Ten Ways to Increase Nurses' Time at the Bedside

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.

Keep supplies in close reach: Nurses spend hours hunting and gathering all the supplies they need during a shift, and often walk miles in the process, retrieving medications and then trekking from linen closet to storage room. Reducing the time nurses spend hunting and gathering for supplies is a vital step in increasing time spent in patient care. Keep patient rooms stocked with the items needed during a shift, such as commonly-used supplies (e.g., pre-filled syringes for flushing IV lines) and extra linens. Locating supply closets and nurses stations in central locations also decreases the miles nurses walk each day.

Outsource discharge follow-up calls: Phone calls to recently-discharged patients increase patient satisfaction and reduce the risk of readmission, but they don't have to be done by nurses on the unit. This is an ideal job for older nurses looking to decrease physically-taxing direct patient care.

Seek physician input: Physician involvement can be critical to the success of any time-saving project. Ask physicians about system improvements they can be involved with.

Ask nurses: The easiest way to know what will save nurses time is to ask them. Stop nurses in the hallway and ask about inefficiencies and they will name umpteen things that drive everyone nuts. Saving five minutes here and there all add up. Removing obstacles that hinder nurses' not only saves time, it also saves frustration.