_* * :, - , - " - --

and

0000

TIME SPENT IN INDIRECT NURSING CARE

by

LTC Terry R. Misener, ANC, USA(Principal Investigator)

LTC A.J. Frelin, ANC, USAPatricia A. Twist

(Associate Investigators)

FINAL REPORT83-004

August 1983 TICSFE{ 2 9 i9BA4.

US ARMY 8EHEALTH SERVICES COMMAND

.,FORT SAM HOUSTON, TEXAS 78234

84 02 27 15V. -;

,S., .::..,., , ..,....,-: : ..... ........ . .. . .. . ., ... ., ..... ,

.'A bL US ARMYEAL DEPARTMENT OF THE ARMY

US uARmMY HKA% CARE STUDIES AND CLINICAL INVIESTIATION ACTIVITVFORT SAR HOUSTON. TEXAS M

HSHN-H 19 March 1984

ba SUBJECT: Changes in Text

CommanderDefense Technical Information CenterATTN: DTIC-DDRCameron StationAlexandria, VA 22314

1. It has been noted that some material was left out of AMEDD Study titled:Time Spent In Indirect Nursing Care, LTC Terry R. Misener. Final report83-004, Health Care Studies and Clinical Investigation Activity, GovernmentAccession Number DA 301090.

2. The following changes will be made:

a) Page 14, line 16. Change ( O.J%). to read (10.5%).

b) Insert page 13-B, APPENDIX 13 Cont.

3. Questions may be referred to Mr. R. J. Plaia, 221-6028/5671.

FOR THE COMMANDER

2 Incl TERRY R. MISENERas LTC, ANC

Asst. Chief, Health Care StudiesDivision

'S

NOTICE

The findings in this report arenot to be construed as an official

Department of the Arnq positionunless so designated by other

authorized documents.

Regular users of the services of the Defense Technical InformatimnCenter (per DOD Instruction 5200.21) may purchase copies directlyfrom the -following:

Defense Technical Information Center (DTIC)ATTN: DTIC-DDRCameron StationAlexandria, VA 22314

Telephones: AUTOVON (108) 28-47633, 34, or 35Commercial (202) 27-47633, 34, or 35

All other requests for these reports will be directed to thefollowing:

US Department of CommerceNational Technical Information Services (NTIS)5285 Port. Royal RoadSpringfield, VA 22161

Telephone: Conmercial (703) 487-4600

71,

SECURITY CLASSIFICATION OF THIS PAGE (t37en Data Entered)

REPORT DOCUMAENTATION PAE READ INSTRUCTIOSBEFORE COMPLETI[NG FORM

1. REPORT NUMR!"R 2. GOVT ACCESSION NO. 3. RECIPIENT'S CATALOG NUMBER83-004 DA 301090 4 ,413K// ,YC. TITLE (anrd Sublde,) S. TYPE OF REPORT & PERIOD COVERED

Final Report

(U) Time Spent in Indirect Nursing Care Oct 82 - Sep 836. PERFORMING ORG. REPORT NUMBER

83-0047. AUTHORfe) . CONTRACT OR GRANT NUMBER(p)

T. R. Misener, LTC, ANC, USA N/A9. PRFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ELEMENT. PROJECT. TASK

AREA & WORK UNIT NUMBERS

US Army Health Care Studies andClinical Investigation Activity N/AFort Sam Houston,-TX 78234

11. CONTROLLING OFFICE NAME AND ADDRESS 12. REPORT DATE

US Army Health Care STudies and September 1983Clinical Investigation Activity 13. NUMBER OF PAGESFort Sam Houston, TX 78234 240

14. MONITORING AGENCY NAME & ADDRESS(fi different Ir.m Controliln Office) IS. SECURITY CLASS. (of this report)

UNCLASSIFIED

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I. DISTRIBUTION STATEMENT (of Oile Report)

Approved for public release; distribution unlimited

17. DISTRIBUTION STATEMENT (of the abtract entered in Block 20. It different from Report)

18. SUPPLEMENTARY NOTES

DA 301090

IS. KEY WORDS (Contlnue on revere side it necessary ad Identify by block number)

RSING; MANAGEMENT; HOSPITAL; CARE REQUIREMENTS; PERSONNEL; STAFFING

/rr A r~qcetmu, an, roee stl of necessavya Id entify by block number)

Part of the FY/83 Army Study Program and in ended to augment the FY 81 completedstudy titled "Nursing Care Hours Standards'" by providing valid and reliable

percentages for hospital patient nursing care unit requirements (i.e., directcare, indirect care, and non-productive time). These data provide the ArmyNurse Corps with the necessary statistics to more objectively determine manpowerrequirements. Work sampling techniques were used at nine CONUS HSC medicaltreatment facilities of varying bed capacity by surveying six services (whereavailable, i.e., medical-surgical, intensive care, obstetrics, pediatrics,

tO J n W ITION OF I NOV CS IS OSOLETE USECURITY CLASSIFICATION OF THIS PAGE (Ohm Dei Entered)

+ .r ... - ,* . . .*. . , .. . . . . . ..

U- ,SECURITY CLASSIFICATION OF THIS PAGE(Whan Date Enterd)

•.. psychiatric, and neonatal). CONCLUSIONS: (1) Across all MTFs,.percentages ofV - time spent by inpatient nursing personnel are: direct care (24.5%); indirect-. care (60.5%); and unavailable for patient care (15.0%); (2) The most variance

(in direct care and unavailable for care) appeared to be a function of hospitalsize and the mix of personnel assigned; (3) Times spent in each activity wereas expected, however, differences among the clinical services (obstetrics andMedical-surgical particularly) indicate a different yardstick might be considerefor each of the six services; (4) Subjective reports from charge nursesexpressed their opinions as to the adequacy of staffing for each shift observedas 24.0% inadequate, most often cause "not enough staff on duty", "aboveaverage number of patients needing extensive nursing care, assistance, orsurveillance"; and "not an optimal mix of personnel skill levels"AMost oftencited remedy was "need for an additional RN for the entire shift" selected by57.0% of respondents. RECOMMENDATION: Findings of this study be combined withthose from a patient classification study currently being conducted by theNursing Research Service at Walter Reed Army Medical Center, Model staffingguides should be developed and tested at selected facilities to determineadequacy of staffing and quality of care,

S.'

',-

~Accession For

N-TIS GRA&I,DTIC TAB-v Unannouncedi Justification

B.

Distributi on/.Availability Codes

Avail zwd/orDist Special

'.

11

4U

S i i U• S Cu RTY CLASSIFICATON OF" "9IS pmAG~ rwe n D te ff e t'd)

..___ \... ., . >,,, ,,, .x... ... .; .... -...... .. , ...; .. . S.... ., - ;

TIME SPENT IN INDIRECT NURSING CARE

SUMMARY. Current manpower standards are inadequate to determine inpatient care

requirements and staffing needs for Army hospital nursing units. A previous

Army study (Sherrod, Rauch, and Twist, 1981) provided reliable and valid data

upon which to quantify direct patient care needs. The current study was commis-

sioned by the Army Nurse Corps to answer the question: What percentage of time

Is spent by inpatient nursing service personnel in each of three temporal

categories: direct care, indirect care, and time unavailable for patient care.

Nine hospitals were selected throughout Health Services Command (HSC) to perform

a work sampling study. Investigators trained data collectors at each site and

demonstrated Interrater reliability using a modification of a tool used in the

"San Joaquin Study" instrument (Murphy, Dunlap, Williams, and McAthie, 1978).

For compatibility with the Sherrod study, data collection was carried out on

each of six clinical services: medical-surgical, pediatrics, intensive care,

psychiatry, neonatal, and obstetrics. A random process was used to select

clinical units within each service and days of the week for data collection.

On each service, ten eight-hour shifts per medical treatment facility (MTF)

were monitored over a two week period (five days, three evenings, and two

nights). Nursing service staff were monitored every ten minutes on each

vselected shift for a total of 107,700 data points. Personnel were classified

into the following categories for data collection: a) head nurse; b) wardmaster;

c) RN (to include civilians and ANCs); d) 91C; e) 91B; f) aide/nursinq

assistant; and g) ward clerk. Across all nine installations for all personnel,

the following percentage of time spent by nursing care providers was reported:

direct care 24.5%; indirect care 60.5%; and unavailable for patient care 15.0%.

iii

, . . ... . . .- 4-., ... . .,-..

'.4.%•o "a"

.°•••"o%. •• ,''." . w

These findings were highly comparable to those reported in the civilian

literature. To provide nurse managers with a more definitive analysis, the

indirect care category was broken into eiqht substrata: communicative acts;

preparation of medications, supplies, and equipment; clerical and charting;

conferences; travel and transportation; administration; environmental controls;

and wait time.

The irdirect care percentages tended to be highly similar across all MTFs

with a range of 58.6% to 64.6%. Unavailable for care percentages for all

hospitals were more variable (range = 11.9-21.2%). Direct care percentages,

by facility, from 17.5% to 29.2% overall, with two installations considered as

outliers at the low end.

When examined by clinical service for all sites, the unavailable for care

components were extremely close (13% to 16.7%) with critical care and medical-

surgical having the highest percentages. Direct care by service ranged from

18.9% for obstetrics to 31.3% for the neonatal service. Obstetrics tends to

have erratic demands. A valid reason for the higher percentage in neonatal

occurs because in the newborn nursery, when a staff member holds an infant,

it is considered direct care.. When the indirect care component was examined

across services, the range was 54.6% (neonatal service) to 62.9% (medical-

surgical).

The results of this study combine with the Sherrod findinqs to provide

objective data upon which to project manpower needs for Army nursing service

S-"personnel. A question for further study concerns the non-linear relationship

of the three temporal elements. As direct care requirements increase, indirect

requirements do not necessarily increase in a linear manner. Furthermore, the

reported findings reflect "what is" and not "what should be."

iv

4;,o. ",• -, ,% % ,% ."."% % ,' , *".' . --- """"''"%,.,

TABLE OF CONTENTS

SECTION PAGE

REPORT DOCUMENTATION PAGE. .... ....... ........... .

TABLE OF CONTENTS. . o . o . o o . . . . . . . o o o a o a & & o o o v

LIST OF FIGURES. o .. o . . .. . . . . o. . . . . . . . . . . . o vii

LIST OF TABLES . o . o o . . . . . . . . . . . . o . . viii

ACKNOWLEDGEMENTS . o . o . . o o o o o o o o o o o o o o o . o o o o ix

.INTRODUCTION . . . o . . . .. . .. o. .o. . . . . . . .o o 1a. Purpose . . . . . . .. o o. . . . . ..o a. .o o. ..o o a * * & o 1

b. Background. . .o. o . .. . .. . . . . . . . o o o o . o 1

2. OBJECTIVES. o . . . . . . . . . . . . . . . . . .o. 3

3. METHODOLOGY . o . . . .. . .. . . .. .. . . . . ... . . 3

b. Procedures. . o . . . . . . .. . . . o . . .. . . . . . . .. 3

a. I r ues. o . . . . . .. o. . . . .. . . o .. . . . . . 6

b. Data Collection Period .. . . . . . . . . . . . . o. . . . 6

c. Data by Servce . . . . . . ... . . . .. . . .... . 7

d. Composite MTF Findings for Objective Data . o o ..o. .. . . 7

e. Findings by MTF o o . o . . .. . .. .. . . . . o . . o. . 11

f. Composite MTF Findings for Subjective Data. . o . . . . . .. . 11

5. DISCUSSION. . . . . . . . . . . o o o o o o a o o o o 9 o o o 14

6. CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

7. RECOMMENDATIONS . . .. . . .. . . . . . . . . . .. . . . . . . 17

8. LITERATURE CITED. . . o o o . o o o o . . . . . 0 & 0 0 0 0 0 0 0 18

9o TABLES* o. . . . &. . . . . . . . ..o o . .o . . ..o o . .a . . . . . . . . .o o 19

10. APPENDICES. . . o .. . . . .. .. . . .. o. . . . . . . . .o. . 44

1. Letter - "Indirect Nursing Care Time Requirements". .0. . . . . I-A

V

Table of Contents continued: Page

2. Data Collection Schedule, Brooke Army Medical Center. . . . . . 2-A

* 3. Data Collection Schedule, Darnall Army Community Hospital . . . 3-A

4. Data Collection Schedule, Fitzsimons Army Medical Center. . . . 4-A

5. Data Collection Schedule, DeWitt Army Community Hospital. . . . 5-A

6. Data Collection Schedule, General Leonard Wood ArmyCommunity Hospital. . . . . . . . . . . . . . . . . . . . . . . 6-A

4 7. Data Collection Schedule, Florence A. BlanchfieldArmy Community Hospital, Fort Campbell, KY. . . . .. .. . . . 7-A

8. Data collection Schedule, US Army Medical ActivityFort Carson, CO . . . . . . .. .. . . . . . . . . .. . . . 8-A

9. Data Collection Schedule, US Army Medical ActivityFort Devens, MA o . o .. . . . . . . .. .. . . . . . . .. . 9-A

10. Data Collection Schedule, Kenner US Army CommunityHospital, Fort Lee, VA. . . 0 ... . ... . . . . . . . . . . 10-A

11. Work Sampling Data Form . .. . . . . . . . . . . . .. . . IA-A

1IB. Instructions: "Work Sampling Data-Ward Personnel" Form . . . . 1IB-A

12. Unit Staffing/Care Evaluation Questionnaire . . . . . . . . . . 12-A4,

13. Operational Definitions . .. .. . o . . . . . . . .... 13-A

14. Training Sessions - Indirect Patient Care Observers . o o . . . 14-A15. Example of Written Test for Observers Doing Work Sampling . o o 15-A

16. Example of Written Test for Observers (2) Doing Work Sampling . 16-A

17. Brooke Army Medical Center-Specific Data. . .... .. . .. 17-A

18. Darnall Army Community Hospital-Specific Data . .. . . . . . . 18-A

19. General Leonard Wood Army Community Hospital-Specific Data. . • 19-A

20. Florence A. Blanchfield Army Community Hospital-Specific Data . 20-A

21. Fltzslmons Army Medical Center-Specific Data. . . . . . . . . . 21-A

* 22. DeWitt Army Community Hospital-Specific Data ...... . . . 22-A

23. USA MEDDAC Fort Carson-Specific Data. . o . .. ... . . . . . 23-A

24. USA MEDDAC Fort Devers-Specific Data. . .0. . . . . . . . . . . 24-A

25. Kenner Army '-wnur y Hospital-Specific Data. . . ... .. . 25-A

11. DISTRIBUTION . . . . . . . . . . .. . . . . . . . . . . . . . . 45

vi

LIST OF FIGURES

FIGURES Page

1. Percentage of Major Nursing Activity CategoriesCombined for All MTFs. . . . . .*. . . . . . . . . . . . . . . . 8

2. Percentage of Time Spent by Nursing Personnelin 11 Activities Across All MTFs . . . . . . . . . . . . . . . . 9

3. Percentage of Time Spent by Nursing Personnelin Indirect Care Activities Across All MTFs. . . . . . . . . . . 12

i

-4j

vii

.5.I"

T.,v-. a 0 -%-

LIST OF TABLES

TABLE Page

1. Months of Data Collection . . . . . . . . . . . . . . ..... 20

2. Weekdays of Data Collection. . . . . . . . . . . . . . . . . . . 21

3. Shifts of Data Collection. . . . . . . . . . . . . . . . . . . . 22

4. Original Clinical Setting. . . . . . . . . . . . . . . . . . . . 23

5. Clinical Services . . . . . . . . . . . . * . . * . . . . . . . 24

6. Data Collection Sites. . . . . . . . . . . . . . . . . . . . . . 25

7. Major Nursing Activity Categories by Data Collection Site .... 26

8. Activities Observed . . . . . . . . . . . . .. .. .. . . . . 27

9. Service by Data Collection Site. . . . . . . . . . . . . . . . . 28

10. Care Provider... 29

11. Care Provider by Data Collection Site. . . . . . . . . . . . . . 30

12. Care Provider by Activity Performed. . ............. 31

13. Major Nursing Activity Categories by Care Provider . . . . . . . 32

14. Service by Care Provider . . . . . . . . . . . . . . . . . . . . 33

15. Service by Activity Performed. . . . . . . . . . . . . . . . . . 34

16. Major Nursing Activity Categories by Service ...... .. ., . 35

17. Day Shift-Major Nursing Activity Categories by Service . . . . . 36

18. Evening Shift-Major Nursing Activity Categories by Service . . . 37

19. Night Shift-Major Nursing Activity Categories by Service . . . . 38

20. Percentages of Time Spent in Indirect Care Across All MTFs . . . 39

21. Indirect Care by Data Collection Site. . . . . . . . . . . . . . 40

22. Indirect Care by Care Provider . . . . . . . . . . . . . . . . . 41

' 23. Indirect Care by Service . 6 * f 6 * * * 6 e * 6 * * o * * o * f 42

24. Percentage and Number of Total ADTs for Each MTF by All Shifts . 43

viii

, 4 ... ,C , ' ' .- ". '.'... . - . *'' '

ACKNOWLEDGMENTS

It is not possible to list all of the individuals that brought this study to

fruition. However, the chief nurses and their staff at the nine data collection

sites must be recognized. The reliability and usefulness of these data would be

questionable without their dedication and cooperation. Two individuals require

special acknowledgment: COL M. Walls, ANC, Senior Staff Officer and Assistant

to the Chief Nursing Division, Health Services Command, served as the Study

Director, provided ongoing consultation and guidance, and carried out all of theS',.

necessary preliminary contacts with the medical treatment facilities to gain

their support for the project. Patricia Kelly Roehrl, R.N., M.S.N., C.N.A.A.,

served as consultant to the study and provided the training of project staff

that contributed to the excellent interrater reliability.

*. X

o,

: . ,ix

% ...... .... ... ,w .. ...- -_- ° - . . . _,

1. INTRODUCTION.

a. Purpose. The overall purpose of this study was to objectively measure

the percentage of time spent by nursing personnel on inpatient clinical services

providing direct and indirect care. In addition, the amount of time personnel

were unavailable to provide care was documented. The study findings, when

combined with the results of the Nursing Care Hours Standards Study (NCHS)

(Sherrod et al., 1981), have potential implications for every department of

nursing at all medical treatment facilities throughout the Army as an objective

report of the time spent by nursing personnel in carrying out their mission.

This provides data for a reassessment of manpower yardsticks.

b. Background. The Army Nurse Corps (ANC) has long been convinced that

current patient classification system and patient census provide an inadequate

basis to determine inpatient nursing care requirements and staffing for nursing

units. To document inpatient nursing needs, NCHS was carried out by the

Health Care Studies Division (HCSD), Directorate of Combat Developments, US

Army Academy of Health Sciences, Fort Sam Houston, Texas. Due to the complexity

of the project, LTC S. Sherrod, ANC, the Principal Investigator for the NCHS,

limited her data collection to the direct care needs of patients, i. e.,

"physical or sensory interaction with the patient having direct bearing on his

5needs such as: physical care of the patient, assisting the doctor with exam-

Inations, treatment or procedure, talking with the patient about his condition,

health teaching needs, etc."

LTC Sherrod and her co-investigators developed standard time frequencies

for an extensive list of direct care nursing tasks in six major inpatient

clinical areas: medical-surgical, intensive care, psychiatric, pediatrics, neo-

natal, and obstetrics. The Sherrod study has been cited as having the most com-

prehensive and best documented task list to be found anywhere in the nursing

literature (Giovanetti, 1982).

". C *. 5.* 5.**. 5 5 . '5* *.~X V - -' o

,

In addition to the patient classification system, the Sherrod study

developed staffing mix ratios. These ratios were specific for each of the six

nursing areas and reflected the levels of personnel actually observed rendering

the direct care.

To complete the work begun by the NCHS, the ANC deemed it necessary to

provide valid and reliable measurements of the time spent by nursing personnel

*.Si in other than the direct care activities. These activities were subsumed under

.., two additional rubrics: indirect patient care and unavailable for patient care.

Indirect patient care activities are defined as those tasks performed away

from the patient and include such tasks as: communications, planning his care,

assessing his needs, preparation of medications and equipment, team conferences,

etc. Unavailable for patient care times include those activities of personnel

not directed toward patient care or unit management which detract from time

available for patient care. The majority of these tasks are performed off the

nursing unit.

It was not known whether the percentages of times spent in nursing activities

differ across clinical services, across MTFs, or between civilian and military

hospitals. In the civilian environment, extensive work has been carried out

by Lake (1982) using work sampling to document the percentages of time spent in

nursing tasks. In the community hospital setting, he reports the following

divisions of labor by nursing personnel: a) direct patient care (28-35%); b)

indirect care (50-62%); and c) personal time (10-15%). In comparing the current

data with those from Lake, it is necessary to know that he utilized four major

* activity categories vs three. In his studies, indirect care is compartmentalized

into an indirect component (charting, communication about patients, preparing

medication, and transcribing orders) and a unit-related component (housekeeping,

clerical, communication with others, errands, meetings, and supplies). Very

preliminary analysis carried out by the Veteran's Administration (VA) on

2

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-J _._ 1 . 0 . P 77 -7F.7

medical-surgical units show the following percentages: a) direct care (38-45%);

b) indirect care (37-49%); and c) personal time (13-18%) (Kuhn, 1983). It must

be noted that, in the VA data, wait time (time waiting to render care) has been

subsumed under personal time.

