Increasing value-adding patient care by applying a modified TCAB program.

Purpose The purpose of this study is to evaluate a development process aimed at increasing registered nurses' (RNs) working time use in value-adding patient care by applying a modified Transforming Care at the Bedside (TCAB) program at inpatient units of two tertiary hospitals. Design/methodology/approach Basic data for the development process were collected on RNs' working time use via external observation in 2011 (RNs = 113). Nursing work was redesigned and implemented by 12 multi-professional teams during 2012-2013. The development process was evaluated by repeating the collection of RNs' working time use data in 2013 (RNs = 95) and by analyzing the memos of the development teams via deductive content analysis ( N = 64). Findings RNs' working time use showed statistically significant increases in value-adding care and direct patient care but decreases in non-value-added work and miscellaneous work. Changes in the nursing work model, division of labor and the nursing work environment all affected RNs' working time use. Practical implications The development process progressed distinctively in each unit, as shown by the results of the development work. Clinical RNs had key roles as innovators and change agents, yet the engagement of nursing managers was most essential for the success of the development work. Originality/value Even minor changes in nurses' daily work profile can have considerable effects on RNs' work. The TCAB program was shown to be a useful method in developing RNs' work also in psychiatric units.

Improving the quality of registered nurses' working time use data.

AIMS AND OBJECTIVES: To examine the advantages and disadvantages of external observation and self-reporting methods in investigating registered nurses' working time use in order to improve the quality of working time use data. BACKGROUND: External observation and self-reporting methods are the most widely used approaches for studying nurses' working time use in observational work sampling studies, but there is scarce information of the data collection procedures and results in the same research context and in the same study. DESIGN: A cross-sectional quantitative study with a structured data collection instrument developed for this study. The same instrument was used in both data collections. METHODS: Data were collected from six inpatient units at two Finnish tertiary hospitals in autumn 2013 over two consecutive weeks. All registered nurses (n = 95) from two internal medical units, two surgical units and two psychiatric units participated in this study. RESULTS: Statistically significantly divergent information was produced by the two data collection methods in the major nursing categories of value-adding care and non-value-adding work as well as in each of the seven nursing subcategories. CONCLUSIONS: External observation and self-reporting gave an overall picture of how registered nurses are using their working time, and both methods were useful in examining registered nurses' working time use when taking into account the advantages and disadvantages of these methods. The deviations between the results improved the quality of data because both methods address recognised shortcomings of the other. RELEVANCE TO CLINICAL PRACTICE: This research promotes awareness of the divergent study results by investigating registered nurses' working time use with these two different data collection methods. In future, it would be wise to aim for more comparable data by applying external observation and self-reporting techniques simultaneously.

Nurses' working time use - how value adding it is?

AIM: To investigate registered nurses' (RN) and licensed practical nurses' (LPN) working time use in adult inpatient units. BACKGROUND: There is only scarce information about value-adding patient care. Nursing care can be divided into three major categories: value-adding care (direct care, indirect care, patient documentation), necessary activities (indirect work, unit-related work) and non-value-adding work (personal time, miscellaneous work). METHOD: A cross-sectional quantitative work sampling study. Total of 11,029 nursing activities were collected from two Finnish tertiary hospitals using registered nurses' (n = 66) and licensed practical nurses' (n = 12) self-reporting. RESULTS: Nearly three-quarters of nurses' work was value-adding care (71%). The working time division was almost identical for necessary activities and non-value-adding work. Registered nurses spent more time carrying out unit-related work, while licensed practical nurses' spent more time on direct care. Nurses' working time use was divided nearly identically in somatic units but there were differences when compared with psychiatric units. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Nurses' work seemed to concentrate on value-adding care. The results of working time use studies can be used when developing nursing work for more value-adding care for the patients.