ABSTRACT

Staff nurses are health care personnel, who are directly responsible to provide
nursing care services to the clients. They are also responsible to manage multiple
tasks of patient care. In India very few studies have been conducted on Time
Utilization by Nurses in different patient care activities.
An observational study was conducted to assess the nurses time utilization in
selected activities in critical care units of Ludhiana from June 1 to June 6, 2009.
Total 72 staff nurses were purposively selected from all shifts for study. Out of
them 24 staff nurses were observed on morning shift, 26 on evening shift and 22 on
night shift. Ward incharges were not included in this study. Data was collected
using an observational proforma in order to record the time utilized by nurses in
selected activities. After that the data was analyzed by using descriptive and
inferential statistics which is presented in the form of tables and figures.
The findings of the study revealed that all staff nurses utilized maximum time in
direct patient care activities (46.15%)and minimum time in indirect patient care
activities (17.27%) where as (36.56 %) of total time was utilized in non productive
activities per day.
In the morning shift, the nurses utilized their maximum time in direct patient care
activities (53.11%) where as minimum time was utilized in indirect patient care
activities (29.05%). Similarly in the evening shift, they utilized their maximum
time in direct patient care activities (47.79%) and minimum time in indirect patient
care activities (18.72%). However in the night shift, the maximum time was
utilized by nurses in non productive activities (42.87%) and minimum time in
indirect patient care activities (16.11%).
Study concluded that maximum time utilized by nurses in direct patient care
activities was in assessing and examining the patient (18.93%) and minimum time
in wound dressing (1.74%) during all duty shifts.

Where as in indirect patient care activities, the maximum time was utilized in
maintenance of records and reports of the patients (48.16%) and minimum time
was in communication with staff (7.70%) during all duty shifts.
However in non-productive activities maximum time was utilized by nurses in
gossiping (38.92%) and minimum time was in attending personal calls (7.89%)
during all duty shifts.
It is recommended that there should be a keen supervision of nursing personnel
during evening and night shifts so that more time can be utilized in direct patient
care activities rather than non productive activities.

CHAPTER - 1
BACKGROUND OF THE STUDY
1.1 Introduction
Time management means to handle time with a degree of great care and skills.
Since being nurses we cannot view time as a concrete three dimensional object;
independent of events. For us our time management means skillfully
accomplishing the patient care events during our shift.

Staff nurses manage

multiple tasks of patient care in the given time period. They have the responsibility
to delegate task to unlicensed assisting personnel and are accountable for their
actions as well as the actions of those under supervision, (Navuluri. B. Ramesh,
2004).1
The different functions that are centered out in a patient in a ward are care of the
sick, promotion of health and prevention of disease, educating the workers in the
hospital service and involved in research activities. Sometime nurses are also made
to do job of non nursing personnel e.g. keeping records of linens, making medical
cards etc. These works can be accomplished by clerks making it possible for the
nurse to give more time for patient care in the ward, (Joamme, 1993) 2.
Ward administration implies to the general management of the unit which include
organization of money, material and manpower. Job responsibilities are to be
delegated to nursing staff for smooth running of unit and to avoid confusion. It is
impossible for a person to perform a number of duties single handed in a
satisfactory way. The kind and number of nursing personnel needed in a special
ward of the hospital can be determined before hand; there must be a proper
delegation of responsibility among nurses working in a ward. All the nurses are
directly related to the kind of the patient care and follow up, (Arallone, 1998) 3.

The nurses are responsible for providing care and managing the therapeutic
environment. In 1978 a classic study was conducted by the Division of Nursing
who defined four categories of nursing care i.e. direct patient care, indirect care,
unit related activities and personal activities. Direct care was defined as all nursing
care activities performed in the presence of patient or family where as indirect care
was all nursing care activities done away from the patient but on a specific
patients behalf. How ever unit related activities were those which were related to
general maintenance of the nursing unit and not patient specific. Although personal
activities were activities related to meals, breaks and socialization with co-workers,
(Margret Mc Clure, 1991) 4.
Many studies reveal the nurses dissatisfaction with staffing due to overload with
non nursing activities, which keep away the skilled hands from providing bed side
care. Improper distributions of unit activities hinder the nurses in providing
comprehensive care to the patients; making them unable to manage their time
efficiently.
Few studies that looked at how nurses spend their time found patient care taking a
backseat to activities such as documentation, administering medication, and
coordinating care. It was concluded that less than half of the nurses' time was spent
on hands-on care meaning that nurses spent a majority of their day performing
tasks that offered the least benefit to their patients.

1.2 Need of the study

The traditional role of the nurse is to provide direct patient care in the hospital
settings. These days nurses are overloaded with administration and other activities,
which remove them from direct contact with patient. She has been forced by nature
of hospital organization to act as a receptionist, housekeeper, clerk, dietician,
storekeeper and supervisor. Thus having little time or no time for practice of
nursing. Therefore this research will help to know the time utilized for actual
patient care rather than other activities. This study will not only help the
investigator to strengthen their clinical skills and confidence in the management of
ward and time, but it will enhance development of nursing profession.
1.3 Problem statement
An observational study to assess the Nurses time utilization in selected activities at
critical care units of DMCH, Ludhiana, Punjab, 2009.
1.4 Objectives
To assess the total time available and utilized by the nurses in selected
activities.
To assess time utilized by nurses in selected activities during three shifts.

1.5 Operational Definitions

Staff nurse: A person who is graduated from recognized nursing institute and
working as a registered staff (RN/RM) in critical care units of, Ludhiana.
Time utilization: In present study nurses time utilization was measure for direct,
indirect patient care and non productive activities during each duty shift i.e.
morning (8am to 2pm), evening (2pm to 8pm), night (8pm to 8am).
Critical care unit: A specially equipped hospital area designed for the treatment
of patients with sudden life-threatening conditions. CCUs contain resuscitation
and monitoring equipment and are staffed by personnel specially trained and
skilled in recognizing and immediately responding to cardiac and other
emergencies.
Direct patient care: It is a process in which nursing skills are utilized for direct
patient contact rather than other activities.
Indirect patient care: An indirect patient care intervention is the treatment
performed away from the patient. It includes nursing actions aimed at
management of the patient care environment and interdisciplinary collaborations.
Non productive activities: These are the activities of staff nurses that produce
no benefit to the patient but are of their personal interest. It includes taking
breaks, attending personal calls, gossiping etc.

1.6 Delimitations
1. The study was limited to nurses working in critical care units of, Ludhiana.
2. The study was limited to a small sample i.e. 72 nurses.
3. The study was conducted on a sample selected by purposive sample
technique.
4. The study was not a measure of effectiveness and quality of care provided by
nurses under study.

1.7 Difficulties faced by investigators

1. Difficulty to gain confidence of nurses and keep the study confidential in the
beginning.
2. In night duty hours it was very difficult to observe them continuously for 12
hours as there was no chair for investigators to sit for even few minutes.
3. Difficulty in taking breaks in all shifts due to continuous participatory
observation.
4. Staff nurses of critical care units insisted investigators to take rest especially
in night duties in resting room.