2. OBJECTIVES.

a. Determine the percentage of time spent by inpatient nursing service

pesonnel in each of three temporal categories: direct care, indirect care,

and unavailable for care.

b. Across the three temporal categories, compare the percentage of time

spent among all nine medical treatment facilities surveyed.

c. Compare the time spent in each of the three temporal categories by

various nursing service personnel within and among services and facilities.

3. METHODOLOGY.

tiesa. Overview. Using a work sampling method, nine medical treatment facili-

ties (MTFs) were surveyed to quantify the percentage of time spent by nursing

service personnel over a representative two week period. Times were subsumed

under a rubric of activities consisting of 11 strata. A total of 107,700 ten-

minute time segments were monitored during the study; this equates to 17,817

hours of nursing time. At the end of each shift observed (n=461), the charge

nurses filled out a survey form to supply basic demographic data pertaining to

the nursing unit in addition to their subjective opinions concerning the ade-

S' quacy of staffing for that shift. Also, the number of admissions, discharges,

and transfers (ADTs) per nursing unit were reported.

b. Procedures.

(1) In consultation with COL C. Slewitzke, ANC, Assistant Chief of the

Army Nurse Corps, and the Study Director, COL M. Walls, ANC, potential study

sites within HSC were identified to provide a representative mix of MFTs by

size, nursing unit configuration, and the mission of the population supported.

3

Several Department of Nursing chiefs and their respective MTF commanders were

consulted regarding their willingness to support the study. Nine sites were

selected: Brooke Army Medical Center, TX (BAMC); Ft Hood, TX; Ft Leonard Wood,

MO; Ft Campbell, KY; Ft Carson, CO; Fitzsimons Army Medical Center, CO (FAMC);

Ft Devens, MA; Ft Belvoir, VA; and Ft Lee, VA. A letter from the Commander,

HCSCIA, was transmitted to the commander of each selected MTF and requested

formal permission to conduct the study (see Appendix 1). All answered in the

affirmative.."

(2) The Chief, Department of Nursing, at each MTF provided the

Principal Investigator (Pl) with three items: a) a list of all inpatient

nursing units broken down by clinical service (i. e., medical-surgical,

pediatrics, neonatal, psychiatry, intersive care, and obstetrics); b) a point

of contact at each site; and c) the names of two to seven nursing personnel

who would be trained to serve as data collectors at the site.

(3) Using a table of random numbers, the study staff selected nursing

units from within each clinical service to collect data. Data collectors were

assigned to gather data on randomly selected days over a two-week period. Data

were collected on 10 eight-hour shifts within the two-week period, randomly

selecting the following shift configurations: a) five days; b) three eve-

.. nings; and c) two nights (see Appendices 2 to 10).

(4) A data collection form (see Appendix 11) was developed as a

modification of a previous study from the US Public Health Service, Division

of Nursing, referred to as the "San Joaquin Study" (Murphy et al, 1978). The

modifications included changes in operational definitions and expansion of

off-the-unit/unavailable for care activities to be more responsive to Army

practices and needs. From the same study, a modified tool (see Appendix 12)

was developed to be completed by the charge nurse at the end of shift on each

of the monitored nursing units. The survey was to determine the basic nursing

4

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,,, . , .-- .- . • . . . ' . o .-. a.. . . . *.*. ... [ .- , -. -, . , ,, ,.- . . ..- t. . .

unit demographics and allow the charge nurse to subjectively assess the adequacy

of the staffing on the shift and to report the number of admissions and disposi-

tions during the tour of duty. Forms were pilot tested at BAMC for validity

checks to insure capturing necessary data and to assure that the operational

definitions (see Appendix 13) encompassed all of the nursing tasks and time

allocations. This also provided an opportunity to carry out checks of interrater

reliability measurements, which were essentially 100%. Minor modifications were

made in the instruments and instructions to insure ease of use and to clarify

operational definitions.

(5) A civilian consultant, with knowledge and experience in training

and carrying out a work sampling study, was contracted to review the protocol

and train study staff in the method. She jointly trained with the investigators

at two facilities and observed the HCSCIA study staff train at one additional

site. The study staff subsequently carried out training at the remaining five

sites. An outline of the training scenario is found at Appendix 14. As a part

of the didactic orientation, data collectors were given two tests (see

Appendices 15 and 16) to insure reliability in classification of activities.

Further training included two observation periods on typical nursing units

allowing data collectors the opportunity to become familiar with the instrument

and to further insure interrater reliability. Training and data collection

occurred between 28 February 1983 and 31 April 1983.

(6) The basic method for data collection was work sampling, a technique

reported by Abdellah and Levine (1954). The method entails collecting data at

predetermined intervals; then based upon sampling theory, extrapolating the

findings over the entire monitored period of time. Time spent in each of the

11 activity categories was recorded for nursing service personnel at each ten-

minute interval during the entire eight-hour shift. The first task observed

being performed by the monitored person was the activity documented.

5

U. ,.

1 -V .

Nursing personnel were assured of not being individually evaluated; data were

to be part of aggregate findings. Staff quickly adjusted to the observers and

it was not felt that behaviors changed due to observation. During training,

data collectors were taught to begin monitoring at random points on the

surveyed nursing unit, travel on varied routes, and to begin their observations

at random times for each observed segment.

psi (7) One data collection form was completed per hour on each of the

observed nursing units. At the completion of the data collection period, all

forms were forwarded to HCSCIA along with a time schedule for the assigned per-

sonnel on each nursing unit and the charge nurse survey forms for each shift.

" Data were key punched by HCSSA at Ft Sam Houston, TX, and analyzed using the

Statistical Package for the Social Sciences (SPSS) and Statistical Analysis

Systems (SAS).

4. FINDINGS

a. Instruments. The findings are based on two instruments: the "objective

form" used to collect the work sampling data and the "subjective form" from a

survey completed by the charge nurse at the end of each monitored shift. The work

sampling data comprised 107,700 data points or ten minute segments of monitored

time, equating to 17,817 hours of nursing service time across all nine study sites

The subjective findings are reported from the 461 forms completed by charge

nurses. Because of the large number of data points, the reporting of statistical

significance lacks value. Only descriptive statistics will be reported in most

instances.

b. Data Collection Period. Table 1 presents the breakout of data collection

-. by month. Table 2 breaks out the data acquisition by day of the week. Table 3

subsumes the hourly data into three shifts.

6

c. Data by Service. Chief nurses submitted lists of their nursing units

representing 17 categories. Table 4 presents the data collected by the 17

original clinical settings. To make the data compatible with the Sherrod study,

the nursing units were subsumed under the six clinical services of interest:

critical care, medical-surgical, psychiatry, OB-labor-delivery, newborn nursery-

neonatal intensive care, and pediatrics-pediatric intensive care (see Table 5).

d. Composite MTF Findings for Objective Data. Table 6 delineates the

frequency and percentages of total data collected at each of the MTFs in the

study. Across all sites and services, 60.5% of nursing time was spent provid-

ing indirect care; 24.5% providing direct care; and 15.0% was reported as time

4 unavailable for care (see Figure 1). Table 7 presents the percentages of time

spent in each of the three temporal activities across all MTFs. Noteworthy are

findings for the indirect care across sites. None of the sites vary more than

4.1% points from the mean (60.5%). To provide a more definitive report for each

of the 11 activities monitored, Table 8 and Figure 2 are provided. Table 9

reports the six clinical services and their proportion of the total data by MTF.

The activities of all full-time nursing service personnel were monitored on

each ward studied. Table 10, 11, and 12 provide the percentage of data points

by all nursing service personnel, nursing personnel by MTF, and nursing

personnel by activity performed. A cursory examination of the data revealed a

tendency for installations with a higher ratio of RN to non-professional staff

to also have a higher proportion of time spent in direct care activities (r=.61,

p <.10).

When all 11 tasks/activities are examined by each category of care provider,

several interesting findings are revealed. Head nurses spent 14.5% of their

time in direct care. Only 2.0% of time by all providers is spent in

environmental tasks. Even the obstetrical service, with its high cleaning

requirements, only spends 3.1% of personnel time in environmental efforts.

7

4AC4

C-44

06

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"lion

l o .1./,

Vt w

End .

-- WI-

= Uv

IO= I-I l

Charting and clerical tasks consume 11.0% of overall time, while travel and

transportation activities take 10.7% of nursing personnel time. The percentage

of time spent waiting is 8.7%. Head nurses spent only 1.6% of their time

LL waiting, however, LPNs, Aides, and 91B/F/G personnel, respectively, spent 13.0%,

13.2%, and 12.5% of their time waiting.

Table 13 truncates the 11 individual activities into the three temporal

activity categories by type of provider. Table 14 provides an overview of the

contribution of each type of provider by the six clinical services for the

entire data set.

The next two tables present the clinical service findings for the entire

data set by the 11 activities (see Table 15), and the three temporal activity

categories by service (see Table 16). This latter table substantiates that the

percentage of direct care provided is highest for the newborn/neonatal intensive

care (31.3%) and critical care units (29.8%), with the least amount of direct

care reported for the obstetrical service (18.9%). The indirect care

requirements are highest for obstetrics (65.6%) and lowest for the newborn

nurseries and neonatal intensive care units (54.6%).

Tables 17, 18, and 19 present the service by activity categories for day,

evening, and night shifts, respectively. Direct care time changes from an

overall mean of 24.5% to 30.3% on the evening shift and unavailable time drops

precipitously from 18.0% on the day shift to 4.1% on the night shift, when

fewer personnel are on duty and when fewer extraneous off-the-ward duties are

required.

Because the major objective of the study was to examine indirect care, the

eight activities subsumed under indirect care were analyzed separately across

all MTFs. Tables 20-23 present these findings in a composite fashion, and then

by facility, provider, and service respectively. Proportions of total time are

10-.%

-.,

4

. . % ", z ,, -V " ' "' -" 9. un mlW *,. ,.- *' Inm mml am,,'..'.m'u.d.-m. *.-m ,,h~, nlJ

not affected; however, a clearer picture is gained of the individual indirect

tasks as compared to all other indirect factors (see Figure 3). Communicative

acts, charting/clerical, and administrative functions account for 49.9% of the

indirect care with travel and transportation components consuming 17.7% of this

subsection. Table 22 illuminates the amount of indirect time that RNs

(excluding head nurses) spend in charting and clerical activities (24.9%),

whereas ward clerks only spend 33.7% of their time in the same function.

e. Findings by MTF. The data to this point has been based on the aggregate.

Appendices (17-25) are provided for each MTF.

f. Composite MTF Findings for Subjective Data. The subjective data were

gathered at the end of each monitored shift via a survey questionnaire completed

by the charge nurse. Study personnel briefed head nurses on the instrument and

then requested that they, in turn, train their charge nurses. OperationalR

definitions were not provided and the form was, by necessity, completed at the

end of the shift, at the same time the nurses in charge were confronted with

several other tasks that they might have felt to be more relevant. These

findings would have been enhanced had the data collectors also subjectively

rated the staffing adequacy for the shift observed. Given these possible

limitations, four pieces of data were examined: 1) admissions, discharges, and

transfers (ADTs) on the shift; 2) the nurses' rating of the adequacy of the

staffing for the shifts; 3) the possible causes for the less than adequate

staffing; and 4) possible remedies for the staffing situation.

When admissions and discharges were tabulated across all reports, 46.4% of

the observed shifts had no admissions and 52.3% of the shifts had no discharges.

When ADTs were combined, 33.3% of the shifts reported no ADTs; 51.5% had one or

*fewer ADTs; 65.4% had two or fewer ADTs; and 72.0% reported three or fewer ADTs.

The range of the ADTs for all MTFs combined were 0-21 on days, 0-7 on evenings,

Z. .- I."p

1'919

4m-

4-4

99 00

00U

ki12

and 0-8 on nights. To compare the number of ADTs by MTF on each of the day,

evening, and night shifts, Table 24 is presented. Across all MTFs, 50.9%

(n=234) of ADTs occur on the day shift; 29.1% (n=134) of the ADTs were on the

evening shift; and 20.0% (n=92) of the ADTs occured on the night shift. Note-

worthy is the closeness of the percentages of ADTs by shift across all MTFs

regardless of size and configuration.

The gross indicator of the overall staffing adequacy were the charge nurses'

subjective reports. Across all sites, from the 461 charge nurse reports, 24.0%

of the shifts were rated as staffed inadequately (4.8%, n=22) or barely adequate

(19.3%, n=89). When the less than adequate staffing responses were examined,

the day shifts were found to be most inadequately staffed with the inadequate

response reported on 30.2% (n=70) shifts. Evening and night shifts were

reported to be less than adequately staffed on 18.6% (n=25) and 17.4% (n=16)

respectively.

The relationships between adequacy of staffing and the percentage of time

spent in each of the temporal categories were examined. The correlation between

the percentage of time spent providing indirect care and staffing adequacy was

not found to be significant. However, a significant correlation (r=0.22, p <.001)

was demonstrated between the percentage of direct care rendered and staffing. As

the percentage of time spent in direct care increases, the charge nurses' percep-

tions about the adequacy of staffing decrease. It is not possible to correlate

the staffing adequacy and unavailable for care times because of several possible

interactions, i. e., when staffing is perceived to be adequate, the charge

nurse may tend to award compensatory time to staff.

If the staffing was "barely adequate" or "inadequate" (n=111), the charge

nurse was provided a list of multiple factors which might describe the reasons

for this: 55.0% indicated "not enough staff on duty"; 53.0% selected "above

average number of patients needing extensive nursing care, assistance, or

13

"4'.- ' o % '.,., . ' ',,. . . - % .. . . • , . % '

surveillance"; 34.0% stated there was "not an optimum mix of personnel skill

levels"; 27.0% indicated a "census fluctuation"; and 19.0% responded "above

average number of patients needing escort by nursing or other departments."

When asked what would have helped the less than adequate staffing situation,

57.0% responded "an additional RN all shift"; 34.0% indicated the need for "an

additional aide all shift"; and 27.0% felt that "an additional LPN all shift"

would have relieved the situation.

Charge nurses were asked to "please judge the following aspects of care

according to your best knowledqe of nursing service given to at least 90.0% of

the patients during this shift. Consider factors such as safety, accuracy,

patient comfort and satisfaction, and agreement with medical and nursinq plans

of care" (see Appendix 12). Two components of nursing care were found to be

* judged less than satisfactory at least ten percent of the time:

a) communications with patient and/or family (explanation of procedures,

teaching, orientation, "therapeutic socializing" (10.7%); and b) rounds with or

assist MD with special procedures ( 0.5%). The remaining eight categories of

care (see Appendix 12) were rated as less than satisfactory from 4.,-8.5% of the

time. While these figures may appear low, the referent for judgement was only

90.0% of the patient census. For the same ten items, 53.2-78.3% of the time the

charge nurse deemed the care to be "more than satisfactory" or "good."

5. DISCUSSION.

The documentation of how nursing service personnel spend their duty time at

nine HSC installations with varying configurations and missions shows that the

percentage of times do not differ substantively from those reported in the

civilian literature (Lake, 1982), given that operational definitions and

categorizations are slightly different. The overall direct care percentages in

this study would have been higher if certain components of indirect care; i. e.,

so! travel/transportation and equipment set-up and tear-down times, had been subsumed

14

... *..***>.*.*;..*;.~~~~~~~~~ %'.. ~ . .L~ ;--*-..~-*.~-.

* :4 T C . - 7 1 %A -. 6

C...,

i-' under direct care. However, conforming to the Sherrod study, direct care

activities only encompassed "bedside-to-bedside" tasks. THE CURRENT STUDY

MEASURES WHAT IS AND NOT WHAT SHOULD BE. No attempt was made to indicate

quality of care, only quantities of time spent.

The findings for the direct care category are not as consistent when exa-

mined across MTFs and clinical specialties. The single factor which appears to

erode most at direct care time is time unavailable for care. When enlisted

personnel make up a high percentage of the staff, particularly at small

installations, the amount of time off the unit increases. When the number of

RNs increases, so does the amount of direct care. These findings may have

implications when reconfiguring the yardsticks for manpower allocations.

The data also indicate that wait time spent by LPNs, Aides, and the 91B, F,

. and G, may be high. This is perhaps a function of their being unable to perform

tasks needing to be done, being unable to recognize what needs to be done, or

lacking motivation. Likewise, head nurses may spend too much time giving

Cdirect care (14.5%). Perhaps more of the head nurse time might be redirected to

teaching, supervising, and motivating other staff members.

Although the objective data are reliable, the subjective data must be

viewed with caution. It was possible to determine probable causes for a

feeling of inadequate staffing reported in 24.0% of the instances and the charqe

nurse could enumerate the classification of personnel that would possibly remedy

the situation.

-. Several chief nurses have indicated that the number of admissions,

dispositions, and transfers on any given shift are a real and significant

problem. However, attempts to correlate the numbers of ADTs with several other

variables (Including adequacy of staffing) failed to demonstrate any relation-

ship. Either the variables which correlate with ADTs were not identified, the

relationships are non-linear, there are multi-casual factors, or the variables

Interactive.

15

-.o

' , -,' " ,- - ' .r -. .-,. . ,z ,.. -.,.-.".,-.- .,., , .. - .. ,- .. . --.,-,% .,,,. . . . _-.'..-,C\ .~ C..,. . . .. . . .- '

. or.

The findings of this study coupled with patient classification studies

(i.e., the amount of direct care needed by patients), allows for a close exami-

nation of manpower requirements for nursing personnel throughout the Army. A

caveat is necessary: as direct care requirements increase, it is not necessar-

ily true that indirect care and unavailable for care requirements will increase

in a linear relationship. Further study ,may be required to develop alternative

staffing methodologies.

6. CONCLUSIONS.

a. Across all MTFs surveyed, the percentages of time spent by inpatient

nursing service personnel in each of three temporal categories are: direct care

(24.5%), indirect care (60.5%); and unavailable for patient care (15.0%). These

findings are comparable to previous civilian studies.

b. A comparison of the times spent in each of the three temporal cate-

gories among all nine MTFs studied demonstrated that the most variance was in

the temporal categories of direct care and unavailable for care. Differences

appeared to be a function of hospital size and the mix of personnel assigned.

c. The times spent in each of the activities were not different from that

expected. However, the differences among the clinical services, especially

obstetrics and medical-surgical, indicate that a different yardstick might be

considered for each of the six services.

d. From the reports of charge nurse opinions of the adequacy of staffing

for each observed shift, 24.0% of the shifts were felt to be inadequately

staffed. The major reasons for the staffing problems were in order of their

selection: "not enough staff on duty"; ."above average number of patients

needing extensive nursing care, assistance, or surveillance"; and "not an opti-

a.... mal mix of personnel skill levels." The most often cited remedy for alleviating

the staffing problem was the "need for an additional RN for the entire shift,"

which was selected by 57.0% of the respondents.

16

4-.4-

7. RECOMMENDATIONS.

It is recommended that the findings for this study be combined with those

from a patient classification study currently being conducted by the Nursinq

Research Service at Walter Reed Army Medical Center. Model staffing guides

should be developed and tested at selected facilities to determine adequacy of

staffing and quality of care.

1..

.

V ,Dee

8. LITERATURE CITED.

Abdellah, F. & Levine, G. "Work Sampling Applied to the Study of NursingPersonnel," Nursing Research, Vol. 3, June 1954, pp. 11-16.

Giovanetti, P. A Review and Analysis of Two Patient Classification Systems,Minneapolis, MN, HMS Associates, 1982.

Kuhn, 0. Personal Communication, July 28, 1983.

Lake, W. H. Nurse Staffing Based on Patient Classification, IMS, Inc.,Rockville, MD, 1982.

Meyer, D. Grasp - A Patient Information and Workload Management System,MCS, Morgantown, NC, 1978.

Murphy, L. N., Dunlap, M. S., Williams, M. A., and McAthie, M. Methodsfor Studying Nurse Staffing in a Patient Unit, DHEW Publication No.-HRA) 78-3. Washington, DC, US Government Printing Office, 1978.

.Sherrod, S. M., Rauch, T. M., and Twist, P. A. Nursing Care Hour StandardsStudy, Parts I-VIII, Health Care Studies Division, Academy of HealthSciences, Fort Sam Houston, TX, September 1981.

-4

5%

--

ee

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a .. ~a -~ * h C . - -9.

4-.

9.,

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44

TABLES

C.

'.4

C.

C,.

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4.

19

Table I

TIME SPENT IN INDIRECT NURSING CARE STUDY

MONTHS OF DATA COLLECTION

.4-

VALUE LABEL VALUE FREQUENCY PERCENT

FEBRUARY 2 18 .0MARCH 3 79110 73.5APRIL 4 28572 26.5

TOTAL 107700 100.0

420 6 i -..

