Time allocated on different tasks among nurses in Bangladesh:
An observational time–motion study
Mizue Hiura1*, Salma Afroz Lily2, Shampa Sengupta3, Yoko Yamamoto4,
Khandoker Sayeda Khatun5
1Chief Advisor, The Project for Strengthening In-service Training System in Cambodia, Cambodia.
2Nursing Instructor, Dhaka Nursing College, Bangladesh.
3Mid Career Consultant, CBNS Project, Phase-II, Bangladesh.
4Research Associate, Faculty of Nursing, Kansai Medical University, Japan.
5Nursing Supervisor, BIRDEM General Hospital, Bangladesh.
*Corresponding Author E-mail: mizue.hiura@jicastrings.com, mizuehwu@hotmail.com
ABSTRACT:
It is important to identify the time allocated by nurses for different tasks to improve the quality of nursing care and patient outcome. Hence, this time–motion study aimed to determine the time spent on specific activities and the factors contributing to the time allocated by nurses at public and private hospitals in Bangladesh. The data was collected from March to May 2021, and the nursing activities of 52 nurses at surgical wards were identified by observing them through day shifts (8:00am – 2:00pm) on weekdays. The proportions of time in 10 categories were calculated, and relationships of nurses' characteristics were examined. Nurses commonly spent their time on direct care (17.0%), followed by medication administration (15.3%), indirect care (14.2%), personal activities (12.3%), and documentation (11.1%). There was no significant relationship between the duration of providing direct and indirect care and medication administration as well as the characteristics of nurses (such as age, sex, and duration of working experience, educational background, and patient-to-nurse ratio). However, public and private hospitals significantly differed in terms of the proportion of time spent by nurses on documentation, administrative tasks, in-transit work, supervision/education, and social activities. Compared with some studies conducted in 2007, the time allocated on direct care has increased particularly in public hospitals; however, nurses also spend significant time on personal and social activities. There is a need to assess the time spent on nursing tasks and to facilitate a closer supervision to achieve efficient time management.
KEYWORDS: Documentation, Hospitals, Nurse, Time and motion studies, Time management.
INTRODUCTION:
A nurse’s workload is multifunctional, and it includes both direct and indirect care. Direct care includes activities directly associated with patient care1. Meanwhile, indirect care comprises patient-related activities2, such as hand washing, care planning, and test ordering, which are not performed at the bedside.
Additionally, unit-related activities, including the management of units and co-ordinating the nursing workload for patients’ care3, need to be performed. Some studies have shown an association between the time nurses spend on direct care and better patient outcomes, fewer errors4,5, and high patient satisfaction6.
According to an observational study, the total times that nurses spent directly with patients were approximately 19.3% in the USA7 and 37% in Australia8. More than 80% of the time is spent on direct and indirect care, medication administration, and professional communication1. Another study conducted in critical care settings revealed that nurses spent 53% of their time providing direct care; the duration of nursing tasks was significantly associated with the type of unit, nurse-to-patient ratio, patient characteristics, and diagnosis9. There has been a severe shortage of nurses in Bangladesh. In 2020, the density of nurses was 3.6 per 10,000 individuals. In 2018, the existing nursing–midwifery workforce did not meet the limit of 1:0.56, which is the international standard10. In 2030, the projected nurses’ shortage range is 300,000–400,00011. This condition has affected nursing activities and interventions. This could explain why nurses from Bangladesh do not provide active, hands-on care to patients like the British nursing model, which was introduced decades ago12. Another study revealed that nurses in public and private hospitals spent 5.3% and 22.7% of their time directly with patients, respectively12. These findings might be attributed to the poor-quality nursing care provided and the fact that family members are often caregivers who provide direct care and that the role of nurses is not evident in Bangladesh.
