Approximately 10% of the time during a nurse’s shift (e.g., workday) is spent on workarounds [1]. Workarounds arise due to systemic inefficiencies or barriers that complicate the ability to complete an activity needed for care delivery. Between 65 to 80% of nursing shifts are 12 hours in length. With 10% time lost to workarounds on a 12-hour shift, this equates to a total of 72 minutes (or 1.25 hours) per nurse lost to operational inefficiencies.
The median hourly wage for nurses across the United States is $41.38 [2]. Many states have a starting hourly wage higher while others lower than this rate. However, consistently across the U.S., nurses are not recognized as a billable service. Instead, nurses are (unfortunately) recognized as a cost to a healthcare organization [3] despite research evidence demonstrating the positive impact of nursing care on improving patient health outcomes [4].
Hospitals are broken into different care units and areas. I worked on a medical care unit, a medical/surgical unit, and a cardiac step-down unit during my years in direct care practice. I worked at three pediatric academic medical centers across the United States. As a bedside nurse, I was responsible for as few as 3 to as many as 6 patients per shift. The number of patients assigned depended on the severity of the patients’ collective care acuity needs and the staffing norms of the unit.
If we use the assumption that there are 8 nurses working on a patient care unit per shift, and each nurse is losing 72 minutes to inefficiencies, the unit loses 576 minutes or 9.6 hours per day! Now, with two shifts per day, that becomes a collective 19.2 hours lost to workarounds per patient care unit. A total of 19.2 hours times the average hourly wage of $41.38 per hour equates to a total of $794.50 per day per patient unit. Applying that daily cost to a full year equates to $289,992 of lost time per year for one patient care unit. Each hospital will have many units. If approximating one hospital to 10 care units, the cost then becomes $2.89 million in time lost over the course of the year. The average salary for a nurse in the US is $89,010. Thus, this equates to the cost of 32 nurses per year.
Now, these are general assumptions made about the number of nurses per unit and number of units per hospital or health system. However, the fundamental opportunity exists. How can nurses obtain 10% of their time back with the help of system (e.g., organizational) level changes while also helping to save costs of nurses that are not there (e.g., 32 nurses per year for example) There are many opportunities to do so. However, such help must be a collective effort between leadership within the healthcare organization and the nurses who are experiencing these challenges in care delivery.
[1] https://pubmed.ncbi.nlm.nih.gov/25102517/
[2] https://www.bls.gov/ooh/healthcare/registered-nurses.htm
[3] https://www.wolterskluwer.com/en/expert-insights/shifting-the-payment-paradigm-for-nurses-and-why-direct-reimbursement-is-critical
[4] https://www.nursing.upenn.edu/live/profiles/93-linda-aiken
