic for leaders charged with improving performance and staff development.

Observers recorded nurse activities and location in real time using predefined lists. More than 98 hours of observations were recorded.

Assessment, charting, and communicating were the most frequent activities, consuming 18.1%, 9.9%, and 11.8% of nurse time, respectively. The duration of 40% of the activities was less than 10 seconds. Timelines revealed that nurses constantly switch activities and locations in a seemingly random pattern.

The results indicate that there is little "flow" in nurse workflow. The chaotic pace implies that nurses rarely complete an activity before switching to another. The opportunity to use critical thinking and engage in planning care is severely limited under these circumstances. The implications for cognition and role transformation are discussed. Part 2 of this research explores the impact of new technology on nurse activities and workflow.