Institutional members access full text with Ovid®

Share this article on:

Transforming Nursing Workflow, Part 1: The Chaotic Nature of Nurse Activities

Cornell, Paul PhD; Herrin-Griffith, Donna MSN, RN, NEA-BC, CNEP, FACHE; Keim, Courtney MS; Petschonek, Sarah MS; Sanders, Adriane M. MS; D'Mello, Sidney PhD; Golden, Teresa W. MSN, RN, NE-BC; Shepherd, Gayle RN

Journal of Nursing Administration: September 2010 - Volume 40 - Issue 9 - p 366-373
doi: 10.1097/NNA.0b013e3181ee4261

Objective: To quantitatively measure workflow and computer use, the activities of 27 medical-surgical RNs were recorded through direct observation.

Background: Previous studies have shown how nurses spend their time but have not documented the pattern, duration, or frequency of activities. The absence of this information is problematic for leaders charged with improving performance and staff development.

Methods: Observers recorded nurse activities and location in real time using predefined lists. More than 98 hours of observations were recorded.

Results: Assessment, charting, and communicating were the most frequent activities, consuming 18.1%, 9.9%, and 11.8% of nurse time, respectively. The duration of 40% of the activities was less than 10 seconds. Timelines revealed that nurses constantly switch activities and locations in a seemingly random pattern.

Conclusion: The results indicate that there is little "flow" in nurse workflow. The chaotic pace implies that nurses rarely complete an activity before switching to another. The opportunity to use critical thinking and engage in planning care is severely limited under these circumstances. The implications for cognition and role transformation are discussed. Part 2 of this research explores the impact of new technology on nurse activities and workflow.

Authors' Affiliations: Director, Center for Healthcare and Technology (Dr Cornell), Graduate Research Assistant (Mss Keim, Petschonek, and Sanders), Postdoctoral Researcher (Dr D'Mello), University of Memphis, Tennessee; Global Healthcare Consultant & Clinical Professor (Ms Herrin-Griffith), University of Alabama-Huntsville, Alabama; Director of Informatics (Ms Shepherd), Methodist LeBonheur Healthcare, Memphis, Tennessee; Vice President (Ms Golden), B.E. Smith, Lenexa, Kansas.

Corresponding author: Dr Cornell, University of Memphis, 365 Innovation Drive, Memphis, TN 38152 (email:

© 2010 Lippincott Williams & Wilkins, Inc.