Exploration of nurses use of time at work at the medical units of Kenyatta National Hospital (KNH)
Magwira-mulele, Mike B
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Introduction: Nurses are the basic building blocks of healthcare and main professional component of the work force in the health care system. Nurses work performance undoubtedly affects the overall quality of patient care in the hospital. Their contribution is essential to meeting development goals and delivering safe and effective care (Buerhaus et al. 2009; Meal BL 2003). Studies have shown that nurses‟ use of time at work can be assumed to have a major impact on patients‟ outcomes and patient safety. Duffield, Gardner & Caltring-Paull, (2008) commented that nurses often undertake tasks which less qualified staff could do while unable to use their high level skills and expertise and spend an average of only 31% of their time with patients (Hendrickson, Doddalo & Kovner 1990). In this climate of nursing shortage Duffield, Gardner & Caltring-Paull (2008) emphasised need to use nurses in a cost-effective but also intellectually satisfying manner because inefficiency in the use of nursing time may also impact negatively on patient care outcomes. Hence, there is a potential to improve quality of care and patient safety by enhancing nurses‟ use of time at work. Ensuring that nurses and other healthcare providers are able to work to their full scope of practice as they use time at work is retention strategy that is critical to resolving workforce shortages (Besner et al 2005). Aim: The purpose of this study was to explore nurses‟ use of time at work at medicine department at Kenyatta National Hospital (KNH). It explored how nurses perceived their time use in the clinical area, identified structural, process and outcome (the personal, professional and organisational variables i.e. facilitators and barriers) variables that might have contributed to maximising use of nurses time and established the proportion of time nurses spend carrying out non-nursing work and purely nursing tasks during a shift in order to develop substantive strategies that would guide proper use of nurses time at work at KNH. The Nursing Role Effectiveness Model by Sidani and Irvine (1998) was applied in the study. Methodology: This study used a mixed methods, descriptive study design that employed qualitative and partly quantitative data collection methods involving self administered questionnaires, observations, and in depth interviews. The sample sizes were (n=145) for self administered questionnaires, (n=25) for structured and unstructured observations and (n=10) for in depth interviews that were drawn randomly from nurses working in the in the medical wards (i.e. ward 7 and 8). Data was collected using self administered questionnaires, in depth interview guides and observation checklists that were administered through interviews and observations by interviewers. Demographic data was collected using self administered questionnaires whilst qualitative data was collected using self administered questionnaires, participant observation checklists and tape recorder. The non probability sampling technique guided the selection of the study participants. Demographic data was analysed using Statistical package for social scientist (SPSS) software version 17 and the qualitative data was analysed using ATLAS.ti 7 through quotations manager and codes manager as well as content analysis and codes using themes and categories. The results of this study: The study revealed that the nurses perceived that time was not used efficiently and was inadequate for nurses to complete work tasks. It also revealed that nurses spend 870:22 minutes (49.9%) on nursing related activities, followed by 464:20 minutes (26.6%) on non nursing activities and 411:13 minutes (23.6%) on core nursing activities. Departmental meetings, inadequate material and human resources were reported to affect adversely nurses‟ use of time at KNH Medical department. Conclusion: This study on the nurses‟ use of time at work established that nurses in the medicine department KNH spent the larger proportion of time performing nursing related activities and non nursing activities than the core nursing activities. Inadequate resources both human and material resources negatively affected the nurses use of time in the medicine department The study recommendations: This study recommended that the hospital should analyse and design the core work activities of professional nurses and ensure enabling conditions that would facilitate the effectiveness and efficient use of nurses‟ time at work for quality patients‟ care and nursing care delivery. The enabling conditions among others should include delegation of some tasks to support personnel and greater use of computers. The study limitations: The study did not include more wards/departments and hospitals but used medical department and one hospital (KNH). This was a study focusing on medical department at KNH hence need for further studies that would include more departments and hospitals for the findings to be generalised to Kenyan nurses workforce.