Moreover, there is a conflict between the British model of nursing and Bangladesh social norm, indicating that nursing has been historically considered a low-prestige job13. Hindus considered touching bodily secretions a lower castes’ task, and the Bangladeshi Islamic culture prohibits physical touching between non-family members13. Family members generally provide direct care to patients, such as bathing and feeding, in hospitals. Nurses should keep their distance from patients to avoid stigma and social misconceptions about the nursing profession by allowing patient’s relatives and support workers to provide direct care13. These factors might have a long-term influence on nurse–patient interaction and nursing tasks.
Since 2016, the government has taken several initiatives to increase the number of nurses (15,000) in health facilities for addressing the severe shortage of the nursing workforce10,14. Furthermore, in 2011, the government upgraded the nursing posts from the third to second class to enhance nursing services and promote nursing career development15.
Recent developments have shown prospects in nursing; however, there are still some challenges. Therefore, the scope of nursing responsibilities must be assessed to ensure adequate human resources and workforce management16,17. Additionally, information regarding the time allocated by nurses is required to maximize the quality of care18 or the care delivery model. However, since the study of Hadley & Roques in 2007, only a few have reported how nurses allocate time on multiple tasks in an inpatient environment.
This study aimed to assess the time spent by nurses on various tasks in public and private hospitals and to validate how the work patterns of nurses have changed over the decade in Bangladesh. Additionally, the factors contributing to the time spent by nurses were evaluated.
MATERIALS AND METHODS:
Study design and setting:
The current cross-sectional observational time–motion study was conducted to identify the patterns of nursing tasks. Data were collected between March and May 2021. The study was performed at four general surgical wards at academic/tertiary-level public and private hospitals in Dhaka, Bangladesh. This research excluded nurses from internal medicine wards to prevent the effects of bed adjustments during the COVID-19 pandemic, which started in 2019. The targeted wards in public hospitals had 58 beds, whereas private hospitals had 33 beds. The wards of both hospitals had a three-shift system. In Bangladesh, the number of patients is generally higher than the number of beds, and the bed occupancy rate occasionally exceeds 100%, particularly in public hospitals. In relation to this, the nurse-to-patient ratio on the survey day was adopted.
The participants were registered nurses who were working full-time at the selected surgical wards of each hospital. The targeted sample size was 52(n = 26, each hospital), and two independent group comparisons were performed using R statistics (two-sample t-test power calculation, Cohen’s d = 0.8, α = 0.05, power = 0.8, two- sided t-test).
The inclusion criteria was as follows: registered nurses with a diploma and bachelor’s degree in nursing who presented in the affiliated ward during dayshift (8:00 am–2:00 pm) on weekdays (Saturday–Thursday).
Study instrument and procedure:
The demographic information of participants (such as age, sex, religion, nurse classification, length of experience, and educational background) was collected using a questionnaire. Additionally, ward data, such as the number of primary patients and patient-to-nurse ratio on the survey day, were collected.
A nursing activity checklist was used; work definitions and categories were based on previous studies19 20. It comprised ten categories, including direct and indirect care, medication administration, documentation, professional communication, administrative task, in-transit work, supervision/education, and social and private activities. All observers (three registered nurses and one medical doctor who could identify different tasks of nurses) had clinical experience. The pilot session was conducted by each observer at the study site. The research team compared the credibility between the evaluators using two data sets; two observers independently observed the activity of one nurse. Work definitions and categories were also examined. Moreover, activities were confirmed using the Bangladeshi context classification and adaption (Table 1).
One observer followed one nurse and recorded the duration (seconds) of all care and non-care-related tasks of each nurse based on a list of categories. The observer categorized one task at a time and identified the primary activity of nurses at a specific moment.
