Impact of emergency department volume on registered nurse time at the bedside

Cherri Hobgood, John Villani, Robert Quattlebaum

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Study objective: We determine how emergency department (ED) registered nurses (RNs) allocate their time between various tasks and describe how RN task distribution changes as a function of various measures of ED patient volume and patient acuity. Methods: This is a 3-year direct observational study using a convenience sample of 63 8-hour nurse shifts. Four RN task categories were defined: (1) direct patient care, (2) indirect patient care, (3) non-RN care, and (4) personal time. Two measures of nurse workload were used, the patient-to-nurse ratio and the ED acuity index (ED acuity index=(Σ reverse order triage scores/half hour)÷total number of nurses staffing). Trained observers classified RN activity at 1-minute intervals during 8-hour shifts daily for 7 nonconsecutive 24-hour periods. RN staffing data, ED patient census, and patient triage scores were collected every half hour. Summary statistics, correlation tables, and regression analysis were used to establish relationships between RN task allocation, patients per nurse, and the ED acuity index. Results: For the 63 nursing shifts studied, on average RNs spent 25.6% of their time performing direct patient care, 48.4% on indirect patient care, 6.8% on non-RN care, and 19.1% on personal time. Regardless of the number of patients per RN, approximately twice as much time is spent on indirect patient care as direct patient care. The correlation between the ED acuity index and the patient-to-nurse ratio was 0.98. Conclusion: Regardless of workload, RNs spend the majority of their time performing indirect patient care. RNs spend little time performing tasks that could be performed by ancillary staff. The patient-to-nurse ratio performs just as well as a more complicated acuity index to measure the workload of RNs within an ED.

Original languageEnglish (US)
Pages (from-to)481-489
Number of pages9
JournalAnnals of Emergency Medicine
Volume46
Issue number6
DOIs
StatePublished - Dec 2005
Externally publishedYes

Fingerprint

Hospital Emergency Service
Nurses
Patient Care
Workload
Patient Acuity
Triage
Censuses
Observational Studies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Impact of emergency department volume on registered nurse time at the bedside. / Hobgood, Cherri; Villani, John; Quattlebaum, Robert.

In: Annals of Emergency Medicine, Vol. 46, No. 6, 12.2005, p. 481-489.

Research output: Contribution to journalArticle

Hobgood, Cherri ; Villani, John ; Quattlebaum, Robert. / Impact of emergency department volume on registered nurse time at the bedside. In: Annals of Emergency Medicine. 2005 ; Vol. 46, No. 6. pp. 481-489.
@article{193e9c8eecc24f0698fbf084a3a9e190,
title = "Impact of emergency department volume on registered nurse time at the bedside",
abstract = "Study objective: We determine how emergency department (ED) registered nurses (RNs) allocate their time between various tasks and describe how RN task distribution changes as a function of various measures of ED patient volume and patient acuity. Methods: This is a 3-year direct observational study using a convenience sample of 63 8-hour nurse shifts. Four RN task categories were defined: (1) direct patient care, (2) indirect patient care, (3) non-RN care, and (4) personal time. Two measures of nurse workload were used, the patient-to-nurse ratio and the ED acuity index (ED acuity index=(Σ reverse order triage scores/half hour)÷total number of nurses staffing). Trained observers classified RN activity at 1-minute intervals during 8-hour shifts daily for 7 nonconsecutive 24-hour periods. RN staffing data, ED patient census, and patient triage scores were collected every half hour. Summary statistics, correlation tables, and regression analysis were used to establish relationships between RN task allocation, patients per nurse, and the ED acuity index. Results: For the 63 nursing shifts studied, on average RNs spent 25.6{\%} of their time performing direct patient care, 48.4{\%} on indirect patient care, 6.8{\%} on non-RN care, and 19.1{\%} on personal time. Regardless of the number of patients per RN, approximately twice as much time is spent on indirect patient care as direct patient care. The correlation between the ED acuity index and the patient-to-nurse ratio was 0.98. Conclusion: Regardless of workload, RNs spend the majority of their time performing indirect patient care. RNs spend little time performing tasks that could be performed by ancillary staff. The patient-to-nurse ratio performs just as well as a more complicated acuity index to measure the workload of RNs within an ED.",
author = "Cherri Hobgood and John Villani and Robert Quattlebaum",
year = "2005",
month = "12",
doi = "10.1016/j.annemergmed.2005.07.014",
language = "English (US)",
volume = "46",
pages = "481--489",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Impact of emergency department volume on registered nurse time at the bedside

