Nursing Workload and Interventions of Licensed Nurses in Nursing Homes: An Observational Time and Motion Study

Abstract

Abstract Demands on long-term care services are growing, but nursing homes have suffered from persistent staffing issues including high turnover rates. To address this challenge, it is critical to understand workload pressure of licensed nurses, registered nurses (RNs) and licensed practical/vocational nurses (LPNs), employed in nursing homes. This research aimed to 1) refine and validate nursing interventions of licensed nurses employed in nursing homes, 2) examine and compare time pressure, operationalized as intervention time, location, and multitasking in a nursing home, and 3) describe and compare content of nursing interventions of licensed nurses in a nursing home. To address Aim 1, a multi-phase, multi-method study was conducted that mapped the content of nurse interviews and evaluated content validity, coding, and inter-observer reliability of nursing interventions. A total of 57 interventions were validated and revised for nursing home observations. To address Aims 2 and 3, a continuous observational time and motion study was conducted in a 250-bed nursing home using the suggested time and motion procedures (STAMP) checklist and the interventions derived in Aim 1. These interventions were embedded within TimeCaT™, a web-based time and motion data recording tool. An observer shadowed 11 nurses over a six-month period and recorded 160 hours of time and motion data throughout 41 four-hour observation sessions. For Aim 2, analysis revealed a high degree of time pressure including number of interventions per hour, short median intervention time, frequent location changes, and multitasking. For Aim 3, analysis revealed that nurses spent extensive time on medication preparation, medication administration, and communication with care team, residents, and family in nursing homes and showed similar RN-LPN practice in nursing homes. Important differences by licensure were also identified in provider communication, plan of care instruction, wound care as well as Surveillance and Case Management interventions. Overall, this research provided insights for clinical and administrative practice and future research in nursing home settings; and showed the value of the Omaha System as a reliable tool for describing and observing nursing interventions of licensed nurses practicing in nursing homes.