In celebration of National Nurses Week: Two ways to end nursing’s 55-second cycle

Post date: May 06, 2019 by Joanie Ching

National Nurses Week (May 6–12) is a time for everyone—not just nurses but other health care professionals, individuals, employers, and community leaders—to recognize the vast contributions and positive impact of America’s 4 million registered nurses. It’s also a time for us, as lean practitioners, to look at emerging research about the complexity of nursing work…work that requires critical thinking, knowledge application, and constant vigilance.

On average, a nurse switches between tasks every 55 seconds. Think about the nurse who cares for you or your loved one moving through 88 separate activities per hour—adjusting an intravenous infusion of medication, supervising an assistant, assessing heart and lung sounds—one task every 55 seconds. Along with the cognitive-shifting required, envision the five miles (or more) of walking this nurse does over a 12-hour shift. Recent time-motion studies of medical-surgical nurses have captured tasks ranging from hunter-gatherer-like searching for medications and supplies to racing down the hallway to catch a provider who’s about to leave the unit. The nonlinearity of nursing care combined with frequent interruptions and multi-tasking is what defines today’s nursing work complexity. These practices and habits are dangerous because they create situations in which a nurse can easily lose focus on important patient needs and potentially err.

We, as lean practitioners, can recognize the professional contributions of nurses in two important ways. First, we can lead by example when we Go, See the actual work that nurses do. During an improvement event a few months ago, team members were asked to quietly observe activities on a busy, medical-surgical nursing unit. Following the observation period, one team member described how two nurses with their heads down rounded the corner of the patient care unit and collided with one another. Both quickly recovered, said nothing to the other, and went on their individual ways. Some of us were startled when we heard this story. We reflected that in our own work settings, we would have stopped to apologize and check on the other person. Sadly, I suggest what isn’t normal behavior has become normalized by nurses who are trying to cope with work complexity. When we lead others to Go, See, we expose the oppressive 55-second cycle of nursing work—and this is critically important. Observing and reflecting upon nursing work can lead to greater empathy and respect for our highly focused, caring nurses who often experience production pressure.

Second, we can eliminate waste in nursing work by improving the patient care environment and our processes. 5S—workplace organization improvement that employs sequential “sort," "set in order," "shine," "standardize" and "sustain" processes—puts frequently used supplies in locations that reduce walking or information needed for decision-making at the point-of-service. For example, recent 5S improvement work with a client contributed to a reduction in steps during a nurse’s shift by 44-55% and a 48% productivity gain for nurses, who spent less time retrieving treatment supplies on the rare occasion that needed supplies were not available in the patient’s room. These improvements can and should be sustainable (note that’s the last “s” of the 5): Another client recently measured sustained improvements 30 days after their 5S workshop, which will result in walking reductions of nearly 1,100 miles a year for nurses on a single unit. This translates to 352 hours—hours that can now be spent providing patient care instead of walking! Anything we do to minimize unnecessary walking or interruptions can potentially lengthen a nurse’s cycle of value-added work, whether it’s sustained, critical thinking, or meaningful interactions with patients, families, and other health care professionals.

So on this National Nurses Week, let’s agree that frequent cognitive-shifting is not a good thing for professionals who play a critical role in detecting and intervening when a patient’s clinical condition changes. Armed with empathy, experimentation, and courage, let’s continue to redesign systems to minimize the cognitive load upon nurses and to build in greater adaptation so they can best respond to patients’ needs.

References

Eisenhauer, L. A., Hurley, A. C., & Dolan, N. (2007). Nurses' reported thinking during medication administration. Journal of Nursing Scholarship, 39(1), 82-87.

Elganzouri, E. S., Standish, C. A., & Androwich, I. (2009, May). Medication administration time study (MATS). Journal of Nursing Administration, 39(5), 204-210.

Potter, P., Wolf, L., Boxerman, S., Grayson, D., Sledge, J., Dunagan, C., & Evanoff, B. (2005). An analysis of nurses' cognitive work: A new perspective for understanding medical errors. In K. Henrikson, Battles, J.B., Marks, E.S., & Lewin, D.I. (Eds.), Advances in Patient Safety: From Research to Implementation, Vol 1, Research Findings (pp. 39-51). Rockfield, MD: Agency for Healthcare Research & Quality.

Westbrook, J. I., Duffield, C., Li, L., & Creswick, N. J. (2011). How much time do nurses have for patients? A longitudinal study quanifying hospital nurses' patterns of task time distribution and interactions with health professionals. BMC Health Services Research, 1-12.

 

Please enjoy a recent profile of the nursing profession and Joanie Ching. “Education requirements for advanced nursing are evolving,” The Seattle Times, May 2, 2019.