-" ,..°,.. ... '.-. ... ...-.-.. ...-..- ...-. .. .. % .

I'--4_ _* 4 . ,, ,, -en '.n; , ; ,, ~qm ,

Table 2

TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTION

. VALID CtLM

VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT44.

SUNDAY 1 7206 6.7 6.7 6.7MONDAY 2 14226 13.2 13.2 1909TUESDAY 3 21060 19. 19.6 39.'WEDNESDAY 4 20310 18.9 18.9 58 3

- THURSDAY 5 21690 20.1 20.1 78.5FRIDAY 6 15366 14.3 14.3 92.7SATURDAY 7 7842 7.3 7.3 100.0

TOTAL 107700 100.0 100.0

VALID CASES 107700 MISSING CASES 0

,21

4.

*1.'. . ;. .. . . . .. . .. . . . ., - . , - .. . , ,

,21, . . ,- \ ',, ' ,,

..

Table 3

4

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

VALUE LABEL VALUE FREQUENCY PERCENT

DAY 1 69630 6497EVENING 2 24660 22.9

NIGHT 3 13410 12.5

TOTAL 107700 100.0

22

'.

" U-, "

°•'• ' "

" . " " w % " % " % • " , " - % " "

4.. ' ' ",, " ".,. ' ' .. ' ' .",-.-" - . " - " • - " " . " . ' " , ." "." "

U'" " ~ l li,

. .. ' ' ' " ' ' " ' ' : " " " -" "- . -' " ": - . "

I.

Table 4

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

VALUE LABEL VALUE FREQUENCY PERCENT

* 144 •.1

M ED 1 8232 7.6SURG 2 11346 10.5PED SRG COMBO 3 2550 2.4

ORTHOPEDIC 4 2748 2.6U8 5 8016 7.4

LAROR E DELIVERY 6 3390 3.1

0B LED CCMBO 7 4638 4.3

NEWBORN 8 13002 12.1

PEDS 9 16146 15.0

SICU 10 3384 3.1

MICU 11 1950 1.8

C CU 12 1740 1.6

ICU COMBO 13 10584 9.8

NICU 14 2316 2.2

PSYCHIATRY 16 12366 11.5

PED ICU 17 1956 1.8

ICU STEP DOWN M S 18 3192 3.0

TOTAL 107700 100.0

* Missing

2.

• 23

.4 ',N ';', , , "" " ""€. " ' ' 1 " ,,€ ""';-" '' , ; ". .,..;3.o -. ;.,..':.-...:.'..-,'.., _, £ , , . r. - , .. ," -"-'""-"'---';-

Table 5

TIME SPENT IN INDIRECT NURSING CARE STUDY

CLINICAL SERVICES

VALUE LABEL VALUE FREQUENCY PERCENI

* 144 • 1CRITICAL CARE 1.00 17656 16.4NED SURG 2.00 28068 26.1PSYCHIATRY 3.00 12366 11.50 LABOR DELIVERY 4.00 16044 14.9NBN NICU 5.00 15318 14.2PEDS PICU 6.00 18102 16.8

TOTAL 107700 100.0'

* Missing

"24

L224

-..-.. ,~7,77 717~ 4~* --

i4

Table 6

TIME SPENT IN IDIRECT NURSING CARE STUDY

DATA COLLECTION SITES

• I

4.

VALUE LABEL VALUE FREQUENCY PERCENT

BROOKE AMC 1 1??46 16.5DARNALL COMM HOSP 2 13932 12.9GEN WOOD COMM HOSP 3 12582 11.7CAMPBELL COMM OSP 4 12282 11.4FITZSIMONS AMC 5 21276 19.8DEW17 CO"M IOSP 6 9282 8.6FORT CARSON HOSP 7 11214 10.4FT DEVE14S COMM HOSP 8 3276 3,0FORT LEE COMM HOSP 9 6108 5.7

TOTAL 107700 100.0

.2,

25

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,C C S Table 8

TIME SPENT IN INDIRECT NURSING CARE STUDY

ACTIVITIES OBSERVED

C, #.'

VALUE LABEL VALUE FREQUENCY PERCENT

DIRECT CARE -1 26375 24.5PERSONAL 0 9477 8.8

OFF UNIT ACTV 1 6712 6.2

COMMUNICATIVE 2 10606 9.8MEDS SUPPLIES EQUIP 3 5435 5.0CHARTING CLERICAL 4 11853 11.0

CONFERENCES 5 4223 3.9

TRAVEL TRANSPORT 6 11532 10.7

ADMINISTRATION 7 10054 9.3

ENVIRONMENTAL 8 2097 1.9

WAIT TIME 9 9336 8.7

TOTAL 107700 100.0

27

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Table 10

TIME SPENT IN INDIRECT NURSING CARE STUDY

CARE PROVIDER

VALUE LABEL VALUE FREQUENCY PERCENT

* 318 .3HEAD NURSE 1 7926 7.4WARDMASTER 2 8634 8o0RN 3 34812 32o39IC 4 8988 8.3LPN 5 10308 996918 91F 91G 6 21120 19.6A IDE 7 9264" 8.6WARD CLERK 8 6330 5.9

TOTAL 107700 100.0

* Missing

29

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APPENDIX 1DEPARTMENT OF THE ARMY

US ARMY HEALTH CARE STUDIES AND CLINICAL INVESTIGATION ACTIVITYFORT SAM HOUSTON, TEXAS 73214

HSHN-Z 2 February 1983

" SUBJECT: Indirect Nursing Care Time Requirements

1. The Army Nurse Corps has long been convinced that patient census alone is aninadequate basis for establishing nursing manpower and staffing requirements.During FY 81, an Army study was completed which provided a valid and reliablemethodology for the quantification of inpatients' direct nursing care needs;however, this provides only one portion of the formula needed for the deter-mination of nursing manpower.

2. Pursuant to The Surgeon General's FY 83 Army Medical Department StudyProgram, under AR 5-5, the aforementioned study is to be continued with thegathering of data necessary to quantify the percentage of time spent in indirectnursing care activities. In order to assure the validity of these data, it willbe necessary to study Medical Treatment Facilities (MTFs) of various sizes.Because of the size and configuration of your MTF, it has been recommended byHQ, HSC as one of the sites for data collection.

3. The proponent agency for this study is Health Care Studies and ClinicalInvestigation Activity (HCSCIA). Colonel Marisn Walls, ANC (HQ, HSC), is theStudy Director. LTC Terry R. Misener, ANC (HCSCIA) is the PrincipalInvestigator.

4. It is planned that training for the conduct of the study (data collection)be provided at each installation by the Principal Investigator's staff. Also,it is envisioned that the Department of Nursing at each selected MEDDAC/MEDCENprovide data collectors from within its staff. These details have beendiscussed with your Chief Nurse, who has expressed an interest in supportingthis effort. Definite timetables for the study are pending; however, trainingand data collection would not commence before 28 February 1983. The exact datesthat our representatives could be at your facility can be coordinated with yourstaff.

1-A

a, . . .:, , - . .. . . . . . . .

HSHN-Z 2. February 1983SUBJECT: Indirect Nursing Care Time Requirements

5. We would appreciate receiving your cooperation and command support for thishigh-priority study. A timely response granting willingness to participatewould be appreciated so that study plans can be formalized.

DAVID G. BRUNNERColonel, Dental CorpsCommanding

List of addressees for Indirect Nursing Care Time Requirements

CommanderColonel Florence A. Blanchfield Army Community HospitalFt Campbell, KY 42223

CommanderUS Army HospitalFt Carson, CO 80913

Cone inderUS Dewitt Army HospitalFt Belvoir, VA 22060

CommanderBrooke Army Medical CenterFt Sam Houston, TX 78234

Commander

US General Leonard Wood Army HospitalFt Leonard Wood, MO 65473

ConuanderUS Kenner Army HospitalFt Lee, VA 23801

CommanderUS Darnell Army HospitalFt Hood, TX 76544

,' CommanderaUS Cutter Army Hospital

Ft Devens, MA 01433

CommanderFitzsimons Army Medical CenterAurora, CO 80045

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APPENDX 1B

INSTRUCIONS: "WORK SU-1LZ-G DATA - tAM ".vSO111mEL" r0n'.M

This is the form that il be used to coilec= all data for the Indirect NursingCare Study in which you are participating. You will be asked to complete ONEFO.L for EACH HOUR of observation. la order for this study to be valid theseforms must be completed precisely. Please follow the instruc:ions carefully:

DATE: in box 1,2 place the Day of the Month (i.e., 05, 14)in box 3,4 the Month (i.e., Feb - 02, M{ar 03, etc.)in box 5,6 the Year which is "83"

DAY OF WEEK: in box 7 place the code for the day of the week (1-Sunday, 2-.Monday,3-Tuesday, 4-Wednesday, 5-Thursday, 6-Friday, 7-Saturday)

.1 TF CODE: As provided in Training Session

UHIT CODE: As provided in Training Session

CENTER BOX: Type of Ward - write "Med/Surg" or "OB" or "L & D" etc.Observer: write your name

SHIFT: in box 13 write the code for the Shift (1-Day, 2-Evening, 3-Night)

HOUR OBSERVED: in boxes 14-17 place the hour the observation began (example:0800 to 0900 observed - "0800")

The remainder of the form is for actual data collection. In the "Provider"colu list each care provider present for duty for the shift. Indicate theprovider code in boxes 18, 25, 32, etc. for each provider observed during thathour as follows:

S- 1Head Nurse 4 - 91C 7 - Aide/NA 0 -Volunteer2 - Wardmaster 5 - LPN 8 - Ward Clerk

3 - RN 6 - 91B 9 - Student

(Example: If the first person listed and observed is the 91C, place acode 4 in block above number 18 and "91C" in blank space under "?ROVIDER"heading.)

Across the form are listed 11 different activity categories broken down into six10-minute sections. As you make each of the six observations for that hour placea check mark in the appropriate activity column.

(Example: At 20 past the hour the obseracion is of the 91C talking to theRN about a'patienc. Place a mark on the provider line marked 91C in theCOMMUI-CATIVE ACTS column under "20" minutes.)

IACTIVITY CODES: LZAVE BLANK

11B-A

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APPENDIX 12

i:JIT STAFFI ":G/CARE Z"'LLUJ 1,JO QUEST I ONNAI RE

* Charge turse: Please com-plete at or toward the end of each shift.STAFF ON SHIFT

Hospital: - _____________ ___________________ ___

Type of Unit: ___r.p.,:;.rL FULLT 1." PARTTI. .-,.SS.. . Ej R"S

Unit: _ _.__/ _ _ _ _

Day of Study: _ _ _ _ _s S

"Shift: D E N LP1Z's

Date: ! Aides ___

Month ay Year Sd

;Person completing form: Id Clar-

-Total Patients .in Each Class at Beginning ".:____ _C__Le

of Shift: * "un:be. of peruonnei on schedule but notavailable for patient care for the en:ire shift

I II III IV (include sick/qtrs, Continuin,- - ducazion, TDY,Ad-n absen:e, Co.p-time, CQ ,ctc. ; DO .07

- -include Leave, Days off, etc.)

Admissions Discharges during shift.

1. In general, did you feel that staffing for this shift was:

!.ore than Pdeouate Cc=fortable Adecu-jte Barely adecuate Inadenuate5(' ) 4 ) 3C ( ) ) ( )

:2. If barely adequate or inadequite, w:ich one(s) of the follcwing factors seemaed to bestdescribe the situation? (Zeck the one(s) that aply.)

2.1 Above average rumter of patients needing extensive nursing care,assistance, o- surveillance.

2.2 ,ot enough staff on duty: e.g., to few scheduled; scheduled butnot on duty, or transferred to another unit.

2.3 Census fluctuations: e.g., above averace nu:er of admissionsthis shift o- previous shift, or above average number of dis-missals or transfers.

2.4 1Not' an optirum mix of personnel skill levels.

2.5 Above average n.;:ber of patients needing escort by nursing orother departments.

2.6 Other (please describe)

[ (over)

12-A

I-"

APPENDIX 12 (continued)

3. In your judgenent, if staffing was barely adequate or inadequate, what wouldhave best helped the situation? (Check the one(s) that apply.)

3.1 Additional Aide all shift 3.7 Addisticnal RU all shift 73.2 Tv:o additional Aides all 3.8 Two additional R.'s all

shift. shift3.3 Additional Aide part of 3.9 Additional RN part of

shift shift3.4 Additional LPN all shift 3.11 WC all shift3.5 Two additional LPU's all 3.12 Additional WC part of

shift shift3.6 Additional LPN part of 3.13 Other (please discribe)

shift

4. Please judge the following aspects of care according to your best knowledgeof nursing services given to at least .900 of the patients cvring this shift.Consider factors such as safty, accuracy, apatient ccn:fort and satisfaction,and agreement with medical and nursing plans of care.

Check the Value that best applies using the followaing scale:

5 - Good 3 = Satisfactory I = Poor4 = More than satisfactory 2 u Less than satisfactory

4.1 Basic hygienic care (bathing, clean linen, oral hygiene, skin care).

1 2 3 4 5

4.2 Basic feeding and toileting (assistance with meals if needed, fluidsJ forced, prompt care of elimination needs).S1 -2 - 3 - 4 S

4.3 Mobility (turning as needed, ambulation, assistance in getting out ofbed as needed, up in wheelchair, pcsitioning).

2 3 4 5

4.4 Medications, IV's (given as ordered and within time limits).1 2 3 4 5

4.5 Co.-.unication with patient and/or fanily (explanation of procedures,teaching, orientation, "therapeutic socializing").1 2- 3 4 5

4.6 Special procedures (oxygen maintained, dressings changed as needed,irrigations, catheter care, etc.).1. 2 3 4 S5

4.7 Observation of patients (.nursing rounds, checking on signs, symptoms).1 _ 2 _ 3 .. 4 5 .

4.8 Vital signs (taken as indicated or ordered).1 2 3- 4. 5

4.9 Roinds with or assist 140 with special procedures.1 2 _ 3 _ 4 5

4.10 Implemnentation of new ord., without undue delay (dismiissal orders,routine and stat orders).1 2 3 4 5.

I." I.

2

12-B

~ ,

APPENDIX 13

OPERATONAL. DEF:NIT:ONS

DIRECT 6T- -? CARE: Physical or sensory interaction with the patient havinga direct bearing on his needs such as: 'nysical care. of the patient, assistingdoctor with examinations, treatment or procedure; talking with the patient.,NDIRECT PATIENT CARE: Patient-centered activities oerformed away from the

.,:-4. patient sucn as: communications, planning his care, assessing his needs,'preparation of medications, equipment, team conference, etc.

0. Personal Activities: Refers to meal time, coffee, personal telephonecalls, socialization not related to work, personal toilet activities.

1. Off unit activities- Refers to activities which removes individualfrom the ward for less tnan a full 8 hour shift.

a. Doctor or Dental Appointment (Outpatient Care)b. Mandatory Training (including ward/clinic or hospital in-service;

DOES include Race Relations/Equal Opportunity Classes, etc.)c. Seminars and Continuing Education Requirements (Seminars, short

courses, etc., ward/clinic in-service)d. Duty Roster Performance (Equivalent time-off after duty as CQ,

CQ Runner, KP, Guard Duty, SONCO, 500 (Military Only)e. Company Duty (Inspections, Parades, etc.)f. Compensatory Time

. g. Leave Without Pay (Less than 8 hours)h. Air Evacuation/Ambulance Runsi. Staff and Other Administrative Meetings (non-patient conferences)1. Educational Advancement Permitted During Duty Timek. Absence due to illness of dependent/taking dependent to medical

appointment1. Miscellaneous (For those activities not covered by any other title,

e.g., Court Duty, EEO Counselor Activities, Award Ceremonies notfnvolving Parades, etc.)

m. Orientationn. Inprocessingo. Outp~rocessi ngp. Cvilian Annual'Leave (Less than 8 hours) (DOES NOT include regular

scheduled day(s) off during week)q. Ill (sick leave)

2. Communicative Acts - Refers to those communicative acts that arenecessary in meeting requirements for patient care. These activities includeanswering the phone and all communicative acts between personnel.

3 Prearation of Medications, Suoolles. and -:uiment - Refers to theset-up ano '!ear-cown of ail zat,,ent :are supiies, meoacatlons, and equipment,and checking of all emergency equipment and supolies.

13.o

~13-A

4.

APPENDIX 13 Cont.

OPERATIONAL DEFINITIONS

4. Charting, Chart Reference, and Clerical - Refers to all activitiesinvolving the patient's care or written materials concerning the patient to

4 .~include checking or reading the Kardex, careplan/chart transcription orwriting of orders, writing in chart, Kardex, or careplan. All information toinclude vital signs, intake and output, completing or filing of clinicalreports.

5. Conferences - Refers to those meetings or planning sessions whichinfringe upon direct nursing care time and includes the change of shiftreport, medical and nursing rounds, patient care conferences, and patient careplanning (include written nursing care plan development).

6. Travel and Transportation Tasks - Refers to those activities thatutilize nursing personnel in transporting people and objects. Theseactivities include the transporting of patients, transporting of all suppliesand equipment, transporting specimens and traveling on the ward.

7. Administrative Tasks - Refers to those activities that are performed inmeeting general management needs of the patient care unit. These activitiesinclude the time schedule, staff assignments, efficiency reports, chart audit,manpower survey records, and special written reports.

8. Environmental Control Tasks - Refers to those cleaning activities thatinfringe upon direct nursing care time. These activities include cleaning thepatient care unit, linen control, cleaning of ward equipment, mopping andcleaning the floors and emptying the trash.

9. Wait Time - Refers to those time intervals when the individual mustwait for supplies, equipment, medical approval or similar actions. Includetime staff may appear to be doing nothing, but waiting to render patient care.

13-B

%

'4

APPENDIX 14

TRAINING SESSIONS - INDIRECT PATIENT CARE OBSERVERS

Introductions

Discussion of purpose, objective, roles, uniform requirements, & duty schedule.

METHODOLOGY -

Work sampling technique effective/accurate over time , will observe ea 10 mi.

Discussed process, data collection instrument.

Caution against bias, don't anticipate, make "snap shot" observations.

Rotate about ward, observe each staff member as approached.

Randomize start time, place, and direction.

Remove yourself from area/staff between rounds.

Inquire intu absence of staff-purpose being personal or business?

*Make notations on back with additional information (ie odd shifts, borrowed help)

Use operational definitions carefully, refer to list often.

Some arbitrary definitions have been made (ie hand washing is "Prep of Meds).

Interaction with staff (other than asking for assistance in locating staff

members) kept to a minimum, do distractions to staff

Answer all questions regarding the study, forms, etc (staff or patients).

All observations, proceedings on ward etc CONFIDENTIAL.

No participating in care except in an emergency situation (immediate).

DATA COLLECTION SCHEDULE -

Each of the 9 MTFs observed on each type of ward (ME9, SURG, PED, NBN, OB,

CCU, & PSY) as follows:

Days - 5 times, Evenings = 3 times, Nights = 2 times TOTAL - 10 times.

If more than I ward of a type, the ward IDs were randomized.

Day-of-the-study (1 to 14) also randomized (adjusted only to allow 5 working

days with 2 days off for each observer for the 2-week period.

14-A

. , L .... .. . ...... % . . . .. .. .. .... ...... i . . ,..... ....

.APPENDIX 14 (cont)

Discussed coding instructions.

Issued supply of forms for practice, clip boards, name tags, #2 pencifls, etc.

Discussed Subjective questionnaire to be completed by Charge Nurse for each

shift - it must be completed near the end of the shift inorder to

reflect what transpired during that shift - no picking it up the next

day, insist on getting it before they leave that shift.

'Observer designated as "team leader" responsible for insuring all forms

are audited. and collected. Also to furnish a copy of the

corrected time schedule for the dates of the study.

TESTING & PRACTICE -

After thorough discussion of operational definitions and rationale for

specific decision making, administered Test #1. Reviewed test results

and discussed incorrect answers until all agree on proper definition

and rationale used.

Practiced in pairs for remainder of first day of training on typical wards.

Toured wards to be observed to establish boundaries and lounge area suitable

for the observer to use between tours.

Meeting at beginning of second day to discuss problemsiapprehension of the

practice session and ask questions. After all comfortable with day one

.' events, Test #2.

Discussed results of test #2 and practiced individually until time for exit

briefing.

Trainer rotated among all wards during practice to observe abservers and

discuss study/questionnaire with HNs on wards to be observed during study.

Last session at the end of day two to answer all questions, issue supply of

forms, exchange contact phone numbers in case of emergency, and final

review of instructions.

14-B

4- - W- i -. -_ -_ -_ .

-F.~. V'. IF. i

p

APPENDIX 14 (cont)

Requested complete name and address of observers for Letters of Appreciation.

Additional instructions to team leader regarding collection of data

instruments and mailing instructions. Also responsible to coordinate

alternate observer if needed.

4-.C.-

-o. '.

.

