There are two phrases that I have thought about quite a bit over the last few months. The first is:
“Do more with less.”
The second is the opposite:
“Do less with more.”
Now, let me explain the first phrase before going to the second in the context of direct care.
As a direct care, bedside nurse, staff nurse or travel nurse (whichever phrase resonates with you the most), you are assigned a patient or group of patients for the shift. If in an Intensive Care Unit, Trauma Unit or other high acuity area where patients need one on one attention, you may only have one patient. All other areas typically have nurses assigned to multiple patients.
When I worked in direct care, I would have anywhere between 3 to 6 patients. The number varied depending on where I worked and also the acuity of the patients. Generally speaking, I knew going in for the day how many patients I may have for the shift.
Now, the purpose of this post is not to discuss the number but rather the many activities that are often “hidden in plain sight” to provide each of these patients the highest quality care.
Each patient requires assessments, vitals every set number of hours, medications, hourly checks (if not more frequently), and other patient specific interventions (e.g., tests, labs, therapies, transport).
As soon as the nurse finishes report with the off-going nurse, the day is a race.
A race to beat the clock.
At least that was how I felt nearly every single shift… (with some exceptions).
Have you ever tried to race the clock? What about every single day you worked?
This feeling is not ideal. You pick up your pace and it means that you have more to do than the clock can allow for at a normal pace.
Going into a shift, each nurse is prepared for this mindset. Where it becomes more challenging is when the clock gets tighter. This can happen when there are additional patients added on to an assignment or there is less help (e.g., clinical assistants, resource nurses, etc.) available that day to assist in the hunting and gathering that often is required to find the equipment, meds, and more for the patients.
This feeling of needing to do more with less can enter one’s mind.
However, what if we were able to do less with more?
My initial thought when I turned that phrase around was, ‘What does that even look like?‘
When I say do less, I do not mean less nursing care or less quality. I actually am referring to all of the “hidden in plain sight” hunting and gathering that eats away at a nurse’s day and contributes to this racing the clock mindset. Additionally, there is the mental struggle of deciding between “nursing the patient” or “nursing the computer” that nurses face multiple times a shift.
In the study, “Nurses’ Time Allocation and Multitasking of Nursing Activities: A Time Motion Study”, nurses’ spent 35% of their time in a patient room. Of the remaining 65%, the researchers found that 25% of the time was spent on EHR related documentation and 10% of the time on tasks that could be delegated out (e.g., the nurse is not required to complete). The remaining 30% was found to be related to communication interruptions.
While this is one study, there are many others that have recognized nurses’ time is not solely dedicated to patient care delivery with a larger than minimal percentage on other categories of activities.
So, how do we have nurses have more time for patient care and reallocate time from the other areas to do less of those actions?
I do not believe that this automatically requires more nurses. In some cases, likely yes. However, some activities could be improvements with technology. Some with workflow refinement and so forth.
This is what I mean by do less with more. Less interruptions. Less searching. Less hunting and gathering. Less documentation burden. With less of these activities, time gets freed up to spend more time on the top of license activities for patient care.
~Dr. Kelley