Table 1. Task category
|
|
Category |
Activities (examples) |
|
1 |
Direct Care: Any activity directly related to patient care |
Admitting a patient・Examining a patient・Performing medical procedures Assisting other staff with a procedure・Escorting a patient・Communicating with patients relatives・Taking medical history |
|
2 |
Indirect Care: Any activity indirectly related to patient care |
Reading and reviewing documents (bedside checking)・Planning care, ordering tests, and ensuring diet・Running blood gas analysis・Retrieving information (from the temporary or permanent records, or computer)・Checking results Washing hands・Gathering and returning equipment・Cleaning up after a procedure・Watching monitors・Finding medical record drop down・Finding radiography/scan drop down |
|
3 |
Medication: Any activity related to medication administration for a particular patient |
Preparation・Administration・Documentation・Discussion and clarification |
|
4 |
Documentation: Any record of patient information on paper or computer |
Writing on temporary records (e.g., own list) ・Writing in patients’ notes・ Getting physicians to sign-off non-medication orders・Discharge summary drop down |
|
5 |
Professional communication: Anywork-related discussion with another staff member |
Requesting medical or nursing consultation or review・Planning care with any health professional・Handover/parts of a ward round |
|
6 |
Administrative: Any administrative activity not related to direct or indirect individual patient care. Also includes activities related with running of the unit in general (but are not associated with direct or indirect patient care). |
Duty rosters・Employment issues・Bed allocations・Coordination of staff activities・Staff meetings (not the case or clinical meetings)・Unit orders for stock・Coordinating beds |
|
7 |
In-transit work: Work-related movement among patients and/or tasks |
Movement when the participant exits a patient room |
|
8 |
Supervision/education: Active supervision or teaching of another staff member or student |
Attending education sessions (e.g., grand rounds) |
|
9 |
Social: All non-work-related activities |
Official meal, tea break・Discussion with colleagues・Reading books/magazines |
|
10 |
Personal activities |
Personal phone calls・Personal breaks・Bathroom breaks |
Ethical consideration:
This study was approved by the institutional review board (no. exp. NIA of 2018-04), and consent was obtained from the research committees of each hospital (no. ERC-DMC/ECC/2021/85 and BADAS-ERC/EC/21/00307). Additionally, written informed consent was obtained. Participants were informed that data will be anonymized and will not affect any working performance evaluation in their workplace.
Statistical analysis:
The demographic characteristics and the length of tasks according to categories were calculated using descriptive statistics.
The characteristic difference between the two hospitals was examined using the chi-square test for categorical data, Fisher’s t-test for continuous data, and Mann–Whitney U test for non-parametric data. The relationships between the length of tasks (% of total minutes) and characteristics of nurses (such as age, sex, duration of working experience, educational background, and patient-to-nurse ratio) were examined using the independent sample’s t-test and analysis of variance. Additionally, the Mann–Whitney U and Kruskal–Wallis tests were used for non-parametric data. A p-value of <0.05 was considered statistically significant, and statistical analysis was performed using the SPSS (version 24.0, IBM Inc.) and R statistics 21.
RESULT:
The participants were commonly women (92.3%), senior staff nurses (98.1%), individuals aged 20–39 years (82.7%), and Muslims (75%). More than half of the nurses had a diploma (63.5%); 23.1%, a bachelor’s degree. There was no significant difference between nurses in the two hospitals regarding the duration of working experience as a nurse and in the ward, sex, religion, and patient-to-nurse ratio (Table 2).