APPENDIX 15

"EXAMPLE OF WRITTEN TEST FOR OBSERVERS

Doing Work Sampling

1. WC answering intercom.

2. NA helping X-Ray Technician position patient.

3. NA delivering dinner to patient.

4. LPN helping patient brush teeth.

5. LPN recording fluid intake.

6. RN signing out a narcotic.

7. NA bagging linen.

8. HN off unit for administrative meeting.

9. Two RN's making intershift narcotic count.'.

10. LPN readed for staff bathroom.

11. HN making out staff assignments.

12. WC delivering mail to patients.

13. 91B off unit for Head Count

14. RN mixing an I.V. in the medicine room.

15. LPN checking a surgical dressing.

16. RN recording a medication given.

17. LPN helping MD with a thoracentesis.

18. RN showing patient how to administer own heparin injection.

19. RN and LPN putting a new patient onto a Stryker frame.

20. LPN helping post-op patient cough and deep breathe.

21. " NA applying TED's to patient's legs.

22. Setting up a bladder irrigation.

23. RN Checking patient's pupils.

24. NA placing chux under patient.

2S. NA combing patient's hair.

15-A

26. RN measuring T-tube drainage.

oi7 2 ____7. LPN giving patient a backrub. H.S.

*28. ____.RN checking emergency cart.

29. RN and LPN in evaluation conference.

30. LPN orienting a new LPN.

31.. NA off unit looking for lost wheelchair..,'..-,

32. WC making out TPR list.

33. HN making entry in patient's chart.

34. RN calling MD about patient's condition.

35. Student consulting with RN about patient's order.

36. HN changing order on Kardex.

37. RN talking with resident about patient's diagnosis.

38. _ HN making out referral form to VNA.

39. LPN applying ice pack to patient's knee.

40. NA's talking about movie seen on TV.

41. RN starting oxygen on patient.

42. LPN assisting patient walk down hallway.

43. NA preparing room for a transfer patient.

44. RN changing I.V. tubing.

45. LPN checking circulation in toes of orthopedic patient.

46. LPN doing range of motion exercises.

47. HN making out staff hours.

48. Night nurse noting swelling on patient's hand.

49. HN adjusting footboard on patient's bed.

50. Orderly (NA) adjusting monkey bar for patient.

15-B

EXAMPLE OF WRITTEN TEST FOR OBSERVERS (2)

Doing Work Sampling

1. _ WC answering intercom.

2. NA helping X-Ray Technician position patient.

3. NA delivering dinner to patient.

4. LPN helping patient brush teeth.

5. LPN recording fluid intake.

6. RN signing out a narcotic.

7. NA bagging linen.

8. HN off unit for administrative meeting.

9. Two RN's making intershift narcotic count.

10. LPN removing chux from under patient.

11. HN making out staff assignments,

12. WC delivering mail to patients.

13. RN charting total intake on patient's chart.

14. RN mixing an I.V. in the medicine room.

15. NA placing linen in laundry chute.

16. RN recording a medication given.

17. RN talking with pharmacist re patients medication.

18. LPN and NA taking body to morque.

19. RN and LPN putting a new patient onto a Stryker frame.

20. RN talking with Chaplin.

21. RN checking medication Kardex.

22. LPN charting intake on I and 0 record at bedside.

23. RN checking patient's pupils.

24. RN hanging blood.

25. RN sorting medicine cards.

16-A

....

26. RN measuring T-tube drainage.

27. RN assisting with after death care.

28. RN reviewing patient classification.29. RN and LPN in evaluation conference.

30. LPN orienting a new LPN.

31. NA off unit looking for lost wheelchair.

32. Two RNs counting narcotics.

33. HN making entry- in patient's chart.

34. RN calling MD about patient's condition.

35. WC c*hecking supplies.

36. HN changing order on Ka-rdex.

37. " RN talking with resident about patient's diagnosis.

38. HN making out referral form .to YNA.

39. _ LPN applying ice pack to patient's knee.

40. NA's talking about movie seen on TV.

41. - RN starting oxygen on patient.,

42. " -R demonstrating crutch walking.

43. - NA preparing room for a transfer potient.

44. "_ LPN'to CMS' for catheterization tray.

45. LPN checking circulation in toes of.orthopedic patient.

46. LPN doing range of motion exercises..,

47. HN making out staff hours.

48. Night nurse noting swelling on patient's hand.

49. HN adjusting footboard on patient's bed.

o50. RN adjusting IV flow.

16-B

.. . o , . o -, -- , _ . • . . - . , . - . . -

APPENDICES 17-25

Appendices 17-25 are comprised of the site specific data for the individual

Medical Treatment Facilities. Tables are isomersous of the composite data.

Therefore, Tables 6, 7, 9, 11, 21, and 24 are purposefully omitted for

individual Medical Treatment Facilities.

.O4

17-25 Memo

:21.

APPENDIX 17

BROOKE ARMY MEDICAL CENTERFORT SAMl HOUSTON, TEXAS

-17-

q lI

%

• APPEND17-A

. -. _ . .. .. -a.. -, . - . . . . -_, .- , .,.. .. .- - - ; .- .,-. *, . o - . . .- . ° ._... .. " ." .o.-. ..

Table 1

BAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

MONTHS OF DATA COLLECTION

p MO

VALID CU4VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

MARCH 3 17748 I000C 100.0 10O0

TOTAL 177§8 100.0 100.0

VALID CASES 17748 VISSING CASES 0

1

7 x.

17-B

a.

Table 2

BAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTION

WKDAY DAY OF dEEK

- VALID CUVALUE LABEL VALUF FFEQUENCY PERCENT PERCENT PERCENT

SUNDAY 1 1272 7.2 7.2 7.2MONDAY 2 2514 14.2 14.2 21.3TUESDAY 3 3384 19.1 19.1 40.fWEDNESDAY 4 3228 18.2 18.2 58.6THURSDAY 5 3492 191 19.7 78.3FRIDAY 6 2166 12.2 12.2 90.5SATURDAY 7 1692 9.5 9.5 100.0

n f -i.io O sfn 4. ,iao, m p .

TOTAL 17748 100.0 100.0

VALID CASES 17748 MISSING CASES 0

17-C

* % - * , ... 4~. . 4 - -'- 'la -,mwk -IJ.l,.,w],, iJaJm4 J i .a u.~~ ;iJ m...J % .m

Table 3

BAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

SHIFT

VALID CU9VALUE LABEL VALUL FREQUENCY PERCENT PERCENT PERCENT

- DAY ] 11553 65.1 65.1 65.1EVENING 3 3B94 21.9 21.9 87.0NIGHT 3 2304 13.C 13.0 100.0

', TCIAL 17748 ICO.C 100.0

VALID CASES 17748 tISSING CASES 0

4.1D

*55*j,5

p

4'

r ,I-5. . . - "e C - d,)4 . : 5 . .

Table 4.'

BAI4C

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

TYPE OF WARD.

VALID CU4VALUE LABEL VALUE FREQUENCY PERCEINT PERCENT PERCENT

-1 144 .e .8 .8MED 1 930 5.2 5.2 6.1SURG 2 276 1.6 1.6 7.6ORTHOPEDIC 4 882 5.0 5.0 12.6LE 5 1362 7.7 7.7 20.3Ob LD COMBO 7 1032 5.8 5.8 26.1NEWbORN 6 1884 10.6 1O.6 36.7PEDS 9 2334 1392 13.2 49.8

*'i SICU 10 1944 11.C 11.0 60.8MICU 11 912 5.1 5.1 65*9CCU 12 336 1.9 1.9 67.8ICU C.MBC 13 672 3.e 3.8 71.6PSYCHIATRY 16 3084 17.4 17.4 89.0PED ICU 17 1956 116C 11.0 100.0

1CTAL 17748 1000 100.0

VALID CASES 1148 KISSING CASES 0

y3.

4

17-E

. .. ". " " , " , . , , , . . 1,§._

Table 5

BAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

CLINICAL SERVICES

SERVICE TYPE CF PATIENT

VALID CU4

VALUE LABEL VALUE FREQUENCY PERCEIT PERCENT PERCENT

-1.00 144 .8 .8

CRITICAL CARE 1.00 3864 21.8 21.8 22.b

MED SURG 2.00 2088 11.E 11.8 34o3

PSYCHIATRY 3.00 3084 17.4 17.4 51.7

08 LABOR VELIVERY 4.00 2394 13.5 13.5 65.2

NBN NICU 5.00 1884 1C.o 10.6 75.8

PEDS PICU 6.00 4290 24.2 24.2 100.0

TCTAL 17748 100.c 100.0

VALID CASES 17748 MISSING CASES 0

17-F

- . ,.

Table 8

BAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

ACTIVITIES OBSERVED

ACT ACTIVITY

VALID CU4VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

DIRECT CARE -1 5174 29.2 29.2 29.2PERSONAL 0 1249 7.C 7.0 36.2OFF UNIT ACIV 1 861 4.9 4.9 41.0CCMMUNICATIVE 2 1735 9.8 9.8 50.8MEDS SUPPLIES EQUIP 3 995 5.6 5.6 56oCHARTING CLERICAL 4 1615 9.1 9.1 61.5CONFEkENCES 5 762 4.3 4.3 69.8TRAVEL IRANSPORT 6 1433 8.1 8.1 779ADMINISTRATION 7 2041 11.5 11.5 89.4ENVIRONMENIAL 1 317 I.E 1.8 91.2WAIT TIME 9 1566 8.8 88 100.0

TCTAL 17748 100.0 100.0

VALID CASES 1777T6 MISSING CASES 0

17-G

"' .." ," " .- tp r.'',.,. ... .% '",' .' .'.,'-.'

V Table 10

S BAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

CARE PROVIDER

~PROV

VALID CU4VALUE LABEL VALUE FREQUENCY PERCE IKT PERCENT PERCENI

HEAD NURSE 1 1452 8.2 8.2 8.2WARDVASIER 2 1410 7o9 7.9 16.1RN 3 6522 36.7 36,7 52.991C 4 172.8 9.7 9.7 62,bLPN 5 738 4,2 4.2 66.8918 91F 91G C 3324 18.7 85.5AIDE 7 1254 7.1 7.1 92.6

WARD CLERK 6 1320 7.4. 7.4 100°0----------------------------------------- -------

,CTAL 17748 100.0 100.0

VALID CASES 17"48 VISSING CASES 0

17-H

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LS

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o "1q q... I I S 0 t "I D4

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:11-' z- Ie

4A C1 31 S 40 N I - ,- I O a Ic

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u mU " W 0 4:e: :ILl cc 0

AP 4p fy 4p% 0 S 00Dc YI

z ~ UU IA 30 1Uc .of SS

( I I

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L0J m I I 6A

4 0p 0

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6

p q INr y ^* a

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17-0

r 1% l I'. .*~* ~ - -

I fr ONM a 1 I34 * *~ 4 0 on

0-#f.N

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4r IL c 9s a a a a "

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a ac

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at OI Ir ee toe N 1 1 04. a&M ago I S SG '.4

we~ No 04 we " m 4N " N a

za CL Q0j m

Iof viaa

.ud v I j v aW 4 I C S

w ;jCL0

17-P

Table 20BAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

PERCENTAGES OF TIME SPENT IN INDIRECT NURSING

WALUE LABLL VALUE FREQUENCY PERCENT

CUMMUNICAIIVE 2 1735 16.6MEDS SUPPLIES EQUIP 3 995 9.5CHAk ING L.ERICAL c Ibis 15.4CULiNKERENCLS 5 762 7.3TRAVEL TRANSPORT 6 14133 13.7&MIN1STiRATION 7 2041 19.15

ENVIRL)NMENTAL. 6 317 3. CWAIl TIME 9 15b6 15.0

TOTAL 1464 .100.0

VALiD CASLS 10404 MISSING CASES 0

417-

~i4..

'4, 1 7-Q

Table 22BAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY CARE PROVIDER

COUP!' 3O W PCi M AU0 hUl. I6UA PASI iN 91C LP N 918 91F 4IOE dASO CLE O0

COA PC I SE it 91. scK TOTALI 11 21 13 61 51 61 71 81

- ACT------------------------. - -- .-. - - - - - - *2 I '16 3 62 1 790 1 134 3 6? 1 231 39 1 16. 1 173$

CiIMUNICATIVE 111 0 1.116..5 1 71.7 i 3.9 1 13.7 2.2 3 &.2 1 16.6I ol 0 1 6.3 1 20.4 1 16.7 I 13.3 1 12.9 1 6.S 1 14.6 a

3 £ !5 1 135 1 610 1 113 1 S1 I 110 1 59 i 4 3 995JkIUS $UPPLIIS E% 3 6.5 1 14.6 1 67.2 1 13.4 1 S.9 1 11.1 i 5.9 I .6 1 9.5

i 1. 1 13.7 I 12.2 i 16.1 A 11.71 6.0 1 9.9 1 .4 1- -- -- ----------------- +------- *---- - --- *

1 168 1 7 1 056 1 Its I se I ISO1 53 I IS10I 16 SLdING LLialC I 3U.4 1 . 3 5.0 1 6.9 1 3.6 i 11.1 1 3.3 1 9.3 1 15.0

1 18.6 1 .7 i 22.2 I 17.9 1 11.5 I 9.8 I 8.9 1 15.4 1

II I1 0 1 3)0 I 51 29 1 109 1 38 1 2 712cLmEcMkhC&S 1 19. 1 6.6 1 3.3 1 7.0 1 30. 1 10.3 i S.0 I .3 I 7.3

I 16.7 1 S.1 I 6.5 1 6.4 1 5.b 1 5.9 1 6.4 1 .2 10--------- - .---- ,------.-- ---------------- *

63 36 1 147 6 45 1 136 1 101 327 1 140 1 67 1 1433IpAVEL TRASPCNT 1 4.7 I 1.3 i 31.5 I 9.6 1 7.0 i -2.e i 9.6 1 6.1 1 13.7

1 4.2 1 16.9 1 11.8 1 11.2 i 20.0 i 17.b i 23.6 1 8.9 I*---- -- - --- 0 . . . ...... *o I--- --------- -- -

I 1 1411 A4l 1 1£ 61 1 b I z91 I 60 I S52 3 20%1AuaNINISIAATION 1 11.0 i 25.2 I 16.1 3 3.0 i .3 1 36.6 1 2.0 1 27.0 3 19.5

1 26.7 1 12.2 1 6. 13 7.6 I 1.2 I 16.3 1 6.7 3 56.6 3*.o....... .-4 ..... -------------- -4----- --------------- -4

a1 3 1 40 1 33 6 13 36 1 66 1 5? 1 5 1 317EidVIONMENlAL 1 .9 1 12.6 1 22.1 1 12.6 1 33.6 1 20.2 1 16.0 I 1.6 1 3.0

S .33 .11 1.93 5.0 1 7,13 3.5 1 9.5 1 .5 1

91 14 3 103 562 1 1191 186 1 s01 1 172 1 33 1166hAlITIIE 1 .9 3 .6 1 35.9 1 1.6' 1 9.5 i 32.6 1 11.0 1 2.1 1 15.0

1.5 1 1.0 1 14.5 1 14.9 1 29.4 I 27.7 1 26.8 i 3.4 i

COLUN 906 9a1 3666 603 106 3533 a96 90 1046tTOTAL 6.6 9.6 36.9 ?*1 6.8 17.S sm? 9.3 100.0

hWUdNI OF MISSING OSSikVATlASll - 0

17-R

%.€W.( . r ~ ** ~ ?~~?? x

X•I M .w ,I..V,. .

Table 23BAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY SERVICE

SERV ICE

NOW PCI ICI•iICAL NED 5IURG Pl 1C41A1 U& LASUR NOU NICU PEGS PIC RON6AL PCI I CARE I 01DL IVEM i TJITAL

1 11 11 31 41 51 ofA c t . .. .. . .* - - - -- -- . - --- - . . . . . . # - *

a 1 3" 1 172 1 327 1 305 I2S 1 404 1 1132C.JNUICATIVE 1 23.0 1 9.9 1 18.9 1 17.6 1 7.2 1 23.3 1 16.?

1 40.1 13.1 i 11.1 1 19.1 11.06 15.9 I

j 1 246 1 106 1 66 1 110 1 17 1 222 3 909NkOS SUPPLIES 1W 1 24.9 1 17.0 I .6.? 11o2 1 11.8 1 22.0 1 9.5

1 32.4 1 13.3 1 3.S 1 10.7 1 10.9 1 9.7 1

1 1 339 1 229 1 233 1 186 3 170 1 081 1 100CoARIN6 CLENICA I d1.1 3 1#.2 1 12.06 i 11.6 1 10.0 1 29.9 1 35.O

1 17.0 1 18.2 1 i0.6 1 11.7 1 15.8 1 19.0 1

s3 17 1 6%! 246 1 90 351 129 1 79LUMENILES 1 22.9 1 11.2 1 32.0 1 11.9 1 0.6 1 17.0 1 7.3

1 6.? 1 60.8 12.9 1 5.0 1 3.3 1 S.1 I

S a 261 1 208 1 171 1 20S I 1 I1 0&1 I 12TRAVEL TISPORI 19.8 1 1406 1 12.0 1 10A 1 10.6 1 29.6 1 13.1

310.1 160.5 9.0 12.8 1 6.01 1.0 1

71 291 261 1 4083 2261 321 1 19 1 2000AAI3 I SSAT loSll 1 10.5 1 13.0 1 24.3 1 11.3 1600 1 23.9 1 19.0

1 10.6 1 20.7 1 25.6 1 14.2 1 29.9 1 10.5 1#---- -----.- *---- ------- ....

a1 62 +003 13 01 4 1ul 1 310Es.VIkONENTAL 1 19.7 1 12.7 1 0.8 1 IS.9 1 12.? 1 30.1 1 3.0

1 3.1 1 3.2 1 ,I1 3.1 1 3.1 1 0.2 I

9 1 19 1 6 i 343 3601 1160 3101 1536WAIT vllE 1 12.8 1 6.3 1 2S.6 1 23.7 1 1.0 1 26.1 1 130k.8

1 9.9 1 7.6 1 20.6 22.0 1 10.8 3 10.6 1

COLUNW 1969 1259 1939 Is9o 1075 2s38 10366TOI. 19.2 12.1 I0s.# 15.0 10.04 20. 100.0

kumbIII OF NISSING OBSERVAIILAS - 10

17-S

,.. r

, - e *h L

APPENDIX 18

DARNALL ARMY COW4UNITY HOSPITALFORT HOOD, TEXAS

18-A

Table 1

Darnal ITIME SPENT IN INDIRECT NURSING CARE STUDY

MONTHS OF DATA COLLECTION

Mc

VALID CU4

VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

MARCH 3 13932 100.0 1000. 1D00

TCTAL 13932 100.0 100.0

VALID CASES 13932 MISSING. CASES 0

i

18-B

'

*1.':.. :./; .;./ ;........ .:.;.;'...: ......... "" "' "I,? i" "o

Wy F am.0-T

Table 2Darna 11

-~TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTION

VALID CU4

VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

SUNDAY 1 996 7.1 7.1 7.1

MONDAY 2 2118 15.2 15.2 22.'.

TUESDAY 3 2292 16.5 16.5 38oB

WEDNESDAY 4 2514f 18.0 18.0 56.8

THURSDAY 5 2766 19.9 19.9 76.7FRIDAY 6 2322 16.7 16.7 9.SATURDAY 7 924 6.6 6.6 100.0

TOTAL 13932 100.0 100.0

VALID CASES 13932 PISSING CASES 0

18-C

p.AL,

Table 3

Darnal l

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

SHIFT

VALID CU

VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

DAY 1 8718 62o6 62.6 62.6EVENING 2 3390' 24.3 24.3 86.9

NIGHT 3 1824 13.1 13.1 100.0

TOTAL 13932 1000. 100.0

VALID CASES 13932 MISSING CASES 0

r,1

.bl

18- D

_ . ,. 4 - .. F * "'r ,"" q " .% <- ',"."qr?% ,

Table 4

Darnal 1

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

.- VALID c U4VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

MED 1 1398 106c 10.0 100SURG 2 1866 13.'. 13.. 23.*1LB 5 876 6.3 6.3 29. 7LA60R & CELIVERY 6 1386 9.9 9.9 39.7NEWbORN 8 2736 19.6 19.6 59.3PEDS 9 2010 14.o 14'.o 73.7CCU 12 972 7.0 7.0 80.7ICU COMbc 13 312 2.2 2.2 82.9PSYCHIATRY 16 2376 17.1 17.1 100.0

TETAL 139 32 1 0.C 100.VALID CASES 13932 VISSING CASES 0

8,

4o.

4.

__18- E

.-

y

Table 5

Darnal l

TIME SPENT IN INDIRECT NURSING CARE STUDY

CLINICAL SERVICES

VALID CLU1VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

CRITICAL CARE 1.00 1284 9.2 9.2 9.2MED SURG 2.00 3264 23.4 23.4 32.6PSYCHIATRY 3.00 2376 17.1 17.1 *9.700 LABOR CELIVERY 4.00 2262 16.2 16.2 65.9NBN NICU 5.00 2736 19ot 19.6 85.