AU - Hobgood, Cherri

AU - Villani, John

AU - Quattlebaum, Robert

PY - 2005/12

Y1 - 2005/12

N2 - Study objective: We determine how emergency department (ED) registered nurses (RNs) allocate their time between various tasks and describe how RN task distribution changes as a function of various measures of ED patient volume and patient acuity. Methods: This is a 3-year direct observational study using a convenience sample of 63 8-hour nurse shifts. Four RN task categories were defined: (1) direct patient care, (2) indirect patient care, (3) non-RN care, and (4) personal time. Two measures of nurse workload were used, the patient-to-nurse ratio and the ED acuity index (ED acuity index=(Σ reverse order triage scores/half hour)÷total number of nurses staffing). Trained observers classified RN activity at 1-minute intervals during 8-hour shifts daily for 7 nonconsecutive 24-hour periods. RN staffing data, ED patient census, and patient triage scores were collected every half hour. Summary statistics, correlation tables, and regression analysis were used to establish relationships between RN task allocation, patients per nurse, and the ED acuity index. Results: For the 63 nursing shifts studied, on average RNs spent 25.6% of their time performing direct patient care, 48.4% on indirect patient care, 6.8% on non-RN care, and 19.1% on personal time. Regardless of the number of patients per RN, approximately twice as much time is spent on indirect patient care as direct patient care. The correlation between the ED acuity index and the patient-to-nurse ratio was 0.98. Conclusion: Regardless of workload, RNs spend the majority of their time performing indirect patient care. RNs spend little time performing tasks that could be performed by ancillary staff. The patient-to-nurse ratio performs just as well as a more complicated acuity index to measure the workload of RNs within an ED.

AB - Study objective: We determine how emergency department (ED) registered nurses (RNs) allocate their time between various tasks and describe how RN task distribution changes as a function of various measures of ED patient volume and patient acuity. Methods: This is a 3-year direct observational study using a convenience sample of 63 8-hour nurse shifts. Four RN task categories were defined: (1) direct patient care, (2) indirect patient care, (3) non-RN care, and (4) personal time. Two measures of nurse workload were used, the patient-to-nurse ratio and the ED acuity index (ED acuity index=(Σ reverse order triage scores/half hour)÷total number of nurses staffing). Trained observers classified RN activity at 1-minute intervals during 8-hour shifts daily for 7 nonconsecutive 24-hour periods. RN staffing data, ED patient census, and patient triage scores were collected every half hour. Summary statistics, correlation tables, and regression analysis were used to establish relationships between RN task allocation, patients per nurse, and the ED acuity index. Results: For the 63 nursing shifts studied, on average RNs spent 25.6% of their time performing direct patient care, 48.4% on indirect patient care, 6.8% on non-RN care, and 19.1% on personal time. Regardless of the number of patients per RN, approximately twice as much time is spent on indirect patient care as direct patient care. The correlation between the ED acuity index and the patient-to-nurse ratio was 0.98. Conclusion: Regardless of workload, RNs spend the majority of their time performing indirect patient care. RNs spend little time performing tasks that could be performed by ancillary staff. The patient-to-nurse ratio performs just as well as a more complicated acuity index to measure the workload of RNs within an ED.

UR - http://www.scopus.com/inward/record.url?scp=27944501529&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=27944501529&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2005.07.014

DO - 10.1016/j.annemergmed.2005.07.014

M3 - Article

C2 - 16308058

AN - SCOPUS:27944501529

VL - 46

SP - 481

EP - 489

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 6

ER -