Ten Ways to Increase Nurses' Time at the Bedside

Rebecca Hendren, for HealthLeaders Media , 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.

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2 comments on "Ten Ways to Increase Nurses' Time at the Bedside"

nurseS (8/14/2013 at 7:05 PM)
I agree this is not for the nursing world today. I speak from using these exact "ten ways to increase nurses time at the bedside" for the last 3 years now....It is not possible. I work in a trauma hospital and get 6-7 pts per RN, and you are pulled in too many directions from the start and cannot possibly assess pt's, pass tons of meds, listen and address pt concerns & questions, and chart on every pts IV/PCA/Epidurals, etc and the rest of the bazillion required charting items and to round hourly in addition. Also, overview to the charge RN, labs to check off for draw, now doing our own IV's, EKG's, and working with less all the time. Yet we are expected to keep doing all and more without getting lunches or potty breaks. I enjoy helping others back to health and educating them, but those who enforce these outrageous expectations onto the RN without regard to his/her health should really keep there nose out of the bedside RN's business and let another bedside nurse come up with the best strategy to be at the bedside. Leave it to the true expert, not the one who no longer is....

Eva June Velez (2/25/2011 at 3:15 PM)
I agree to these strategies but did you consider the number of patients the nurses are loaded with? How many patients the nurses could have for these strategies be effective? In just first visit out of 7 patients during rounding report, calls start asking for pain meds, patient hurry to discharge pending from morning shift, patient ask assistance to bathroom etc, family wants to speak with the nurse, doctors awaiting in telephone line, giving orders to be carried out, doctors waiting in the nurses station wants to speak with the nurse, awaiting blood transfusion, unfinished admission process and many more variables in the patient environment....how could a rounding report plus assessment be feasible to be done by incoming and outgoing nurse to balance her time accommodating all her patient's needs and demands, time for doctor concerns, carrying out orders, documentation, and unexpected other responsibilities? i appreciate your response..




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