, PEDS PICU 6.00 2010 14.* 140 100.0

7CTAL 1332 1 000 100.0

VALID CASES 13932 MISSING CASES 0

18-F

i

Table 8

Darnall

TIME SPENT IN INDIRECT NURSING CARE STUDY

ACTIVITIES OBSERVED

ACT ACTIVITY

VALID CU4VALUE LABEL VALUE FREQUENCY PERCEhT PERCENT PERCENT

DIRECT CARE -1 3784 27.2 27.2 272PERSONAL 0 1290 9.3 9.3 36o4OFF UNIT ACTV 1 639 4.6 4.6 410CON MUNICA I VE 2 1132 8.1 8.1 49.1MEDS SUPPLIES EQUIP 3 573 401 4.1 53.2CHARTING CLERICAL 4 1984 14.2 14o2 67.5CONFERENCES 5 678 4.9 4.9 72.4TRAVEL TRANSPORT 6 1803 12.9 12.9 85e3ADMINISTiATION 7 981 7,C 7.0 92.3ENVIRONMEKTAL 8 327 2.? 2.3 94.7WAIl TIME 9 741 5.3 5.3 1000

-.- *; ICTAL 13932 100.0 100.0

VALID CASES 13932 PI SSING CASES 0

18-G

°.

Table 10

Darnal1

TIME SPENT IN INDIRECT NURSING CARE STUDY

CARE PROVIDER

VALID C.U4

VALUE LABEL VALUE FREQUENCY PERCE NT PERCENT PERCENT

-1 186 1.3 1.3 1.3

HEAD NURSE 1 930 6.7 6.7 8.0

WARDNASIER ? 1152 F*.3 8.3 16.3

RN 3 4698 33.7 33.7 50.0

91C 4 342 2.5 2.5 52.5

LPN 5 324 2.3 2.3 54.8

91B 91F 91G 6 3360 24.1 24.1 78.9AIDE 7 2226 16.0 16.0 94.9

WARD CLERK 8 714 501 5.1 100.0

TC7AL 13932 100.0 100.0

VALID CASES 13932 HISSING CASES 0

18q

I.

'o~i 18-H

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Table 20Darna I 1

TIME SPENT IN INDIRECT NURSING CARE STUDY

PERCENTAGES OF TIME SPENT IN INDIRECT CARE

.,, 4

VALUE LABEL VALUk FREaUENCY PERCENT

CUMMUNI CAlI VE 1132KEOS SUPPLIES EI"UIP 3 573 70 CCHARTING CLtRICAL 4 1981 24.1CONFEkE ECLS 5 .23 .2TRAVEL IRANSPUR7 6 1-803 21.5ADMINISTRAIION 7 981 11.9EhNVIRNMENTAL a 327 40CWAIl TIME 9 741 9.C

swm .o d D S a,, -, S ,a S st ,,o

TOTAL 62I: 100.0

VALID CASES e219 MISSING CASLS 0

1*8

iI

18-Q

, .V...-", "- N '"•* . ,. . . , , ,% %'

Table 22Darnal 1

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY CARE PROVIDER

PRUVROM NT bKItARDHASI it 91c LPM 91b 91F AIDE WARD .LE Rad

COL PCI ISE Li 916 ftil TOT&L1 Al 21 31 41 51 61 71 61

ALT ---- ,-- -- - -------------------- ----2 1 145 1 83 1 810 1 2t 1 id I 171 1 102 1 11 1 IIa

CuMHUNI CAII 12.9 1 7.4 1 41.7 1 2.5 1 1.6 1 15.2 1 9.0 i 9.8 1 13.81 23.7 1 10.2 1 16.2 I 13.1 1 11.6 i 9.6 1 8.7 3 22.1 3

3 1 24 1 341 333 1 16 1 2 1 951 56 1 10 1 510MNDS SUPPLIES jl 1 4.d i 6.0 I 56.4 1 2.8 1 .4 i 15.7 I 9.8 i 1.6 1 1.0

1 3.93 1 .21 LI.5 7.5 1 1.3 i 5.3 1 4.8 1 2.0 1

4 1 84 1 46 1 400 1 37 1 41 1 358 1 281 1 206 1 195?ChA4IIM6 CLERIC 4.3 1 2.4 46.2 1.9 1 ! 15.3 1 14.4 1 10.5 1 100

I 13.1 1 5.6 1 31.2 1 17.3 1 26.5 1 20.0 1 Z8.0 1 41.0 i-----------------------4 ---------*---*- -----------.--------- *

SI I I 1 29 1 12 11 II 1 122 1 2 1 b1tCuftiRk& S 1 13.1 1 6.4 1 41.4 1 1.8 1 1.6 1 17.8 1 18.1 I .3 1 1.3

1 14.4 1 5.3 1 9.6 1 5.6 I 1.1 i 5.5 30.41 i .4 I

6 3 114 1 2 I1 456 1 1z 1 67 1 "b 1 291 1 82 1 1786IkAV&L IMANSPCT I 6.4 I 6.5 1 25.5 1 4.0 1 1.6 I 33.6 1 16.6 1 4.6 i 21.9

1 1807 1 18.6 115.7 1 33.6 1 4.1, 1 3.6 1 25.4 16.3 1--- ---------4 ---- #--------- -------4--- ----- #

1 7 152 1 417 1 232 1 24 1 41 79 1 27 1 74 i 979AUMt16SIRATIOli 1 35.5 I 42.6 1 20.6 1 2.5 1 .41 5.1 1 2.6 1 7.6 1 12.0

1 24.9 1 51.0 1 7.0 1 11 it 1 2.61 14.8 1 2.3 1 14.7 i

8 1 1 281 171 81 2 i 9 1 1 326W3RatmIIM I 1 1.5 1 7.8 1 5.2 1 .1 1 55.8 1 zo.s I .3 1 84.0

.! 1 .8 1 7.9 1 2.6 i 10.2 1 7.9 i .2 1

9 1 4 3 1 2321 61 I 81 2391 192 1 11 i31.11 TIME . s . I 5.0 1 31.5 1 1.1 1 1.1 I 32.8 I 26.1 1 2.3 i 9.0

1 .7 1 4.5 8.0 1 3.7 1 5.2 1 13.4 1 16.4 1 3.414- - --- 0-------- -4- -4-

COLUMN 612 17 2930 218 155 1187 1170 503 8157TOTAL 7.9 10.0 35.6 2.6 1.9 21.9 14.3 6.2 100.0

t.UMbiR UF MISSING OBSERVAIINS 62

18-R

"r " " " .* ".' . ., ., *". . . "", , ." ,,. ..% . *. . " .. % " * " ""',

Table 23Darna 1 I

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY SERVICE

SERV ICECOUNT 1NOW PCI ICRITI.AL MD SUk6 P 1C4lAT U8 LAbOR NON NICU PEOS PlC ROWCOh. PC1 1 CARE qv DELIVER U MTAL

1 11 21 31 #,1 51 ,61& 'J ------- *, --------- - ---.--- + -------- -- -- - *o00 -- -- - *o0 . _ .

2 1 95 1 2t( 6 16 1 220 1 18? 1 202 1 1132CuMMNI AIIVE 1 8.4 1 23.S 1 14.3 1 19.4 1 16.5 I 11.6 i 13.6

1 Id.4 1 12.5 1 12.2 1 15.0 I 12.8 I 14.7 1-------------------------- ---------------------- #------- *------

3 1 37 1 202 1 22 1 110 I 11 I 80 1 573MLOS SUPPLIES Ea 6 0.5 1 3b.3 1 3.6 1 20.6 1 19.9 i 1.0 1 7.0

40 1 .51 1.73 I 8.1 1 7.01! 1.0 i

4 I f64 2S33 1 335 1 325 1 3Wo 1 199 1 1984CnA.(W1NG CLERII 1 IJ.3 6.9 .104 1 16.4 1 16.1 1 1 3.0 1 24.1

S 34.4 1 25.1 1 13.1 1 22.2 i 24.6 1 15.3 1f--------------4-*--------------- *-------- -------.

': 7 11 14 158 i 67 1 134 ! 89 1 676CUNFEkiNCES I1t..2 22.7 1 Z3.3 1 9.9 1 19,.8 1 13.t 1 6 .2

1 9.9 1 7.3 1 11.9 1 406 1 9.2 1 8.2 1S- - ----- ---------------- .4

6 1 123 1 573 1 218 1 289 1 378 1 222 1 1003InAVEL TRANSPORT I 6.8 1 31.8 1 12.1 i 16.0 1 21.0 1 1I.3 1 21.9

1 16.0 1 27.0 1 16.5 1 19.8 1 2S.9 1 23.5 1

I1 67 193 1 191 1 241 1 124 I 14S 1 981AjMINISIRATION 1 8.9 1 19.7 1 19.5 1 24.6 1 12.6 1 10.6 1 11.9

i 11.3 1 9.1 1 1.4 I 16.5 i &.S I 13.0 if4-- 4- -- --------------- ------------- --- --. *

a 1 9 1 04 1 37 1 114 1 60 1 t3 1 32?ENVIRUNMENTAL 1 2.6 1 19.6 1 11.3 1 34.9 1 18.3 I 13.1 1 4.0

i 1.2 1 3.0 i 2.8 1 1.8 1 4.1 1 o.0 i

9 1 771 138 1 230 1 08 1 105 i 103 1 741WAIT 11I 1 10.4 1 18.6 1 31.0 1 11.9 I 14.2 1 13.9 1 9.0

1 10.01 6.5 1 1.4 1 6.0 1 7.2 1 9.5 I--------------------------;---4---.------4-----4-

- 2. 9COkLjN 768 2123 1323 1462 1001 1302 8239

TOTAL 9.3 25.8 16.1 17.0 11.0 13.2 100.0

k uER O3F MISSING OSSERVATI(S • 0

18-S

1~.*.

VV

4

NI'

V1.*

* APPENDIX 19

GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITALFORT LEONARD WOOD, MISSOURI

* S.

.1

4

i.

PS...

I19-A

ad

aa,

* .5- $~**~. '~%* '9 -1~ ~... /!%~% . ~ % ~ *.*

. 4....%, . , . *.,. ,,,.. . ' . - . L. . . . .. . , , . , .. . . -.4, . . . . .,, . .. . . 4,. . , ., . . . ,- .. ., .. . . .. . , . . . . , .

Table 1

General Wood%'

TIME SPENT IN INDIRECT NURSING CARE STUDY

- S4MONTHS OF DATA COLLECTION

VALID CU4

VALUE LABEL VALUE FREQUENCY PERCEI7 PERCENT PERCENT

MARCH 3 10728 85. 65e.3 85.3

APRIL 4 1854 14.7 14s7 100.0

TOTAL 12582 10000 100.0

VALID CASES 12582 VISSING CASES 0

9.

F.,F,

I 19-B

-, t,, ,.w -',o. ,,4.w ,( " . , '*.f.4

*. 4,- . . . . .. . .. . .: C . - -.. . -- .

Table 2

General Wood

TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTION

VALID CUM'. ' '=. NCy PERCESI PERCENT PERCENT

-N ,AY 1 2002 8.C 80 8.0P'UNDAY 2 1650 13.1 13.1 21.1iUESDAY 3 3042 2f.2 24.2 45.3JAEONESDAY 4 2322 18.5 18.5 63.7IURSDAY 5 2160 17.2 17.2 80.9FkIEDAY 6 1596 12,. 12.7 93o6SATURDAY 7 810 6.4 6.4 100.0

TOTAL 12582 100.0 100.0

VALID CASLS 12582 MISSING CASES

.9

19-

- .. --. . . . ..--. .

Table 3

General Wood

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

VALID CU4VALUE LABEL VALUE FREQUENCY PERCEN T PERCENT PERCENT

[# AY 1 7878 62.6 62.6 62.6EVENING 2 3168 25.2 25.2 87.NIGHT 3 1536 12s2 12.2 100.0

7074L 12582 100.0 100.0

VALID CASES 12582 IISSING CASES 04%

19-D

.

..,,. .. . . . . . . . . .. '% % % '.. . ., . . . .~ , , . . . , . . - .. . . . . , ,. , . . . .

Table 4

General Wood

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

VALID CU4VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

CRITICAL CARE 1.00 2394 9.C 19.0 19.0MED SURG 2.0C 3126 24.8 24.8 43.9

PSYCHIATRY 3,00 2196 17 5 17.5 61.300 LABOR LELIVERY 4.00 2136 17.C 17.0 78.3NBN NICU 5000 1410 I1.2 11.2 89.5PEDS PJCU 6.00 1320 10.5 10.5 100.0

T(UTAL 12582 100.0 100.0

VALID CASES 12582 PISSING CASES 0

9.,

1 9-E

V%" "." , '.€ %" ,q r4"- w , '- .. , 'e"A. v *'~' 'W" ,e, .,, " .'-../ •a - ..-. '. .'

Table 5

General Wood

TIME SPENT IN INDIRECT NURSING CARE"STUDY

CLINICAL SERVICES

VALID CU4VALUE LABEL VALUE FREQUENCY PERCEKT PERCENT PERCENT

MEL I 960 7.e 7.6 7.6SURG 2 1734 13.8 13.8 21.4URTHOPEVIC 4 " 432 3.4 3.4 24.8uk 5 288 2.3 2.3 27.1LABOR £ DELIVERY 6 25Z 2.C 2.0 29.1LB L&D COPSO 7 159b 12.7 12s7 41.8NEWBORN 8 1110 11.2 11.2 53.0PEDS 9 1320 10.,5 10.5 63.5ICU COMbO 13 2394 19.c 19.0 82.5PSYCHIA1RY it, 2196 17.5 17.5 100.0

TOTAL 12582 100.0 100.0

VALID CASES 12582 ,ISSING CASES 0

-1 F

*%1

,. 19-F

Table 8

General Wood

TIME SPENT IN INDIRECT NURSING CARE STUDY

ACTIVITIES OBSERVED

VALID CU4VALUE LABEL VALUE FREQUENCY PERCENT PERCEN1 PERCENT

DIRECT CARE -1 2347 lt.7 18.7 18.7PERSONAL 0 1012 8.C 8.0 26.7OFF UNIT ACTV 1 1655 13.2 13.2 39.9COMMUNICATIVE 2 1499 11.9 11.9 51.8MEDS SUPPLIES EQUIP 3 565 i.5 f.5 56.3CHARTING CLERICAL 4 1270 10.1 10.1 66.3CONFERENCES 5 479 3.8 3.8 70.2TRAVEL TRANSPORT 6 901 7.2 7.2 77.3ADMINISTRAT IUN 7 1068 8.5 8.5 85.8LNVIRONMEKTAL 8 170 1.4 1.4 87.2WAIT TIME 9 1616 12.8 12.8 100.0

TOTAL 12582 100.0 100.0%9,

VALID CASES 125l82 PISSING CASES 0

a1.94.,,

~19-G

J.

..,

,,, ,'-. r 't .'-., ., .,, -, . . . . .•. , *, *' ,% . **.' ", ' ,•.v,.,", -, .",-.. "".. . , "' ," "'",. . ". -, ". -' ...

Table 10

General Wood

TIME SPENT IN INDIRECT NURSING CARE STUDY

CARE PROVIDER*-

VALID CU4VALUE LABEL VALUE FREQUENCY PERCEIT PERCEtI1 PERCENt

HEAD NURSE 1 1110 2.8 8.8 8.8WARDHASIEk 2 1200 9.5 9.5 18.ARN 3 3786 30.1 30.1 48o591C 4 966 7.7 7.7 56.1LPN 5 1194 9.5 9.15 65.6

*91B 91F 91G 6 3102 2*.0 24,7 90.3AIDE 7 816 6,* 6.5 96.8WARD CLERK 8 409 3.2 3.2 100.0

tOTAL 12582 100.0 100.0

VALID CASES 12582 ,I5S1NG CA.ES 0

4

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V.U

I Table 20General Wood

TIME SPENT IN INDIRECT NURSING CARE STUDY

PERCENTAGES OF TIME SPENT IN INDIRECT CARE

VALUE LAbLL VALUc FREwuENCV PERCE lT

CLiMMUNICAIIVE 2 1499 19.bNMEk : SUPPLI S EQUIP 3 565 7.5CPIRTINh6 CLERICAL 4 127: 16.8CUN .EE NCLS 5 471 6.3TRAVEL TRANSPIRT 6 901 11.9

" AL ,MINISIRATION 7 10 6 13 I IENV I RONML hl AL 8 17) 2.2WAIT IME 21.b l :

TUTAL 7563 100.0

VALID CAS4ES 750 MISSING CASES 0A

veA

,

'

Table 22

General Wood

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY CARE PROVIDER

'.

PROW1R~COW InoI P1 I.EAD I. uAUI14ASI aln 91C LPN 918 91F AIOE MARO CLE RodCOL KY I SE LR 91G tK TOTAL

1 11 21 s1 41 si 61 11 &1ACT--- -- 0 -------- ------ * --- ---- - -

a2 1 28 I 179 1 560 1 91 1 184 1 234 i 43 1 40 1 1%ftCwIfitlCIVE 1 13.9 1 11.9 1 37.4 i 6.1 1 9.6 I 18.6 i 2.9 1 2.7 1 19.6

i 26.3 3 2b.3 i 24.3 I 18.3 I 19.0 i 14.0 1 0.0 i 11.4 I* -- +- - ---- 4 ----- - - -- -4--- -.-- 4 -

3 1 301 30 1 234 1 ss 1 61 1 19 1 25 i 11 sbs"LOS 1UES 9Q 1 5.3 1 5.3 1 36.1 1 9.7 1 10.8 i 20.1 1 0.4 I .2 1 1.5

i 3.8 1 0.2 1 8.8 1 11.1 1 0.1 I 9.5 1 1.7 I .3 I

J., 4 1 48 1 53 1 453 1 121 1 it? 1 241 1 76 1 131 1 210-£iixTiN c CLiEiC& 1 3.0 1 4.2 I 35.7 1 9.5 1 11.6 1 1.0 1 6.0 i 10.3 1 18.5

-1 6.1 1 .S 1 19.6 1 24.4 1 19.4 14.4 1 4.21 03.0 1

5 1 1 271 i? 1 23 1 30 1 1211 291 I 019CJWNE&E. CS 1 15.9 1 5.6 i 37.0 1 0.6 1 6.3 1 25.3 1 S.2 I 1 b.3

1 9.6 1 3.8 1 7.7 1 4.6 1 4.0 1 1.2 I 4.7 1 1

6 1 31 1 901 11 i IC 1 971 297 1 i 1 32 1 921IAVEI &ANSPOWI 1 4.1 1 10.4 1 18.5 1 11.3 1 10.8 1 33.0 1 8.3 i 3.6 1 11.9

1 4.7 1 13.3 1 7.2 1 20.6 1 12.8 1 11.7 i 10.0 1 10.? 1---- ------- 4----- ----- ------ ---------

71 328 1 2512 25 1 11 11 J I 2 1 22 3 60 1 lob8AuMlINISIxATI061 1 30.7 1 23.6 i 2J.9 i 3.8 1 1.? I 5.6 I 2.1 I 5.6 1 10.1

1 01.9 i 35.6 I 11.1 i 8.3 1 4.4 1 5.5 I 0.1 1 20.1 1

aNV1RDN AL 1 1 .4 1 16.a 1 1.633 1 57 1 35 1 1 l90 1 1 .4 1 1 .1 1 1 20.6 1 1 1.2

1 1 .6 1.2 1 2.6 1 4.04 1 3.4 1 6.5 1 1% ~ ~ ~ 4- -4 - - 4--------------- *.........*-------*.....#-------- -------- 4

91 63 1 68 i 0 3 I S03 221 i 474 1 236 1 35 1 1616WAIT T1IE 1 3.9 1 4.2 1 28.7 1 3.1 A 14.0 1 2P.3 1 10.6 1 2.2 1 21.0

1 8.0 1 9.6 1 20.1 i 10.1 1 30.0 I 29.3 1 43.9 1 1t.7 I# ----. *--. .... 4------- ---------- ---------* ---------------------

CULUMN 190 77 2331 496 i91 1875 537 299 7M8TOTAL 10.4 9.3 30.s 6.6 10.0 22.1 7.1 4.0 100.0

NUlN.A UF NSSING O&SERVAIICNS a 0

19-R

.5" W o .* .. -Yj.o. . . ¢ . .

