PubMed · 15199711
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Sue Cameron. A streamlined service.. https://doi.org/10.7748/ns2004.06.18.38.96.c3620
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STUDY OBJECTIVE: We determine how emergency department (ED) registered nurses (RNs) allocate their time between various tasks and describe how RN task distribution changes as a function of various measures of ED patient volume and patient acuity. METHODS: This is a 3-year direct observational study using a convenience sample of 63 8-hour nurse shifts. Four RN task categories were defined: (1) direct patient care, (2) indirect patient care, (3) non-RN care, and (4) personal time. Two measures of nurse workload were used, the patient-to-nurse ratio and the ED acuity index (ED acuity index=(Sigma reverse order triage scores/half hour)/total number of nurses staffing). Trained observers classified RN activity at 1-minute intervals during 8-hour shifts daily for 7 nonconsecutive 24-hour periods. RN staffing data, ED patient census, and patient triage scores were collected every half hour. Summary statistics, correlation tables, and regression analysis were used to establish relationships between RN task allocation, patients per nurse, and the ED acuity index. RESULTS: For the 63 nursing shifts studied, on average RNs spent 25.6% of their time performing direct patient care, 48.4% on indirect patient care, 6.8% on non-RN care, and 19.1% on personal time. Regardless of the number of patients per RN, approximately twice as much time is spent on indirect patient care as direct patient care. The correlation between the ED acuity index and the patient-to-nurse ratio was 0.98. CONCLUSION: Regardless of workload, RNs spend the majority of their time performing indirect patient care. RNs spend little time performing tasks that could be performed by ancillary staff. The patient-to-nurse ratio performs just as well as a more complicated acuity index to measure the workload of RNs within an ED.
This paper explores the nature of nurse-patient relationships in accident and emergency (A&E) drawing from nursing theory and research, and with reflection on three episodes of practice from the author's experience. First the case for nurse-patient relationships is presented with reference to nursing theory, statutory and professional literature. The benefits of positive nurse-patient relationships in A&E are then explored, followed by a discussion of the barriers to nurse-patient relationships forming in A&E. How relationships are formed is then considered, highlighting the short space of time available, and the importance of first impressions. The first practice episode analysed is a situation where the author felt she had not formed a relationship with the patient at all. In the second, the author questions whether the relationship had been over-involved and this is discussed in relation to the nature of involvement and what constitutes over-involvement. In the final practice episode the author felt that a positive relationship was formed with benefits to the patient concerned. The paper concludes by highlighting the importance of nurse-patient relationships in A&E, and how they can be formed in light of the barriers discussed previously.