Table 2. Demographic characteristics of nurses
|
|
Total number of nurses (n = 52) |
Total number of nurses in public hospitals (n = 26) |
Total number of nurses in private hospitals (n = 26) |
p value |
||||
|
Age(years) |
n |
% |
n |
% |
n |
% |
|
|
|
20–29 |
30 |
57.7% |
11 |
42.3% |
19 |
73.1% |
0.004a |
|
|
30–39 |
13 |
25.0% |
12 |
46.2% |
1 |
3.8% |
||
|
40–49 |
5 |
9.6% |
1 |
3.8% |
4 |
15.4% |
||
|
50–59 |
4 |
7.7% |
2 |
7.7% |
2 |
7.7% |
||
|
Sex |
||||||||
|
Male |
48 |
92.3% |
22 |
84.6% |
26 |
100.0% |
0.110b |
|
|
Female |
4 |
7.7% |
4 |
15.4% |
0 |
0 |
||
|
Employment position |
||||||||
|
SSN |
51 |
98.1% |
26 |
100.0% |
25 |
96.2% |
1.000b |
|
|
Nursing supervisor |
1 |
1.9% |
0 |
0 |
1 |
3.8% |
||
|
Duration of working experience in the ward |
||||||||
|
(months) |
35.4 ± 48.69 |
35.6 ± 51.9 |
35.3 ± 46.3 |
0.360c |
||||
|
Duration of working experience as a nurse |
||||||||
|
(months) |
108.3 ± 103.47 |
108.2 ± 93.2 |
108.5 ± 114.7 |
0.126c |
||||
|
Educational background |
||||||||
|
Diploma |
33 |
63.5% |
16 |
61.5% |
17 |
65.4% |
0.018a |
|
|
Bachelor’s degree |
12 |
23.1% |
3 |
11.5% |
9 |
34.6% |
||
|
Post basic BSc |
4 |
7.7% |
4 |
15.4% |
0 |
0 |
||
|
Master’s or higher |
3 |
5.8% |
3 |
11.5% |
0 |
0 |
||
|
Religion |
||||||||
|
Islam |
39 |
75.0% |
22 |
84.6% |
17 |
65.4% |
0.600a |
|
|
Hinduism |
8 |
15.4% |
4 |
15.4% |
4 |
15.4% |
||
|
Catholic/Christian |
5 |
9.6% |
0 |
0 |
5 |
19.2% |
||
|
Nurse-to-patient ratio (Pt/Ns) |
4.43 ± 1.80 |
4.85 ± 2.24 |
4.00 ± 1.09 |
0.309c |
||||
The significance level was set at 0.5. Mean ± SD
a. Pearson chi-square test, b. Fisher’s exact test, c. Mann–Whitney U test
SSN: Senior staff nurse who is working as a nurse and below charge nurse
Post basic: Two years B.Sc. in nursing with a diploma
The total working hours was 316:41, with an average of 6:05:25 ± 0:06:54 during a 6-h dayshift. Figure 1 shows the total percentages of time spent on nursing activities. Overall, nurses commonly spent their time on direct care (17.0%), followed by medication administration (15.3%), indirect care (14.2%), and personal activities (12.3%).
Figure 1: Proportions of time spent on tasks by nurses.
The associations between the length of tasks (% of total minutes) and the characteristics of nurses were examined. The patient-to-nurse ratio (high: >4.2, low: ≤4.2) as well as the duration of working experience in the ward (long: >18, short: ≤18 months) and as a nurse (long: >67.5, short: ≤67.5 months) were classified into two groups according to the median (Table3)
Table 3. Association between nursing tasks and characteristics of nurses
Continue Table 3
|
6. Administrative task |
7. In-transit work |
8. Supervision/ education |
9. Social activities |