Table 23

General Wood

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY SERVICE

n o PCI ICRIIICAL ND SUNG PSVCIAT Ub LABOR MN* NICU PEDS PIC RawCOL PCl I GA£ fly DEL IVEk TOTAL

1 11 21 31 93 53 61ALI "!! -'----- --- - -- ------- --- '-------

a I 270 1 315 1 Z67 1 202 I 196 I 81 1 1499CUNAUhtL.AIVE a 1.O 1 25.0 1 11. I 13.5 I 13.? 1 12.5 1 £9.8

1 20.1 1 19.4 1 23.4 1 13.b I 23.0 1 22.7 1*I - -- A- 4.....*-------- -------- *------- *-------- *

3 i 114 1 143 1 29 1 113 1 92 3 19 i 565KtO5 SUPPLIES Eg i 30.6 1 25.3 i 42 1 20.0 1 16.3 1 3.A 1 7.5

i 12.9 I 7.4 I 2.1 1 1.7 1 10.? 1 2.3 1

8 1 3311 %69 I .11 1 15' 1 51 1 110 1 £210CNAIRIING CLERICA 1 26.1 I 36.9 1 11.9 1 12.4 1 4.0 1 9. 1 168.6

1 24.6 I 29.3 1 13.2 1 I10b 1 5.9 1 13.3 1* - --- A - ---- *-------- +- ----------- A-

S 16 0 1 118 1 13? 1 30 I 39 1 30 1 419CARIIftCES 1 £8.1 1 29.6 I 39.0 I 6.3 1 7.1 I 8.3 1 6.3

3 5.9 1 6.1 £ 18.9 1 2.1 1 s9 I 3.6 1

6 17 1 341 1 11 192 1 4 1 5 1 901IRAVEL 1i8M6P59081 11.9 1 37.6 1 12.3 1 21.3 1 4.9 1 b.2 1 11.9

1 11.7 1 11.6 1 9.1 1 13.1 1 5.1 1 .8 1

* ----- *------- *----------- --.- -- ---- #UI Is% 1 291 1 310 I 212 1 li I 189% 1 106

"6lIlISlltRAll 1 14.4 1 23.1 1 12.2 1 19.9 1 16.9 1 13.5 I 14.11 11.4 1 12.6 1 11.4 1 14.5 1 21.0 1 11.5 1

L W a 1 36 I 36 1 16 1 47 1 19 3 161 170*EVIRUNNAL 1 21.2 1 21.2 1 9.4 1 2?.6 1 11.2 1 9.4 i 2.2

1 2.7 1 1.9 1 1. 1 3.1 1 i.2 I 1.9 1

9 1 14 1 2C5 I 255 1 501 1 .013 1 262 2 1616all TIME 1 8.9 1 12.7 1 IS.8 I 31.4 1 15.0 1 1s.? 1 21.4

I 10.? I 10.6 1 22.3 1 S9.? 1 2.2 i 31.11 1

COLJNi 1346 1939 11911 1461 16 W24 7568TOTAL 17.8 25.6 Is.1 19.3 11.9 12.9 10000

hUH&8E OF HISSEN& OSSERVATIIS a 0

19-S

', ' . . . ... ..-- ... -, ., -.. ., , .-. - - -. . '. , -, , , ',. ,. , , .,',o ',, , .£ q,% ,' ,' ,- -, ..+ , '..,. ,( " ",'.' '-' '.' .. .-. .... .-, ..-.-. -. .,- -. -. -. ..- ,-, -. . -. , -,-, ,,-

.. '

%~

.~- 4-

'p..

-. 44.

S.-'

I

APPENDIX 20

FORT CAMPBELL COMMUNITY HOSPITALFORT CAMPBELL, KENTUCKY

-a

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20-A

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............................... ~

'. \

%.

.4

.J.

**.* w

-"--4

* 4

-A'S.

4..'-'

P

4*

.4vq ~ 4 ~ ~ ~. ~ wv ~ . '% " '4.-- ~ ~'-~-' ~ * ' 4

Table 1

Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

MONTHS OF DATA COLLECTION

MO

VAL I CU4VALUE LABEL VALUE FREQUENCY PERCEIT PERCENT PERCENT

MARCH 3 4830 39.3 39.3 39.3APRIL 4 7452 60.7 60.7 100.0

TOTAL 1 282 100.0 100.0

VALID CASES 12282 MISSING CASES 0

.,,,

4

s~i20-B

--': " " - " - " " ~~~~~~~~~~~~~~~~~~~~. ' .., ,- , v - ." .v . -- -- . -v . .. . . . -.. ,. ..... ...... ...... , -.. .. , ,.. .- . .., ,.. . . .. . . . . . . .

Table 2

Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTIONS

4VALID CL

VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

SUNDAY 1 504 4.1 4.1 4.1M CNAY 2 1506 12.3 12.3 18.4TUESDAY 3 2832 23.1 23.1 39.4WEDNESDAY 4 2256 18.3*4 18.4 57.8

,, THURSDAY 5 2580 21.0 21.0 78.8FRIDAY t 1?52 14.3 14.3 93.1SATURDAY 7 852 6. 6.9 100.0

TOTAL 12282 100.0 100.0

VALID CASkS 12282 IeISSING CASES 0

00

-v 20-C

Table 3

Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

VALID CU4VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

DAY 1 8136 66.2 66.2 66.2EVENING 2 2670 21.1 21.7 88.0NIGHT 3 1476 12.0 12.0 100,0

ATOAL 12282 100.0. 100.0

, VALID CASES 12282 MISSING CASES 0

~2O-D

P-0*

Table 4

Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

VALID CU,VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

MED I 888 7.2 7.2 7.2SURG 2 1104 9.0 9.0 16.2ORTHOPEDI. 4 324 2.6 2.6 18.911B 5 1776 14.5 14.5 33.3NEWBORN 6 2328 19.C 19.0 52.3PEDS 9 1962 16.0 16.0 68.2ICU COMBO 13 2544 20.7 20.7 89.0PSYCHIATRY 16 1356 11.C 11.0 100.0

TOTAL 12282 100.0 100.0

VALID CASES 12282 MISSING CASES 0

20-E

'4.',,. . . .... , .-.,. . .: . .. ... . . .., ...,.,,., .,a, ',, ,. ,,, ,

.1- -x -. : VTW.

Table 5

Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

CLINICAL SERVICES

VALID c U44VALUE LABEL VALUE FREOUENCY PERCENT PERCENT PERCENT

CRITICAL CARE I.OC 2544 2C.7 20.7 20.1MED SURG 2.00 2316 18.9 18.9 39.6PSYCHIATRY 3.00 1356 i1.C 11.0 50.6OB LABOR CELIVERY '..00 1776 14.5 14.5 6.1INBN NICU 5.00 2328 19.c 1900 fP EDS PICU 6.00 1962 16.C 16.0 100.0

TOTAL 12282 100 100.

VALID CASES 12282 M ISS ING CASES 0

20-F

i7

Table 8

Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

ACTIVITIES OBSERVED

VALID CU4

VALUE LABEL VALUE FREQUENCY PERCENTf PERCENT PERCENT

DIRECT CAkE -1 3076 25.C 25.0 25.0

PERSONAL 0 1096 8.9 8.9 34.0

OFF UNIT ACTV 1 6*0 5.2 5.2 39.2

COMMUNICATIVE 2 1266 10.3 10.3 49.

MEDS SUPPLIES EQUIP 3 398 3.2 3.2 52.7

CHARTING CLERICAL 4 1301 10.1 10.6 63.3

CENFERENCES 5 330 2.7 2.7 66.0

TRAVEL TRANSPORT 6 1204 9.8 9.8 75.8

ADMINISTRAIION 7 1189 9.7 9.7 85.5

ENVIRONMENTAL 8 103 .8 .8 B6.3

1*AIT TIME 9 1679 13.7 13.7 100.0--------------------------------------- -------

TOTAL 12282 100.0 100.0

VALID CASES 12282 IvISSING CASES 02,.0

, .

20- G

,4.,S ..,,.

' ,'- wr~.,,.,.,,,,,:-:..,', ";"-', -..-- ,-.". ,- -,1''. -' . •.. . ". -'-.-. -.----. *"-''> -. ,,. .''," " , ,".?w':I ='~r ill-dd M , i~l~lcl ,O-'I I ,*. ' - * - . " . *.*. - -" '""- " . .- " " *q".

* 6 - *. 6 77. .

Table 10

Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

CARE PROVIDER

VALID CU4

VALUE LABEL VALUE FREQUENCY PERCEI1 PERCENT PERCENT

-I 48 0n .4 .4

HEAG NURSE 1 954 7.8 7.8 6.2WARODASTER 2 1i1b 9.1 9.1 17.2RN 3 3540 28.8 28.8 16. 1

91C 4 630 5.1 5.1 51.2LPN 5 1866 15.2 15.2 66. q918 91F 91G b 1842 15.0 15.0 el04A IDE 7 1614 13.1 13.1 941.5WARD CLERK a 672 5.5 5.5 100.0

TOTAL 12282 100.0 100.0

VALID CASES 12282 .MISSING CASES 0

20-H

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20-P

Table 20Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

PERCENTAGES OF TIME SPENT IN INDIRECT CARE

4

VALUE LABLL VALUE FREJUENCY PERCENT 1

CuMMUNICAIIVE 2 1265 16.MEDS SUFPLiES EQQ1P 3 393 5.3CHARTING CLERICAL 4 1301 17.4CONFERE hCI:S 5 331 3,4TIRAVEL 1iANWPIRtT 6 1204 16.1ALMINISTRATION 7 11|4 15.9ENVIRL)NNEhiAL 8 103 1.4WAIl TIME 9 1674 22.5

TIAL 7473 100.c

VALID CASES "1%70 MISSING CASES 0

20-Q

.I........, ...w..''''' '''""'';''."-',, . -_.'',A ,. ,% 2,'" ' ' ' -",".-,. .'..' ' .- -.,

Table 22Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY CARE PROVIDER

: PRoW

CUiUNI I

ROW PC, IMEA MUk hA IqASI RN ,1¢ LPN 918 91F AIDE WARD CLE Raw16 PCI 1E EX 91G RK T31AL

1 11 21 31 41 51 61 7l $IAL.I .....-- - -o----*- ------ *-oo------ - -0 ------ ... o-o--- 0oo-o-

2 1 20 11 1 41#6 1 37 1 146 1 91 1 118 69 1 61.11"MUNIEATIVE 3 16.5i09 1 11. 1 1.2 1 9.6 1 5.5 1 09

1 3 .5 i 19.0 1 19.0 1 11.3 1 1 3.2 1 11.1 1 12.S 1 13.3S----------------- ------- -

31 1 1 1 40 1 *42 1 15 1 761 $ 611 5* 1 93 396L$OS SUPPLIES EQ 1 3.8 1 10.1 1 35.? 3.8 5 19.1 1 11.8 1 13.6 1 2.3 1 5.3

1 2.2 1 5.3 1 6.0 1 4.6 1 1.3 1 5.7 1 5.7 1 1.? 1---- -- - --.------- --- - ------- 4

A 3 142 3 35 1 548 1 26 1 11 1 1 1 112 1 133 1 1IZILdCiAING CLERJA 1 11.1 1 2.7 i 66.6 1 2.Q 1 13.3 1 5.2 1 8.7 1 10.6 1 11.3

1 20.8 1 6.6 1 25.S 1 7.9 1 1601 1 6.1 1 11.9 i 2s.1 1

s1 363 1 9 1 1$6 3 10 1 43 1 37 1 34 1 1 32hCUEbELS 1 11.0 1 6.9 1 41.7 3 3.1 1 13.2 3 11.3 1 10.4 i .3 3 0.6I S.3 1 3.8 S.3 1 3.0 1 6.1 1 %S 1 3.6 .21

6 1 S6 1 36i 31 3 1 13 2003 18 1 2091 611 1204TRAVEL IRANSPCRI 1 6.7 1 9.6 1 25.2 1 6.2 1 16.6 1 15.3 1 17.4 1 5.1 1 15.2

1 8.2 1 15.3 1 12.9 1 22.9 1 19.2 1 22.1 i 22.1 1 11.6 1

13 3 9731 31461 225 1 36 1 151 1 23 1 583 1 9 1% 11189ALUNISTRATION 1 16.6 1 26.4 1 18.1 3.Z 1 6.0 1 6.1 1 5.7 1 16.3 1 16.0

1 28.9 1 41.S 1 9.6 1 11.6 1 I.1e i 8.7 1 7.2 1 37.5 1

51 31 63 1 1 1 19 251 29 1 3 103ENVIRUNNTAL 1 2.9 1 S.0 1 16.5 1 1.0 1 18. 1 24.3 1 26.2 1 2.9 1 1.6

1 .4 1 .8 1 .7 1 .3 1 1.8 1 3.0 1 3.1 1 .6 1*-.---4.... -# --- - -- ------------- *---------*

9 1 25 3 121 1 1 126 1 302 1 300 3 3211 461 1615WA11 11 1 1.S 1 6.3 I 28.7 1 1.5 1 18.0 1 1I.9 1 19.2 1 2.9 1 22.S

.1 3.7 1 9.5 I 20.5 1 35o• 1 29.0 1 35.5 i 36.0 1 9.3 1C(3LU .--.. , 4------------- -- 4--------------.--,...........--- -- 4.

CUMN 662 756 2368 328 1040 d23 9*5 s53 76tOIOlAL 9.2 10.2 31.6 4.6 16.0 11.1 12.7 1.0 100.0

MNUdE OF NISSING OSSERVAli(NS * 30

20-R

<I"-.

Table 23V. Campbell

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY SERVICE

SERV ICEC0INT I

ROd PC[ ICWiTICAL RED SWG PSVCIdAI US LABOR NN NICU PEDS PIC iONCOL PCT I CARE 0y OELIVEk U TOTAL

1 21 3 41 1 .0 61ACT ------- -------- ... ....... ".......---......---....-------- -------

2 132 13 sa0 a Il a 2 I 210 11 I 1121u2UI 1 23. I 1 16.1 1 6. I 1%.1 1 1.69

I 13.9 1 I0.2 I 1.8 1 12.3 I 17.8 1 13.9 I* -------- l * 0 - ----- ------- 4------------------ --------

3 1 1 921 1 1 ! * 1 I 1 38 1 390CfLO$ SUPPLIES I 17I1 1 36. 1 13.0 1 13.8 1 201 I 15 1 5.3

i .1 3 9.09 1.0 1 4.0 1 6d 1 3.0 1

14 2 61 110 O 1 2 1 Z70 1 116 1 1301MCAWilING LfRICA I IS.2 1 23.0 1 7.8 1 19. 1 19.61 12.6 1 1.14

I 11.9 1 10.2 1 I.1 1 21.3 1 2.0 1 12.0 1

S 96 I 1 6 I f 39 1 32 1 30AJN161 EN $ I 17.6 1 27.9 113.3 1 13.6 1 11.8 1 17.8 1 14.9

1 23. 1 1.0 1 6.9 I 3.9 1 1.3 I .0 1

P26 1 26 1 91 161 1 1 i zuo1 1034iIA0W I. H L 1 6.7 I 19.6,I 6.2 1 13.6 I 1.6 I 1.6 1 16.1

I 11. 1 11.3 t Is.l 1 14. 1 6.07o I 1.3 1

9 I 3 1* 160 1 8 1 137 1 176 1 Z06 1 1169A:IMI SlRull0h 1 3. 1 214.1I 1 0.2 1 11. I I0.6 1 1.3 1 1.9

1 2916 1 13.0 1 26.9 £ 11.9 I 16.5 I 16.0 1

C0L, 0 169 1 20 1 9i 1161 1 1 121*1 103.oo N iUMKIAL 1 O,? i 19.4 1 001 1 Is,5 I 31.1 1 15.9 1 104

1 160. o. l 1 1. 6 1 9.4 1 2. 6 1 .3 1

9u i 04 1 20 1t0 1 274 ! 171 ! %29 1 169mill lint I 2S.3 1 124 1!0.5 1 16.31I 10.2 1 2S.& 1 22.5

•1 25.,4 1 13.,4 26.8 1 d3.8 1 10.5 1 33.4 1

€IOLUM16 1669 Vo 32 6506 11z 11? szUo ?%?a,.TOTALI 2J.3 2U.5 6.0 15.4 15.8 11.2 100.0

''I

*4 20-S

1%5"'&

* APPENDIX 21

FITZSIMONS ARMY MEDICAL CENTERDENVER, COLORADO

21-A

Table 1

FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

MONTHS OF DATA COLLECTION

VALID CUtIVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

FEBRUARY 2 i .1 .1 .1MARCH 3 19692 92.6 92.6 92.6APRIL 4 1566 7.4 7.4 100.0

7ITAL 21276 100.0 100.0

VALID CASES 21216 MISSING CASES 0

a'21i

.21-

• h,".:'" ..,..'-.., ,. ',,'-.. - - - - .. .. . -

Table 2

FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTION

VALID CUlfVALUE LABEL VALUE FREQUENCY PErCEhT PERCENT PERCENT

SUN.AY 1 1362 6o4 6.4 6.4MONDAY 2 3291 15.5 ]5.5 21o9TUESDAY 3 4434 20.8 20.8 42.7WEDNESDAY 4 4320 20.3 20o3 63.0THURSDAY 5 4800 22o6 22.6 85.6FRIDAY 6 2148 10.1 10.1 95.7SATURDAY 7 918 4o3 4o3 100.0

TOTAL 2127b 100.0 100.0

VALID CASES 21276 FISSING CASES 0

2C

.5,.

'' 21-C

.- *J **** . 5 % %%'jV'~'

5'. 5** *** Na.. *a.

4'.

Table 3

FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

VALID CU4VALUE LABEL VALUE FREQUENCY PERCET PERCENT PERCENT

, DAY 1 13512 63.5 63.5 63.5EVENING 2 4968 23,4 23.4 86o9NIGH.T 3 2796 13.1 13.1 100.0

------------------

TOTAL 21276 100.0 100.0

VALID CASES 21276 MISSING CASES 0

21.

as

21-D

4~

Table 4

FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

VALID CUIVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCEN1

OED 1 1890 8.9 8.9 8.9SURC 2 114b 5.4 5.4 11.3ORTHOPEDIC 4 14 *7 ,7 1409OB 5 1566 7.4 7.4 22.3LABOR E DELIVERY 6 1752 8.2 8.2 30.5NEWBORN E 2220 1004 10.4 410.PEDS 9 3978 18." 18.7 59.7SICU 10 1440 6.8 6.8 66.

N MICU 11 1038 a.9 409 71.3CCU 1 432 2.0 2.0 73.4NICU 14 2316 10.9 10.9 84.2PSYCHIATRY 16 3354 15.P 15.8 100.0

7OTAL 21276 1000 100.0

VALID CASES 2127b MISSING CASES 0

21-E

Table 5

FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

CLINICAL SERVICES

VALID CUIVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

CRITICAL CARE 1.00 2910 13.7 13.7 13.7MED SURG 2.00 3180 14.9 11.9 28.6PSYCHIATRY 3.00 3354 15.e 15.8 44.08 LABOR LELIVERY 4-OC 3318 150C 15.6 60.0NBN NICU 5.00 4536 21.3 21.3 81.3PEDS PICU 6.00 3978 18.7 18.7 100.0

TOTAL 21276 100.0 100.0

VALID CASES 21276 MISSING CASES 0

4

i

'; 21I- F

Table 8

FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

ACTIVITIES OBSERVED

VALID CUIVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENIT

DIRECT CARE -I 5302 24.9 24.9 24.9PERSONAL 0 1913 9.c 9.0 33.9OFF UNIT ACTV 1 1266 6.0 6.0 39.9COMMUNICATIVE 2 2083 9.8 9.8 49.7MEDS SUPPLIES ECUIP 3 1165 5.5 5.5 55.1CHARTING CLERICAL 4 1966 9.2 9.2 64.ICONFERENCES 5 1004 t.7 4.7 69.1TRAVEL TRANSPORT b 2981 14.C 14.0 83.1ADMINISTRATION 7 2327 10.9 10.9 94.0ENVIRONMENTAL 8 368 1.7 1.7 95.8WAIT lIME 9 901 4.2 4.2 100.0

TOTAL 23276 100.0 00.0

VALID CASES 21276 MISSING CASES 0

21-G

I,... .,'"'.-.x'Nj: -',""" --- " " " "-".".w

• w * ' i .- , o v v f 'I * * * *' ' .*:- q

p.

