chapter 11 | Time Management 159expected to follow precisely set schedules and meet
deadlines for almost everything, from distributing
medications to completing reports on time. Many
agencies produce vast quantities of computer-
generated data that can be analyzed to determine
the amount of time spent on various activities.
Several fallacies exist regarding time manage-
ment. One of the foremost is that time can be man-
aged like other resources. Time is finite. There are
only 24 hours in a day, so the amount of time avail-
able cannot be controlled, only how it is used
(Brumm, 2004). Individual personality, culture,
and environment interact to influence human
perceptions of time (Matejka & Dunsing, 1988).
Everybody has an internal tempo (Chappel, 1970).
Some internal tempos are quicker than others.
Environment also affects the way people respond to
time. A fast-paced environment influences most peo-
ple to work at a faster pace, despite their internal
tempo. For individuals with a slower tempo, this
pace can cause discomfort. If you are high-
achievement–oriented, you are likely to have already
set some career goals for yourself and to have a men-
tal schedule of deadlines for reaching these goals (“go
on to complete my bachelor of science in nursing in
4 years; a master of science in nursing in 6 years”).
Many health-care professionals are linear, fast-
tempo, achievement-oriented people. Simply
working at a fast pace, however, is not necessarily
equivalent to achieving a great deal. Much energy
can be wasted in rushing around and stirring things
up but actually accomplishing very little. This
chapter looks at ways in which you can use your
time and energy wisely to accomplish your goals.
How Do Nurses Spend Their Time?
Nurses are the largest group of health-care profes-
sionals. Because of the number of nurses needed and
the shift variations, attention concerning the effi-
ciency and effectiveness of their time management is
needed. Efficient nurses deliver care in an organized
manner that makes best use of time, resources, and
effort. Effective care improves a situation.
Today’s labor market for skilled health-care pro-
fessionals remains tight. Institutions face new chal-
lenges, not of “trimming the fat, but compensate
[sic] for loss of muscle” (Baldwin, 2002, p. 1).
Current shortages of nurses, radiology technicians,
pharmacists, and other health-care specialists show
all the signs of a long-term problem. Health-care
institutions need to change their thinking on how to
manage work. Most are looking toward technology
to help cope with staffing shortages (Baldwin, 2002).
For example:
A new graduate worked in a medical intensive care
unit from 7 a.m. to 3 p.m. and rotated every third
week to 11 p.m. to 7 a.m., working 7 days straight
before getting 2 days off. It was not diff icult to
remain awake during the entire shift the f irst night
on duty, but each night thereafter staying awake
became increasingly diff icult. After taking and
recording the 2 a.m. vital signs, the new graduate
inevitably fell asleep at the nurses’ station. He was so
tired that he had to check and recheck patient med-
ications and other procedures for fear of making a
fatal error. He became so anxious over the possibility
of injuring someone that sleep during the day became
impossible. Because of his obsession with rechecking
his work, he had diff iculty completing tasks and
was always behind at the end of the shift (of course,
napping did not help his time management).
A number of studies have examined how nurses use
their time, especially nurses in acute care. For exam-
ple, a study by Arthur Andersen found that only
35% of nursing time is spent in direct patient care
(including care planning, assessment teaching, and
technical activities). Lundgren and Segesten (2001)
found that this increases to 50% when an all-RN
staff is involved in patient care delivery, as the nurses
spent less time supervising non-nursing personnel.
Documentation accounts for another 20% of
nursing time. The remainder of time is spent on
transporting patients, processing transactions,
performing administrative responsibilities, and
undertaking hotel services (Brider, 1992).
Categories may change from study to study, but
the amount of time spent on direct patient care is
usually less than half the workday. As hospitals
continue to reevaluate the way they deliver health
care, nurses are finding themselves more involved
with tasks that are not directly patient-related,
such as determining quality improvement, devel-
oping critical pathways, and so forth. These are
added to their already existing patient care func-
tions. The critical nursing shortage compounds
this problem. The result is that, in some cases,
nurses are able to meet only the highest-priority
patient needs, particularly in certain clinical set-
tings such as short-stay units or ambulatory care
centers (Curry, 2002).