10. Personal activities |
||||||
|
Mean±SD |
p value |
Mean± SD |
p value |
Mean ± SD |
p value |
Mean ± SD |
p value |
Mean± SD |
p value |
|
|
Site |
||||||||||
|
Public hospital |
4.8±7.04 |
0.036*c |
3.1±4.30 |
0.013*c |
1.6±2.97 |
0.000*c |
12.5±5.75 |
0.011*c |
15.6±12.15 |
0.065c |
|
Private hospital |
8.7±7.28 |
1.5±0.71 |
0.1±0.28 |
8.6 ±5.63 |
9.0±5.56 |
|||||
|
Age |
||||||||||
|
A: 20–29 years |
7.2±6.94 |
0.428d |
1.7±1.02 |
0.008*d |
0.7±1.96 |
0.814 d |
10.4±6.79 |
0.996d |
9.4±8.51 |
0.044*d |
|
B: 30–39 years |
4.1±4.01 |
4.3±5.84 |
B>A |
0.6±0.99 |
10.3±3.90 |
15.8±10.22 |
A<B |
|||
|
C: 40–49 years |
8.9±6.39 |
1.9±0.40 |
B>D |
2.4±5.37 |
11.4 ±7.64 |
12.8 ±7.71 |
A<D |
|||
|
D: 50–59 years |
9.2±17.07 |
1.1±0.42 |
0.5±0.98 |
11.8 ±4.14 |
21.8 ±4.14 |
|||||
|
Gender |
||||||||||
|
Male |
1.9±1.28 |
0.16c |
2.7±1.8 |
0.276c |
2.5±4.05 |
0.377c |
17.8±10.85 |
0.105c |
18.9±11.24 |
0.113c |
|
Female |
7.1±7.53 |
2.3±3.26 |
0.7±2.03 |
10±5.14 |
11.8±9.76 |
|||||
|
Patient-to-nurse ratio |
||||||||||
|
High:>4.2 |
8.9±6.41 |
0.001*c |
2.9±4.29 |
0.176c |
1.0±2.43 |
0.453c |
10.8±7.24 |
0.942c |
10.5±7.75 |
0.249c |
|
Low:≤4.2 |
4.6±7.74 |
1.7±1.09 |
0.7±2.06 |
10.4±4.49 |
14.1±11.61 |
|||||
|
Duration of working experience in the ward |
||||||||||
|
Long:>18 months |
7.2±7.17 |
0.679c |
1.9±1.25 |
0.405c |
0.5±1.38 |
0.414c |
10.1±6.75 |
0.292c |
9.7±9.00 |
0.011*c |
|
Short:≤18 months |
6.3±7.69 |
2.8±4.37 |
1.2±2.88 |
11.2±5.07 |
15.1±10.31 |
|||||
|
Duration of working experience as a nurse |
||||||||||
|
Long:>67.5 months |
7.0±7.17 |
0.762c |
1.8±1.02 |
0.583c |
0.6±1.76 |
0.227c |
10.5±6.99 |
0.898 c |
12.3±9.49 |
0.84c |
|
Short:≤67.5 months |
6.5± 7.7 |
2.8±4.33 |
1.1±2.64 |
10.6±4.89 |
12.3±10.56 |
|||||
|
Educational background |
||||||||||
|
A: Diploma |
7.1±8.09 |
0.148d |
1.8±1.08 |
0.075d |
0.9±2.57 |
0.011*d |
10.0±5.41 |
0.094b |
13.9±11.11 |
0.510d |
|
B:Bachelor degree |
7.4±6.38 |
2.1±1.19 |
0.2±0.42 |
D>A |
9.4±4.76 |
9.1±5.02 |
||||
|
C: Post basic BSc |
1.2±2.47 |
8.2±10.08 |
0.6±0.88 |
D>B |
17.2±11.65 |
12.9±12.39 |
||||
|
D: Master or higher |
7.4±6.12 |
1.3±0.21 |
3.1±2.97 |
13.0±1.33 |
6.3±4.06 |
|||||
|
Religion |
||||||||||
|
A: Islam |
6.2±7.61 |
0.178d |
2.4±3.55 |
0.77d |
0.9±2.37 |
0.275d |
11.4±5.93 |
0.159d |
13.5±10.68 |
0.239 d |
|
B: Hinduism |
6.2±5.78 |
2.5±1.91 |
0.9±2.3 |
8.4±4.87 |
7.3±4.13 |
|||||
|
C: Catholic/Christian |
11.5±7.27 |
1.6±0.66 |
0±0 |
8.1±7.52 |
10.7±8.84 |
|||||
The significance level was set at 0.05. Data were presented as mean ± SD.
a. Independent samples t-test, b. ANOVA, c. Mann–Whitney U test,
d. Kruskal–Wallis test. The significant values were adjusted using the Bonferroni correction method for multiple tests.