Table 10IFA4C

TIME SPENT IN INDIRECT NURSING CARE STUDY

CARE PROVIDER

VALID CU4VALUE LABEL VALUE FREQUENCY PERCEKT PERCENT PERCENT

HEAD NURSE 1 1506 7.1 7.1 7.1WARDMAS7ER 2 1524 7.2 7.2 14.2RN 3 7962 37.4 37.4 51.791C 4 1218 5.7 5.7 57.4LPN 5 2622 12,3 12.3 69o791B 91F 91G 6 3978 18.1 18.7 88.4AIDE 7 1194 5e 5.6 94.0bARD CLERK 6 1272 6.C 6.0 100.0

TCTAL 21276 100.0 100.0

VALID CASES 21276 1ISSING CASES 0

21-H

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21-1

TABLE 13FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

MAJOR NURSING ACTIVITY CATEGORIES BY CARE PROVIDER

PRUVCOUNT IROW PCI IIIEAD NUR WARDMAS1 RN 91C LPN 918 91F AIDE WARD CLE R3WCL.t PCI SE ER 91G RK TOTAL

I 11 21 31 41 51 61 71 at

I 1 340 1 380 1 903 1 205 I 347 1 6S 1 119 1 267 1 3179IINAVAILARLF 1 10.7 1 12.0 1 28.4 1 6.4 1 10.9 1 19.4 1 3.1 1 . .4 1 14.9

1 22.6 1 29.9 1 11.3 1 16.8 1 13.2 1 15.5 1 10.0 1 21.0 i# ------- *- -- --- 4------- -------------------------- 4

2 1 3031 1 1056 I %6S? 1 633 i 1494 1 2193 i 755 1 968 i 12195INDIRECT CARE I 6.1 8.3 I 36.94 1 4.9 1 11. 1 17.1 1 5.9 1 7.6 I 60.1

1 66.9 1 69.4 I 56.5 I 52.0 I 57.0 1 55.1 I 63.2 1 ?6.1 I

3 129 166 1 402 1 380 1 781 1 1167 1 320 1 37 1 5302IPIRECI EARF 1 2. I 1 1 5.3 1 7.2 1 14.? 1 22.0 1 6.0 1 o? 1 24.9

1 6.6 1 5.6 I 30.2 1 31.2 1 29.8 1 29.3 1 26.8 1 2.9 1* .eeeee ...--------------- e * e•een, o O*e eemeoso efa.e o 4l o~~, ~ee o

COLUMN 1506 1524 1962 1218 2622 3976 1194 1272 21276TOTA. 7.1 1.2 31o S. 12.3 18.7 5o6 6.0 100.0

P114I 1ER Il MISSING CSSFRVAiIILNS a 0

2

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Table 20FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

PERCENTAGES .' TIME SPENT IN INDIRECT CARE

.'. Y A L IDv IALUE LABEL VALUE FRk4JENCY PERCENTi PERCE NT

CLMMUNICATIVE 2 2083 16.3 16.3HkLi SUPPLIES E-UIP 3 116" 9.1 9.1

* ChAu'ING LLLRICAL 4 19bb 15.4 15.4C_NFERENICeS 5 1004 7.," 7.8TRAVEL TRANSPORT 6 2981 23.3 23.3AIM INI STRAI ION 7 z327 18.2 18.2ENVIRONMENTAL a 363 2.9 2.9WAIlT TIME 9 901 7.C 7.0

TOTAL 12795 100.0 100.0

VALID CASES 12795 MIESING CASES 0

21- Q

.5 '

Table 22FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY CARE PROVIDER

PROWCUUNl I

kOW PCT INEAD NUN N D1WA.t tN 91C LPN 916 91F 41DE WARD CLE XaidCAL PC] ISE Lk 916 UI TOT4L

I it 21 31 41 si 61 71 8ALT ----- ------------ ---------------

2 1 160 I 104 1 962 1 78 1 236 1 212 1 120 1 199 2083CUNUWICATIVE 1 7.7 1 5.0 1 66.2 1 3.7 1 11.4 1 1J.7 1 5.8 1 9.6 1 16.3

I 15.4 1 9.8 1 20.7 1 12.3 1 15.9 1 13.1 1 15.9 1 20.6 1*-- -...--------- -.------ ....----- -------- . -4------ ------- 4-

33 1 125 1 535 1 133 1 165 100 1 66 1 13 1 1165MtDS SUPPLIES E £ 4.1 1 11.7 1 45.9 1 11.6 1 14.2 9.6 1 3.9 1 1.1 9.1

1 6.6 1 11.8 ! 11.5 ,1.0 1 11.0 1 6.6 1 6.1 I 1.3 1

4 1 111 1 & 1 1043 1 69 1 19d 1 19 1 94 l 284 1 l9b6

ChAk*IT6 LLERICA 1 5.6 i .4 1 53.1 1 3.5 1 10.1 1 1.1 I 4.8 i 14.4 1 15.6I 10.7 1 .6_J _22.6 10.9 113.3 1 7.3 1 12.5 1 29.3 1+_--- -- - *- -- ,--* ------ *------------------4 -4

5 1 114 1 40 1 388 1 2b 7f 293 1 67 ! 1004C3AfEkE&NCS I 13.4 1 1.0 1 3b.6 1 2.0 1 1.4 1 2;.2 i 6.7 i 1 .B

1 11.0 1 3.8 1 8.3 1 4.6 1 5.0 1 11.4 1 8.9 i 1* ----. 4---- -------- # ---- ----- -4------*

6 1 89 1 246 1 875 1 176 1 404 1 742 1 280 1 169 1 2981ITAWIL IRANSPRI 1 3.0 1 8.3 1 29.4 1 S.9 1 13.6 1 26.9 i 9.6 1 5.? 1 23.3

i 8.6 1 23.3 1 18.8 1 27.8 1 27.0 I 33.8 1 37.1 1 17.5 1

I --- - - +------ -------.---- ------------------1 501 4 ;1 "1 76 1 15b1 223 1 42 262 12327

AbNIIISIRATION 1 21.6 i 21.4 1 24.1 1 3.3 1 6.8 3 9.6 1 1.8 1 11.3 1 18.21 49.0 1 47.0 I 12.0 1 12.0 1 10.6 1 13.2 1 5.6 1 27.1 I

a 1 6 i 18 831 31 1 1211 ? 1 4 1 61 368kNVkOfN*TAL £ 1.6 1 4.9 1 17.1 1 8.4 1 32.9 1 21.2 1 12.2 1 1.6 1 2.9

1 .6 I 1.7 1 1.4 1 4.9 1 8.1 1 J.6 I 6.0 I .6 1*4------ -------- -4------ --- ,-- ---------- -4 ------- -------- -------- 4

9 9 1 1 20 3 230 1 2 1 136 S761 61 1 351 901*MAI TIME 1 .1 1 2.2 1 25.5 1 4.7 1 15.1 1 61.7 1 6.8 1 3.9 1 7.0

1 .1 1 1.91 4.91 6.6 1 9.1 17.1 1 8.1 3.63# ------ *------.-------------------------- ---- -------- -------- 4

COLUMN 1031 1058 4b7 633 1494 2193 755 968 12795TOTAL. 8.1 8.3 *36.4 4.9 1.7 17.1 5.9 7.6 100.0

UN5umoE OF MISSING OSSERVATIILS - 0

21-R

Table 23FAMC

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY SERVICE

,.. SERVIckCOUNT I

N "Wn PCI ICRIIICAL NED SUNG PSVCIAI Us LAd "N NICU PEDS PlC RawCOL PCI I L.AU* Ry DELIVER U TOTAL

-(11 11 21 31 41 51 61A- ... + ....----.......--------,,-- . -- •------- --. ----- #

2 1 325 1 312 1 226 1 3 4 1 420 I 47 1 2083C.jNUif hICAIIVE 1 15.6 1 1S.0 I 10.u I 16.6 1 .u.2 i 21.9 1 16.3

1 20.6 1 16.0 1 10.0 1 16.1 1 18.3 I 17.8 1

3 *71 3 36 1 226 1 369 1 149 116NLDS SUPPLIES EO 1 12.6 i 20.6 I 3.1 1 19.4 1 31.7 1 12.6 1 9.1

I 9.3 1 12.2 I 1.6 i 10.6 1 16.1 1 5.6 1#--------------------------------------- --------------- ------- -------- .1 265 1 366 1 193 1 3S21 66 51 3751 1966

CHARIING CLIIICA I 13.5 1 17.6 1 9.3 1 17.9 1 22.6 1 19.1 1 19.4i 16. 1 17.7 1 8.1 1 16.4 1 19. 4 1 %.6 1* - ------- ----- --.-- *---- -- #-----+

5 I 2 1 I, 1 63 I 116 I I11i 12 1 1004COM . CNFERL. OES 1 9.2 1 10.9 1 4..b 1 11.6 1 i2.1 I 12.7 1 7.8

1 b.8 1 5.6 1 19.5 I S.4 1 5.3 I 5.0 1

6 i 36 I 662 1 716 1 35 1 65k I 67 1 2981tRAVEL iANSPIT 1 11.5 1 16.6 I 24.1 1 11.9 1 15.1 1 22.5 1 23.3

1 21.8 1 22.6 1 31.9 1 16.6 1 19.7 1 2b.1 1

1 1 276 1 367 1 416 I 527 1 344 1 399 1 2321AONINISTRATION 1 11.9 1 15.8 I 17.6 1 22.6 I 14.8 1 17.1 1 16.2

I 17.S 1 18.8 I 18. 1 246.6 1 15.0 I 15.5 1*------4 --- - -- --- ---------- 4

a 1 28 1 68 1 31 1 122 1 851 56 368ENIVIRONMENTAL 1 7.6 I 13.Q 1 8.6f I 33.2 1 23.1 1 1.? 1 2.9

1 1.8 1 2.5 1 1.7 1 .1 2.1 1

91 10 1 96 1 231 1 981 58 3)0 I 901itAl TIME 1 11.5 1 10.4 1 23.0 1 10.9 1 6.4 i 37.7 1 1.0

1 6.6 1 6.8 1 9.2 1 4.6 1 2.5 I 13.2 1• ..-.... ---- 4-------..,.---- ---.....--

COLUMN 1561 1956 2251 2161 2293 2573 12795TOTAL 12.4 15.3 37.6 16.7 17.9 23.1 100.0

NU814 OF MISSING USSERVATIEWS a 0

2 S

21-S

.' ,.

i. .

'p.APPENDIX

22

W DEWITT COMMUNITY HOSPITAL

•. FORT BELVOIR, VIRGINIA

4-.

C..;

22-

4-

Table 1

DeWitt

TIME SPENT IN INDIRECT NURSING CARE STUDY

MONTHS OF DATA COLLECTION

VALID CUI

VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

MARCH 3 6426 69.2 69.2 69.2

APRIL 4 2856 30.E 30.8 100.0--------------------------------------- -------

7OTAL 9282 100.0 100.0

VALID CASES 9282 PISSING CASES 0

22-B

j* ;-. ,-, -.-. : '.-" ....- ,. ,-, U,-,, ,..,.,..,-..:.,

* Table 2

DeWitt

TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTION

VALID CUnVALUE LABEL VALUE FREQUENCY PERCEIT PERCENT PERCENT

SUNDAY 1 852 9.2 9.2 9.2MONDAY 2 972 10.5 10.5 19.7TUESDAY 3 1482 16.0 16.0 35.6WEDNESDAY 4 174 b 18.8 18.8 54.4THURSDAY 5 2034 21.9 21.9 76.3FRIDAY 6 1158 12.5 12.5 88.8SATURDAY 7 1038 11.2 11.2 100.0

TOTAL 9282 100.0 100.0

* VALID CASES 9282 MISSING CASES 0

22-C

*|- *~ * v

Table. 3

DeWitt

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

VALID CU4VALUE LABEL VALUE FaEQUENCY PERCENIT PERCENT PERCENTI

DAY 1 5592 60.2 60.2 60.2EVENING 2 24511 26.. 26. 86.7NiGHT 3 1236 13.3 13.3 100.0

TOTAL 9282 100.0 100.0

VALID CASLS 9282 "ISS1NG CASES 0

2:

22- D

I, '"" ; I . . ',_ , , ,.. , . ' i ,,,.- ; - .-.,-.,; .., .. ?.?.;, ,,..-.., .i-.."C, ?.- ; . --.--- .

Table 4

DeWitt

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

VALID CUl

VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

MED 1 774 8.3 8.3 8.3SURG 2 1434 I5.e. 15.4 23.8u 08 5 1440 15.5 15.5 39.3NEWBORN 8 996 10.7 10.7 50.0PEDS 9 2130 22.9 22.9 7.3.0ICU COMBO 13 2508 27. C 27.0 100.0

TOTAL 9282 100.0 100.0

VALID CASkS 9282 MISSING CASES 0

2

"*54

'52-

I " . ' ", ' ' °

" ". . . . . ". " "" % " % . " °

" " "" " " ". . . .. " * • . " - " " • -

4 ", .'.,..", ", "., . ,. . , , .,".".".,",",-.,'',.,,'/ '..'.., ,'. ... ,. :.

Table 5

DeWi tt

TIME SPENT IN INDIRECT NURSING CARE STUDY

CLINICAL SERIVCES

VALID CUIVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

CRITICAL CARE 1.00 2508 27.0 27.0 27.0MED SURG 2.00 2208 23.8 23.8 50.808 LABOR DELIVERY ,00 1440 15.5 15.5 66.3NBN NICU 5.00 996 10.7 10. 77.1PEDS PICU 6.00 2130 22.9 22.9 100.0

TOTAL 9282 100.0 100.0

VALID CASES 9282 MISSING CASES 0

22-F

Table 8

DeWitt

TIME SPENT IN INDIRECT NURSING CARE STUDY

ACTIVITIES OBSERVED

VALID CLMVALUE LABEL VALUE FREQUENCY PERCEN'1 PERCENT PERCENT

DIRECT CARE -I 2524 27.2 27.2 27.2PER SONAL 0 730 7.9 79 35.1OFF UNIT ACTV 1 399 4.3 4.3 3994COMIMUNICA71VE 2 995 10.1 10.7 501MEDS SUPPLIES EQUIP 3 584 6.3 6.3 56.4CHARTING CLERICAL 4 1396 15.0 15.0 71.4CONFERENCES 5 275 3.C 3.0 74.4TRAVEL TRANSPORT 6 940 10.1 10.1 81#.5

AOMINISTRATION 7 662 /.1 7.1 91.6ENVIRONMENTAL 8 205 2.2 2.2 93.8WAIT TIME 9 572 692 6.2 100.0

TOTAL 9282 100.0 100.0

VALID CASES 9282 MISSING CASES 0

,2'Io

i 22- G

.... 4 "," ". .°

"'',' ' r q r ,.. , ."v,. ,% , %

" ',"T

, ,'"..,''°°

Table 10

DeWi tt

TIME SPENT IN INDIRECT NURSING CARE STUDY

CARE PROVIDER

VALID CUMVALUE LABEL VALUL FREQUENCY PERCEIT PERCENT PERCENT

-1 84 .9 .9 .9HEAD NURSE 1 774 8.3 8.3 9.2WARDASTER 2 888 9.6 9.6 18.8RN 3 2880 31.C 31.0 49.B91C 4 1668 180C 18.0 67.8LPN 5 192 29 1 2.1 69.991B 91F 91G 6 1452 15.6 15.6 85.5AIDE 7 762 8.2 8.2 93.7WARD CLERK 8 582 6.3 6.3 100.0

ICTAL 9282 100.C 100.0

VALID CASES 9282 MISSING CASES 0

22-H

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CS N N-4 I NfI 10N4 I MOqN NI I0 1ww I I N I I 4I I I I

4p- P-S I en in In 0 N

US II IS I U.FA. I 0O I 0%.0o S N IN I m a Lm I .4 In I UA r- 0 1 ANN.0( I .40 r I NN Cy

I 4p *I N e S 8 NAS Sd fiS E l f'CJ.

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m w -.O I I i a I IsZ

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mi I ''I A' P-

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cza 0

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- - - -I0 0 O - 0- + -00-N- - 0-I- -A S+

I~ ~~~~ ~ ~ ~ N 8 4104a (.c-01 00 - D4 I N4 W I )

10 N4 Iz I; II I S

p44 ~ - aw4-P '4-S 4 Sw -N Qw t . - p4 - 400 ONO w w

Z Sw a

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4 04 5 5 5 I 22-1

TABLE 13DeWitt

TIME SPENT IN INDIRECT NURSING CARE STUDY

MAJOR NURSING ACTIVITY CATEGORIES BY CARE PROVIDER

PROVCOUNI IRON PCI IHEAD NUR WARODAST 44 91C LPN 915 91F 4IDE WARD CLE R3dCUt PCI ISE ER 916 RK 10ors

I II 21 31 41 51 61 ?1 81PR .....--------- -------- 4------------------------ ---- *- ------ ---- --------- ,- -----

1 3 74 I 124 I 239 I 266 1 6 1 195 I 67 1 137 I 1108UNAVAILABLE I 6.1 I 11e 1 21.6 1 2s.0 i .5 1 11.6 1 6.0 1 12.4 1 12.0

I 9.6 1 14.0 1 8.3 I 15.9 1 3.1 1 13.4 1 88 1 23.5 1S4--------4------------,-------------- -- -,-----

2 1 554 I 650 1 17q41 858 1 71 1 815 1 481 1 429 1 5602INDIRECT CARE 1 9.9 1 116 I 31:1 1 153 i 13 i 1%.5 i 86 1 717 1 60.91 71,6 1 73o2 3 60,6 1 51*4 1 37*0 1 5S.1 1 63ol 1 73.7 1

DI3 I 146 i 114 1 897 1 544 1 115 1 %442 1 214 1 16 1 2488DIRECT CARE 1 5.9 1 4.6 I 36.1 I 21.9 1 4.6 1 17.0 1 06 1 .6 1 27.0

1 16.9 1 12, 1 31.1 1 32.6 1 5999 1 30.4 i 2801 1 2.7 1

COLUMN 774 888 2680 1668 192 1452 762 562 9196TOTAL 8,4 9ol 31.3 18.1 2.l 15.8 8.3 6.3 100.0

NUMBER OF MISSING OBSRVAIIONS • 84

22- J

W%- -

MJ I9 0 a (7

~~.Ca a 'T -0-s a 1 .?0t a %

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4.J 6- 1 1. - .~ a I I Iz 000 Oamo I wCwoN~anI

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W& S 9NS 0 PI~. 0. S 64. wq.isz4 -4

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S L&J LU 99 u I u'O '@jIC.a 4A Q I 4A~e.4 *.~

z C6Qca a w I S f IA

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I= C

cc~, %C,!x 9 01

OD 4q NN I CP0400424 4 a 0 6 1 A 04 0

1 i n N S0 4

(AS 1 PNN C I (V

V) zLai U Sc "m Po Ip "P- " P A

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CD P4 N Il I N e ce I e-0 + p" Sp 0 q a o we +

LA 0 a An - - - a=2 040 V4 CI T41 i

L. I-. aM I

- ~ w4 aa I Szl 01. 21 I- I I N, C .9 . j6

4A z at W i~ o VCLA OA S U S6AII

." .o 0a 0 0 a 0"0 w 4o

- 5$- W

ZAQ 1 .d 0 -

I0 0 w SM finM

z CA 4

4 U

0A 0 atz 0 2

22-P

-7V

Table 20DeWi tt

TIME SPENT IN INDIRECT NURSING CARE STUDY

PERCENTAGES OF TIME SPENT IN INDIRECT CARE

VALUE L4BL VALUt FRE4UENCY PERCENT

CUNMUNICATIVE 2 995 17.7

Mk4DS SUf-PLIkS EQUIP 3 58 1004

CHAIq1ING CLEIICAL 4 1396 24.e

COM-EkENCLS 5 275 4.9

TRAVEL TRANSPORT 6 943 16.7

ACINISTRATION 7 bbZ 118

E KV IRONMEhTAL b 205WAIT TlIME 9 57? 10.2

TUAL 5629 100.0

VALID CASES 5629 MISSING CASES 0

~,

,"I

22-Q

, , .. . . ..0. . . .. V ' ; V <..: :. - :

Table 22DeWi tt

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY CARE PROVIDER

4..',V

CGlihi 1

NOW PCT INE*D NUN NfiDHiAST 4M 91C LPN 916 91F AIDE idlS CLE A3dCOL PCI ISE ER 91G AK IOIL

I 11 21 31 41 SI 61 71 oI

ACT----------------------------------------------------- -171 1 98 1 311 i 971 121 B I 56 1 93 1 950

C JNhILA1IVE 1 18.0 1 10.0 I 37.7 1 9.9 £ 1.2 1 5.I 1 5.7 1 9.5 1 17.61 31.9 1 15.1 1 21.3 1 11.3 I 16.9 1 9. l 11.6 1 21.7 1

3 461 69 1 2321 107 1 9 1111 S I 1 1 564OLDS SUPPLiES all 1 1.9 1 8.4 1 36.6 1 18.3 1 1.5 1 0.0 1 10.1 1 .2 1 10.4

1 8.3 1 1.5 1 11.6 i 12.5 1 12.1 1 13.6 1 12.3 1 .2 1

:A 143 i 61 625 1 I50 1 29 1 1%0 1 S6 1 194 1 1366CiAKMI11w6 LERIC 10.3 I 3.4 1 5.2 1 13.8 1 2.1 1 10.1 1 4.0 I 16.0 1 24.1

125.0 1 7.2 1 3S.6 111.5 1 40.6 11.2 1 11.6 1 45.2 1* ... 4-----------,---------- ----------- 4-

51 311 i1 115 1 54 1 21 36 1 01 a 215CJiFERkh"S 1 11.3 i 7.6 1 61.6 1 19.6 1 .1 13.1 1 2.9 3 2.9 t 4.9

1 9.6 J 3.2 6 4.4 1 6.3 1 2.6 1 t.4 1 1. 1 1.A I

6 5 1 1271 156 1 1821 1 201 156 i 50 939

TAVIL IRA&SPCRI 1 6.1 i 13.5 1 16.6 1 19.4 1 .1 21.7 1 16.6 1 5.3 1 16.01 10.3 i 19.5 80.9 1 21.2 1 9.9 1 2S.0 1 32S4 I 11.1 1

