Ten Ways to Increase Nurses' Time at the Bedside

Rebecca Hendren, March 16, 2010

Bedside nurses are occupied in non-patient care tasks for a quarter of their shifts, according to a new survey. The report shows nurses lose three hours of patient care every 12-hour shift to non-direct care tasks, such as redundant paperwork and regulatory requirements. I've seen other studies that predict nurses spend as little as 30% of their time with patients.

Time away from the bedside, often spent on frustrating and exhausting tasks, increases stress and burnout. Decreasing distractions that take nurses away from patient care benefits both nurses and patients. Studies show a direct correlation between increasing nursing hours per patient day and a reduction in patient morbidity, such as urinary tract infections and pneumonia.

How can healthcare organizations help their nurses spend more time in patient care? Here are 10 successful strategies:

Hourly rounding: Incessant call lights going off decrease nurses' productivity by taking them away from what they were doing to attend to patients' immediate needs. Studies have shown the benefits of moving to an hourly rounding system, where nurses visit each patient at specified times to check on them, attending to pains, position, and bathroom requests. This reduces call-bells and ensures those calls are more important to patients' wellbeing. Patients know their nurse will be in to see them regularly, so they don't use the call bell as often. This increases nurses' ability to complete their tasks without constant interruption.

Bedside reporting: In traditional shift to shift reporting, nurses spend the end of their shift (and often into overtime) transcribing or taping a report for the oncoming nurse, who then spends the first portion of his or her shift reading the notes or listening to the tape. Bedside shift reporting saves time and allows the incoming nurse to ask questions. It also improves patient safety by involving the patient and ensuring patient and caregivers are on the same page.

Bedside documentation: Charting at the bedside improves patient safety, but it's also been shown to save time, especially with the help of technology such as computer carts that can be wheeled to patients' beds. Electronic health records take time to learn and all too often are unwieldy and duplicative, however, causing nurses to find work-arounds that may save time, but circumvent patient safety. When implementing EHRs, involve bedside caregivers in the process to ensure it's user-friendly and avoids duplicating efforts.

Electronic medication administration records: eMARs can save time for all caregivers, for example, by making it easy to access a list of medications a patient is taking, and simplify medication administration for bedside nurses. As with EHRs, if the program is not developed with input from end users, it may add to inefficiencies and even take far longer.

Bedside medication administration: Similar to eMARs, bedside medication administration removes inefficiencies and improves patient safety, but only if the process works for caregivers.

Patient handoffs: Using standardized tools, such as SBAR, provide communication checklists and ensure appropriate information is conveyed swiftly and smoothly.

Rebecca Hendren Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits www.StrategiesForNurseManagers.com and manages The Leaders' Lounge blog for nurse managers. Email her at rhendren@hcpro.com.
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