There were no significant differences between the characteristics of nurses and the proportion of time spent on direct and indirect care and medication administration.
The public and private hospitals significantly differ in terms of the proportion of time spent by nurses on documentation (8.8% vs. 13.4%, U = 211, p = 0.02), administrative task (4.8% vs. 8.7%, U = 211, p = 0.036), in-transit work (3.1% vs. 1.5%, U = 474, p = 0.013), supervision/education (1.6% vs. 0.1%, U = 520, p < 0.001),and social activities (12.5% vs. 8.6%, U = 477, p = 0.011).
The in-transit duration (χ2 = 1.77, df = 3, p = 0.008) and personal activities (χ2 = 8.08, df = 3, P < 0.044) significantly differed between individuals aged 30–39 years and those aged 20–29 and 50–59 years. That is, nurses aged 30–39 years spent more time than those aged 20–29 and 50–59 years on in-transit work (4.3%, 1.7%, and 1.1%, respectively) and personal activities (9.4%, 15.8%, and 21.8%, respectively).
The patient-nurse ratio (High, Low) had a significant difference based on the duration of administrative activities (8.9% vs. 4.6%, U = 384, p = 0.001).
The working experience in the ward (>18 months, ≤18 months) had a significant difference with the time spent on professional communication (11.1% vs. 8.1%, U = 226, p = 0.041) and personal activities (9.7% vs. 15.1%, U = 476, p = 0.011). Nurses with longer working experience in the ward spent more time on professional communication and less on personal activities.
The educational background showed a significant difference with the time spent on supervision/education (χ2 = 11.22, df = 3, p = 0.11). The nurses with a master’s or higher degree spent more time (3.1%) on supervision/education than those with a diploma (0.9%) and a bachelor’s degree (0.2%).
DISCUSSION:
Nurses commonly spend most of their time on direct care, followed by medication administration, indirect care, and personal activities. In a previous study conducted in Australia 1, more than 80% of their nurses’ was spent on direct and indirect care, medication administration, and professional communication. Meanwhile, in our study, the nurses allocated only 56.1% of their time on these tasks.
In 2007, Hadley et al. 13 revealed that public and private hospital nurses spent 5.3% and 22.7% of their time on direct care, respectively. Meanwhile, in our study, nurses spent an average time of 17.0% on direct care (15.4% in public and 18.6% in private hospitals). In the previous research, medication administration was included in the category of direct care, which we categorized separately.
Direct care is the primary responsibility of nurses, and patient monitoring is essential to ensure patient safety. However, in Bangladesh, family members or support workers are still the primary direct care providers in public hospitals. In recent years, private hospitals were better at managing visitors than public hospitals. Therefore, nurses at private hospitals may supervise primary care. However, our study showed no significant difference between public and private hospitals in terms of time spent on direct care.
Medication management is important for patient safety. Our results showed that nurses spent a significant time on medication administration. In Bangladesh, nurses take pride in administering intravenous drugs because they believe that this task cannot be performed by family caregivers22. The administration of medication, including intravenous infusions ordered by doctors, was generally considered as the primary role of nurses. Approximately 17.8% of the nurses’ total work comprised both documentation and administration work, and nurses in private hospitals spent more time on these activities. This result was similar to that of the study by Hardly et al.13. In other words, nurses spent 22.6% of their time on written activities.
Documentation is crucial in nursing as it can maintain the quality of nursing intervention and care. With the use of electronic recording, previous studies reported that 25% of nurses’ time is spent on documentation in the USA23. Our target hospitals have not applied electronic recording at the ward, and personal records were kept primarily for cases of serious illness. An ethnographic study conducted in Bangladesh22 reported that most of the nurses’ work time was spent on paperwork; therefore, they could barely perform any nursing or medical work.
