The Work of Adult and Pediatric Intensive Care Unit Nurses

Background:Researchers have used various methods to describe and quantify the work of nurses. Many of these studies were focused on nursing in general care settings; therefore, less is known about the unique work nurses perform in intensive care units (ICUs). Objectives:The aim of this study was to observe adult and pediatric ICU nurses in order to quantify and compare the duration and frequency of nursing tasks across four ICUs as well as within two discrete workflows: nurse handoffs at shift change and patient interdisciplinary rounds. Methods:A behavioral task analysis of adult and pediatric nurses was used to allow unobtrusive, real-time observation. A total of 147 hours of observation were conducted in an adult medical–surgical, a cardiac, a pediatric, and a neonatal ICU at one rural, tertiary care community teaching hospital. Results:Over 75% of ICU nurses’ time was spent on patient care activities. Approximately 50% of this time was spent on direct patient care, over 20% on care coordination, 28% on nonpatient care, and approximately 2% on indirect patient care activities. Variations were observed between units; for example, nurses in the two adult units spent more time using monitors and devices. A high rate and variety of tasks were also observed: Nurses performed about 125 activities per hour, averaging a switch between tasks every 29 seconds. Discussion:This study provides useful information about how nurses spend their time in various ICUs. The methodology can be used in future research to examine changes in work related to, for example, implementation of health information technology.

[1]  Stuart B. Boxerman,et al.  Describing Nurses' Work: Combining Quantitative and Qualitative Analysis , 2006, Hum. Factors.

[2]  Ann Page,et al.  Keeping patients safe. , 2011, Consumer reports.

[3]  Bruce Thompson,et al.  Practical Guide for Reporting Effect Size in Quantitative Research in the Journal of Counseling & Development , 2004 .

[4]  Richard Pak,et al.  Using a Task Analysis to Describe Nursing Work in Acute Care Patient Environments , 2009, The Journal of nursing administration.

[5]  B. Kuehn.  No End in Sight to Nursing Shortage , 2007 .

[6]  Colin Robson,et al.  Real World Research: A Resource for Social Scientists and Practitioner-Researchers , 1993 .

[7]  B. Kuehn.  No end in sight to nursing shortage: bottleneck at nursing schools a key factor. , 2007, JAMA.

[8]  Pascale Carayon,et al.  Development of a Job Task Analysis Tool for Assessing the Work of Physicians in the Intensive Care Unit , 2006 .

[9]  L. Aiken,et al.  Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. , 2002, JAMA.

[10]  Peter Buerhaus,et al.  Nurse-staffing levels and the quality of care in hospitals. , 2002, The New England journal of medicine.

[11]  Matthew B Weinger,et al.  Assessment of the Intrarater and Interrater Reliability of an Established Clinical Task Analysis Methodology , 2002, Anesthesiology.

[12]  Pascale Carayon,et al.  A human factors engineering conceptual framework of nursing workload and patient safety in intensive care units. , 2005, Intensive & critical care nursing.

[13]  S. Rough,et al.  Work redesign and role restructuring in a pharmacy department with pharmacist assistants. , 1996, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[14]  Matthew B Weinger,et al.  Multiple Measures of Anesthesia Workload During Teaching and Nonteaching Cases , 2004, Anesthesia and analgesia.

[15]  M. Weinger,et al.  Real–Time Assessment of Nurse Work Environment and Stress , 2011, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[16]  Howard B. Lee,et al.  Foundations of Behavioral Research , 1973 .

[17]  J. Marc Overhage,et al.  Research Paper: Controlled Trial of Direct Physician Order Entry: Effects on Physicians' Time Utilization in Ambulatory Primary Care Internal Medicine Practices , 2001, J. Am. Medical Informatics Assoc..

[18]  Ann E. K. Page.  Keeping Patients Safe: Transforming the Work Environment of Nurses , 2004 .

[19]  J. Marc Overhage,et al.  Controlled Trial of Direct Physician Order Entry , 2001 .

[20]  E. Patterson,et al.  Understanding the Complexity of Registered Nurse Work in Acute Care Settings , 2003, The Journal of nursing administration.

[21]  C. Coogler,et al.  Foundations of Behavioral Research 2nd ed , 1974 .

[22]  J. A. N. Eedleman,et al.  Nurse-Staffing Levels and the Quality of Care in Hospitals , 2002 .

[23]  D. Bates,et al.  Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. , 1997, Critical care medicine.

[24]  D M Gaba,et al.  The Effect of Electronic Record Keeping and Transesophageal Echocardiography on Task Distribution, Workload, and Vigilance During Cardiac Anesthesia , 1997, Anesthesiology.

[25]  L. Cranley,et al.  Impact of nursing on hospital patient mortality: a focused review and related policy implications , 2006, Quality and Safety in Health Care.

[26]  P. Carayon,et al.  Work system design for patient safety: the SEIPS model , 2006, Quality and Safety in Health Care.

[27]  Ann Hendrich,et al.  A 36-hospital time and motion study: how do medical-surgical nurses spend their time? , 2008, The Permanente journal.

[28]  T. Conine,et al.  Productivity of respiratory therapy personnel. , 1979, Respiratory care.

[29]  Edward G. Carmines,et al.  Reliability and Validity Assessment , 1979 .

[30]  Matthew B. Weinger,et al.  Effects of Intraoperative Reading on Vigilance and Workload during Anesthesia Care in an Academic Medical Center , 2009, Anesthesiology.

[31]  G Hendrickson,et al.  How Do Nurses Use Their Time? , 1990, The Journal of nursing administration.

[32]  Matthew B Weinger,et al.  Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system , 2003, Critical care medicine.