Nurses with master’s or higher degrees spent more time on supervision/education than those with diplomas and bachelor’s degrees. In this study, there were three nurses with master’s degrees in the public hospital. Nurses with a similar work position might take teaching and supervising roles. In addition, nurses with greater working experience at the ward spent more time on professional communication. Therefore, nurses with longer experience might take the role of a team leader and might discuss or consult with other healthcare workers.
Our participants spent more time on social or personal activities (a combined time of 22.9%) rather than unit- related activities, such as professional communication, administration tasks, and in-transit work. Additionally, nurses in public hospitals spent more time on social activities than those in private hospitals. A previous study conducted at a public hospital in Iran24 revealed that a considerable proportion of nurses spent more time on personal activities rather than direct and indirect care. Hadley et al.13 revealed that nurses form Bangladesh spend their time on unrelated activities, such as chatting, knitting, and taking snacks in private storerooms. However, more than 15 years since the study of Hadley et al.13, nurses were making personal phone calls or visiting other wards to check on other nurses and relatives or friends.
There might be differences in terms of management between public and private hospitals. Private hospitals might have standardized break time with working rules. Nurses in private hospitals might be held responsible for their duties, and they strongly recognize the need to provide services that should correspond to payments made by the patients. However, there was no significant difference between public and private hospitals in terms of personal activities. Notably, individuals aged 20–29 years and those with more work experience in the wards spent less time on personal activities. Considering seniority and cultural background, younger age groups might have a better performance at work. By contrast, nurses with longer working experiences in the ward have less personal time. Therefore, their role might influence their work attitude25,26. The weaknesses of managerial supervision and their limited knowledge about job descriptions could affect the activities of nurses.
A qualitative study revealed12 that nurses may allocate time on leisure activities and paperwork, thereby justifying their time away from patients and avoiding exposure to social norms that do not promote physical contact with non-family members. Furthermore, due to the typical gender role of a woman, nurses attempted to avoid some issues, including complaints from patients and dissatisfied relatives, by remaining silent or withdrawing from the scene22. However, further qualitative studies are required to validate the findings of this study.
LIMITATIONS:
This study was conducted at general surgical wards in public and private hospitals in Dhaka, Bangladesh. Hence, the generalizability of the findings is limited. We selected the surgical wards, and data about the characteristics of patients were not assessed due to limitations in collecting patient information. Information about the patient- dependent level should be assessed to examine the influence of nursing activities. Our direct observational approach could not detect multi-tasking activities. Hence, to better understand nursing activities, further studies with a better methodology should be performed to correct data about multi-tasking and task-switching activities.
CONCLUSION:
Our study provided quantifiable data on multidimensional nursing activities and organization differences in terms of the time spent on various nursing activities. The health system of Bangladesh has been characterized by staff shortage, inappropriate skills, and inequitable deployment. Compared with a previous study conducted in 2007, the time spent on direct care has increased, especially in public hospitals. In Bangladesh, nursing activities are evolving due to improvements in the health care system and the higher number of nurses. However, the characteristics of nursing services, including the patient-to-nurse ratio, did not directly affect the time spent on direct care. Some studies have revealed an association between the time spent by nurses on direct care and better patient outcomes1 and higher patient and nurse satisfaction27,28,29. Therefore, nurses must spend sufficient time on direct care and engage in interdisciplinary care while understanding the significance of direct care and the role of nurses. Our study discovered differences in nursing activities due to varying organizations. The findings could help nurse managers in developing workload management techniques and strategies for transforming practice through nursing activities.
CONFLICT OF INTEREST:
The authors have no conflicts of interest regarding this study.
ACKNOWLEDGMENTS:
We wish to acknowledge the assistance received from the staff and management of hospitals. Additionally, we thank the nurses who generously participated in this study.
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Received on 17.04.2022 Modified on 18.06.2022
Accepted on 12.10.2022 ©A&V Publications All right reserved
Int. J. of Advances in Nur. Management. 2022; 10(4):339-346.
DOI: 10.52711/2454-2652.2022.00076