11 93 1 261 1221 63 I 1 3 1 1 1 662AUMINISIRAI16 1 14.0 1 40.0 1 18.4 1 6.5 1 .2 I 3.8 1 6.8 1 12.2 1 11.1

1 16.& 1 40.8 1 1.0 I 5.0 1 1.4 1 3.1 1 6.1 16.9 1#4----4#- - ------- --------- - ---- 4---------- --

a1 2 1 37 20£ 51 1 63 1 21 1 234kXVIDIONAL 1 1.0 1 18.1 1 9.8 1 25.0 1 6.4 1 21.1 1 Z0.6 1 1 3.6

.4 1 5.7 1 1.1 1 S.9 1 12.1 1 5.3 1 8.7 1 1

9 1 133 1 141 2 1 716 1 72 1 2 1 $10,6AlI T1E 1 .9 1 1.1 1 23.3 1 30.5 1 .4 1 30.9 I 12.6 1 .4 1 10.2

1 .9 1 .9 1 7.6 1 20.3 1 2.8 1 21.06 15.0 1 .5 10a . ...... -- - ----- - -- ------

CULWW 554 650 174 050 71 315 461 629 5632101 9.9 11.6 31.1 15.3 1.3 16.5 0.6 17 100.0

*mumbkR 3*5MISSING OSSEAVAMINS - 21

oil

22-

,.4 ,,,, _ P _ .. _..o ,, +-; , - ,. . . - --•.-. ... ... . .. _ .... . , .....-.-.........-., . -.- .,.-.,,+. ,, ,.. . . .. . ., . .,,. . .

q P -- '-. * *~~* ~ 4 -~ . - - - -

i .Tabl e 23DeWi tt

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY SERIVCE

41;

$W~l E AV ICE

V k ja PCI ICRITILAL NED SURG Jo LABOR NBW NICU PEGS PIC S.M

COL PtI I CARE UELIVERI U TOTALI I. i l 41 51 61

2 1 25* 1 ,51 I 130 1 109 I 197 1 995Co IC&0IVE 1 2 1. i 252 1 18.s 1 11.0 3 29.9 1 179

1 1.7 ! 17.7 1 18.6 1 21.7 1 24.5 1

I S--- ------------ # ----

3 1 3 1 151.1 192 1 1 j0 i 584HiOS $UIOPLIE5 &%1 1 24.3 1 25.09 1 1508 1 I0.* 1 2J.6 1 i0.4

1 10.03 1 3O.2 9.4 15.2 1 lo.7 I- ----- *-..--.......----.--.-------

01 341 1 352 1 3? t 127 1 329 1196CHORV16 CL RICA I 1.273 1 2.2 1 14.8 1 9l I 23.6 1 2t.8

1 21.7 ! 81 21.2 1 0 2%.2 1

5 1 93 1 166 ]1 if 1 7 I 78 l 27'S,CU0 FERANES 1 33.6 1 16.7 1 11.3 1 9.8 1 26.4 1 f#.9

1 6.0 1 3.2 1 3.2 1 '5e.• 1 5.7 1

6 1 161 3 350 1 161 1 60 1 208 1 40IKAVIL TRANqSPORT 1 i1,1 1 37.2 1 17.1 1 6.4 1 22.1 1 1S,7

1 11.7 1 2 -.7 1 16. 1 12.0 1 1.3 1

71 132 1 151 1 102 1 3v9 19 1 6$2AOuIlImSTRATiON I 19.9 i 22.06 1 21. 1 5.9 1 29.9 i l1.e

1 9.6 1 10.6 i 10.5 1 7.6 1 10.6 i* -- , -- • l O m ,m ~ e o mLe• o

8 1 8 1 67 )2 1 19 1 49 1 205E.VIONSENIAL I 1l.5 I 3.7 1 Is. 1 9.3 1 2 .9 1 3.06

S2.0 1 40.7 1 3.3 1 3.6 i s.6 I

95J 1721l 5411 1295 i 001 161 I 572

1WAIT TlME 1 30.1 I 0.7 1 2.b 1 10.5 1 2b.1 1 10.21 £2.5 1 3.5 1 13.2 I 12.0 1 11.9 I

CuLLifit 1373 1418 978 $02 1358 b29TOTAL 20. Z5.2 17.04 .9 24.1 100.0

NUsbER UF #4ISSINto UOS.RVATI1NS * 0

N 22-S

,-.t ~ . ... .a,.. :,, ., P.,". -- .-",-¢,,-.',' ,'.€.,"',._'.', '. .-'_-. -... ".".. ,",, ,.'',_':'..'' ',.:\'_'- ', "-., ,-" - ' '-" "

APPENDIX 23

US ARMY MEDICAL ACTIVITYFORT CARSON, COLORADO

-23-

Table 1

Ft Carson

TIME SPENT IN INDIRECT NURSING CARE STUDY

MONTHS OF DATA COLLECTION

VALID CUVALUE LABEL VALUL FREQUENCY PERCENT PERCENT PERCENT

"V

MARCH 3 4470 39.9 39.9 39.9APRIL 4 6744 60.1 60.1 100.0

TCTAL 11214 100.0 100.0

VALID CASES 11214 PISSING CASES 0

-'.3-

23-B

Table 2

Ft Carson

TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTION

'I

VALID Cu4VALUE LABEL VALUE FREQUENCY PERCEhT PERCENT PERCENTSUNDAY 1 714 6e4 6.4 6.4MONDAY 2 1656 14.8 14.8 21.1TUESDAY 3 2040 1812 18.2 39.3WEDNESDAY 2100 18.7 18.7 58.1. THURSDAY 5 2196 19.6 19.6 77.bFRIDAY 6 1836 16.4 16.4 94.0SATURDAY 7 672 6.C 6.0 100.0

TOTAL 11214 100.0 100.0VALID CASES 11214 ISSING CASES 0

23-C

aS

Table 3

Ft Carson

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

VALID CUIVALUE LABEL VALUE FREQUENCY PERCEIT PERCENT PERCENT

DAY 1 7368 65.7 65.7 65.7EVENING 2 2502 22.3 22.3 P8.0NIGHT 3 1344 12.C 12.0 100.0

-- - - - - - -

TOTAL 11214 100.0 100.0

VALID CASES 11214' MISSING CASES 0

42

.54 . . : .. . .. . v . . .. . .. ,', ..' ." .-" , .... , , -' ., .,' -, .- -. ,- "

Table 4

Ft Carson

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

VALID CU1

VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

MED SURG COMBO 3 1536 13.7 13.7 13.7ORTHOPEDIC A 966 8.6 8.6 22.3Go 5 708 6.3 6.3 28.6Ob LED COMBO 7 2010 17.9 17.9 16.5NEWBORN b 1428 12.7 12.7 59.3PEDS 9 241Z 21.5 21.5 80.BICU COMBC 13 2154 19.2 19.2 100.0

TCTAL 11214 10000 100.0

VALID CASES 1121* MISSING CASES 0

~23-E

U % I • " w - - - - - ' - " "" " W " " " " " • " " " " " " ' " " ' " " "" ' "" " "

.low

.1

Table 5

Ft Carson

TIME SPENT IN INDIRECT NURSING CARE STUDY

CLINICAL SERVICES

VALID CUVALUE LABEL VALUE FREQUENCY PERCEINT PERCENT PERCENI

CRITICAL CARE 1.00 2154 19.2 19.2 19024ED SURG 2.00 2502 22.3 22.3 4105

08 LABOR CELIVERY 4.00 2718 24.2 24.2 65.8NBN N]CU 5.00 1428 12.7 12.7 78.5PEDS PICU 6.00 2412 21.5 21.5 1000

I(TAL 11214 1O0.C 100.0

a,. VALID CASES 11214 MISSING CASES 0

23-F

Table 8

Ft Carson

TIME SPENT IN INDIRECT NURSING CARE STUDY

ACTIVITIES OBSERVED

VALID CLMVALUE LABEL VALUE FREQUENCY PERCENT' PERCENT PERCEN

DIRECT CARE -1 2396 21.4 21.4 21.4PERSONAL 0 1026 9.1 9.1 30.5OFF UNIT ACIV 1 664 5.9 5.9 36.4C 0" UNICAII VE 2 il1i 9.9 .9.9 46.3MEDS SUPPLIES ECUIP 3 644 5.7 5.7 52.1CHARTING CLERICAL 4 1213 10.8 10.8 62.9:CONFERENCES 5 233 2.1 2.1 65.0TRAVEL TRANSPORT 6 1178 10.5 10.5 75.5ADMINISTRATION 7 1080 9.6 9.6 85.1ENVIRONMENTAL 8 335 3.C 3.0 88.1WAIT TIME 9 1335 11.9 11.9 100D.

TCTAL 11214 100.0 100.0VALID CASES 11214 PsISSING CASES 0

a2'..-

a-

23-

-.

a..- qeL

'..-'| -I: ".. ,t ",.-*, . ." -.- - -. '.". .• . .. ',. , ",-,.'.% .,.' ,".,.iTS( 23 / I - G-1 I jm l - 1 i m | I II i m

Table 10

Ft Carson

TIME SPENT IN INDIRECT NURSING CARE STUDY

ICARE PROVIDER

.4

VALID CU4

VALUE LABEL VALUE FREQUENCY PERCEK7 PERCENT PERCENI

HEAD NURSE 1 720 6., 6.4 .",

WARDOASTER, 2 768 6.8 6.8 13.3

R 3 317s 28.3 28.3 41.6

91C 4 154.2 13.8 13.8 55.3

LPN 5 2400 21.4 21.4 76.1

91B 91F 91G 6 1194, 10.6 10.6 87.4

AIDE 7 624 5.6 5.6 92.9

WARD CLERK 8 792 7.1 7.1 100.0

-1 TOTAL 11214 100.0 100.0

VALID CASES 11214 ISSING CASES 0

'21

a'

-j 0.0 40 0 A N o o OE 'o E0 'a ftQL 0~ 04 !: Z.Os N. - ~ 4@

ago M"N -- N 4 o

4I V to", 14 .CaQ I o .M Sr" O N O W aC%.O- C, * ' - 9 1~ 44 10 A.44:N f :-.4:a ,

- UA

3wd -4 -:1 -4 -441

%4 3 S 0- ~ 1E .4. 1'I4 % -f"I 0-4 1 0MMM 1 1

ot 4 I I I I I F6- ~

iU ILA I a .1 2s 044W N0%0 fo

Iv4 a I4 q a" e 94 a5 V

MD4 N 40 0N goM S, P. p I (A04 U I N : 9 a; I S I

UUj S S I I I'-5-O t* 0 1

4a oo *o #~ so ow awooe *moo"" va~ s4~ *.I o"

O 42 a I 4 .oe -N a4

U4~' 6 S 1.4U 1 .4 In I I I

0 a S I

LI UW L US 01 It.. 0. ef I I

IL5 Z I I I I I I I I

L0 Ine* MeN 0 M rg An fl. d% NI

Ln = 00 0 0 14op. wn 5- e I SSI II

uj LL + an .** +4--44 oe +4E 4- 4-

U I mo I OW m 6 V4 046

10 1w 04 a N 11 S I

,aI -m .0 n f NI. a VI 10~I We* se r.a e u el C-Igc..4

L&. 0: z lAW S; MMI 1d S % I6 i C 'O4 -c .40-4C I a N I NN I -46

- U NII I SI I0- w 0% 0 Cs a. a,. I N:0

5.,1 . IV I SgI w I p I 9a 1 64 1I

w wS I N I" 4P a a P. E d

w. Iu 0-1 .1 N .45 6 5

%. w a, I II

0~~a cr. .44 2 4

-C 4. I g I I 23-1

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z4 1 a. ANB o.

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cc4. CA S N4to fIn M 46 . %ca ty0 aij .4 a m a .4 PO

L) 8-4 Ot asoaa

to 4.1 b" dc4A4 1n ."N ~ eiO O 1 1~ ~ i5.. i. Q 0- a Ni 1s i l

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1 L&1MMJo 0 aF I %IOw I M ev0 CYN e

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co aC C

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23-

- 3 - -. , . . ,, ,. a * * , - .- - " -' * < ,,<- " - :" - :- -" - " -- -"- . . . ." " "' - " " -

" - - J "

Table 20Ft Carson

I. TIME SPENT IN INDIRECT NURSING CARE STUDY

PERCENTAGES OF TIME SPENT IN INDIRECT NURSING

VALUE L.BEL VALUE FREZJENi.Y PERCENT

COhIUNICAIIVE z 1113 15.MkES SUPPLIES EQUIP 3 64# 90cCHARTING CLERICAL 4 1213 17.CCUNFERENCkS 5 233 3.3TRAVEL TRANSPORT 6 1173 16.5ADMifI SRATION 7 1083 15.2

, E NVIRLNhEITAL 6 33, 4.. WA1T TIME 9 1335 18,7

.-, TUTAL 7123 O00.

VALID CASES 7128 P I SSING, CASES 0

.9

ell

%

" 2 3-Q

i .... .",, ." ,';'../ ' . . .". ." . .".". ,".. : . ."., ."...". . . .. , . .'. '

Table 22

Ft Carson

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY CARE PROVIDER

PRUVCiUNT I

ROW PCI iMEAU Milk HAKfIASI AN 91C LPN 91b 91F AlIDE MAID CLE ROwCDL PCI ISk EN 91G 3K TOT&L

1 11 21 11 61 51 61 71 iAC . -. 9- 9- - ----.----------- #------

a i 160 1 63 1 416 1 82 1 142 i bS 1 38 I 124 1 iliaC ONNIIM 1CA I I VE 1 16.2 1 5.7 1 )7.5 1 7.4 1 12.8 1 S.9 1 3.4 1 11.2 1 15.6

1 36.9 i 11.4 1 18.8 1 10.0 1 10.4 I 9.6 I 10.1 i 20.3 1

3 1 24 1 37 1 166 6 133 1 ISO 1 781 3 1 , I 666LD0$ SUPPLIES EU 1 3.7 1 5.7 1 2S.8 1 20.7 1 2t.S I 12.1 I 6.7 1 .8 1 9.0

1 4.9 1 6.1 1 .1.5 i 16.1 1 i.S 1 11.2 1 11.4 1 .8 i6*~ -. ~ - .9 .9-----.-- .9 ---------

1 76 1 7 1 WS 1 al11 16031 66 1 36 1 266 1 1213.CdANTIN CLEkICA 1 6.1 1 .6 1 43.3 1 6.1 1 13.2 I 9.3 1 2.8 I 22.1 1 11.0

1 1i.2 1 1.3 1 23.8 1 9.8 1 11.7 i 9.2 1 9.0 I 63.6 1

S 1 21 1 8 1 113 1 20 1 42 i 1S 1 11 1 I 233LONFERE14C S 1 9.0 1 3.41 i 8.S 1 8.6 1 16.0 I 7.7 1 %.? 1 1 3.3

i 4.3 1 1.4 1 9.1 1 2.4 1 3.1 1 1.6 1 2.9 i 1

6 i 46 1 1 1 216 1 212 1 283 1 185 1 as 6I I IliaIkAVEL IRAkSPINl 1 4.1 1 6.9 1 15.3 1 18.0 1 24.0 1 12.? I 7.2 1 %.8 1 16.5

1 9.8 1 14.6 1 9.6 1 25.7 1 20.6 I 26.7 1 22.6 I 11.1 i* ---- -4-------- ----- *----9------------

1 1 114 1 297 1 38 I 97 1 86 i 56 1 19 1 93 1 1060AuN1iISIRATINi 1 10.6 1 27.9 i 33.1 1 5.3 1 6.u I 1.2 1 1.6 1 8.6 I 15.2

i 23.4 I 93.1 1 16.2 1 6.9 1 o.3 1 8.1 1 5.1 i 19.2 I

a I 9 1 1 1 27 61 1 125 1 36 1 6b01 21 33SkNVIRONPIUAL 1 2.7 1 6.5 1 6.1 1 24.2 1 37.3 I 13.7 1 11.9 1 .6 1 6.7

1 1.61 1 .7 1 1.2 1 9.8 1 9.1 i S.2 1 10.6 3 .31

9 b 1 45 369 1 19S 1 375 1 192 1 106 i 52 1 1335WAIT IIl .I 1.3 1 3.6 I 29.1 1 11.8 I 26.1 1 1.6 I 7.9 1 3.9 1 1.?

1 3.7 1 8.1 i 17.6 1 19o2 1 27.6 I 27.7 1 28.2 1 3 .5 1*- ---- ------ ---------------------. - - -------

COLNN 4988 53 2210 824 1371 S9 376 612 1128iTiAL 7.8 31.0 11.6 19.2 ;.7 5.3 6.6 100.0

NUNOER OF HISSINI i SE.VATILUhS * 0

23-R

1%,-0-

Table 23

Ft Carson

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY SERVICE

SERVICECOUNI IRp F ' ICkITICAL 38R0 SUNG Oh LAOOR NBN NIC PEGS PIC RawLCL PF.1 I CARE DELIVER U TOTAL

I if 21 %1 SL 61ACT - ------------ * -------- * - ------------4 - *

1 1 173 1 259 1 2f9 1 381 ?*6 1 1110CUNUh ILATIVE 1 15.6 1 Z3.3 1 22.4 1 16.3 1 22.3 1 15.6

1 12.6 1 16.5 1 14.3 I 18.2 1 11.2 I- ---- *- ------------------- *

3 i 145 1 125 1 1Z 1 76 1 126 1 S%4HMiOS SUPPLIES I1 1 22.5 1 19.4 1 26.7 1 11.8 1 1I0.6 i 3.0

1 10.5 I 7.9 1 9.9 1 1.7 1 b.7 I

4 1 224 1 305 1 317 1 ICh 1 259 I 1213CnANITING C;LERILA~ 1 18.5 1 26.01 1 Z6.1 1 8.9g 11.4 1 17.0

1 1b,,3 1 li.% 1 18.2 i 10.9 1 17.9 £5 1 94 1 44 1 49 1 26 1 60 1 233

CiNFERENCRE S 1 23.2 1 18.9 i 21.0 1 11.2 1 2,j.6 1 1.)

1 3.9 1 1.6 1 2.6 1 2.6 1 4.,2 1

6 1 206 1 351 1 265 I lid 1 23 i 1 1176TRAVEL INAN.SPRI I 11.b 1 29.8 1 22.5 I 10.0 1 20.Z I lb.5

I IS.0 1 22.3 1 15.2 1 11.9 1 16.5 I

* 1 193 1 232 1 298 1 66 1 191 1 1050a DINfISINArIA 1 17.9 1 21.5 1 17.6 1 15.4 1 11 1 15.2

£ 4.6 1 1.7 1 17.1 I 16.7 1 13.1 1* 4---------- -----

.6 1 35 1 73 1 117 1 I8 1 62 I 335ENVIRNIENTAL 1 10.4 1 21.8 1 39.9 1 14.3 1 16.5 1 4.7

1 2.5 1 .6 1 6.1 1 4.8 1 4.3 I*-------4- - 4----------- ----------- -

9 1 346 1 185 1 275 1 270 1 259 1 135WAIT TIME I 25.9 1 13.9 i 20.6 1 20.2 1 19.4 1 1,.7

1 25.1 1 11.0 1 15.0 1 27.2 1 11.9 1

CUL LW 1 6 157 1792 993 1Me3 71lSIUTAL 19.3 22.1 24.4 13.9 20.2 100.0

NUMBER OF NSSING OBSERVATIONS - 0

23-S

4 , - ,' ° -. . . ., , . - . ,.o,., -- ... -. . .. , .9.

NA

qia.

'. a,

APPNDIA2

Table 1

Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

MONTHS OF DATA COLLECTION

VALID C UlfVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

MARCH 3 1284 39.2 39.2 39.2

APRIL 4 1992 60.B 60.8 100.0

TOTAL 3276 100.0 100.0

VALID CASES 3276 MISSING CASES 0

I24-,

y-€

m-

I,

i 24-B

,'o

z - ',. *r . ;.- . _, " " *. " . . . ....-. ... -. ,..,- -.-... .,. . '-. .

I

Table 2

Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTION

VALID CUIVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

SUNDAY 1 168 5.1 5.1 5.lMONDAY 2 483 14.7 14.7 19.8TUESDAY 3 108 3.3 3.3 23.1WEDNESDAY 4 864 26.4 26.4 49.5THURSDAY 5 576 17.6 17.6 67.0FRIUAY 6 912 27.8 27o8 94.9SATURDAY 7 168 5.1 .o1 100.0

ICTAL 3276 100.0 300.0

VALID CASES 3276 MISSING CASES 0

24-C

Table 3

'I" Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

VALID CUIVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

DAY 1 2358 72.C 72.0 72.0EVENING 2 600 18.3 18.3 90.3NIGHT 3 318 9.? 9.7 100.0

TCIAL 3276 100.0 100.0

VALID CASES 3276 PISSING CASES 0

.24-

,%

4"%

Table 4

Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

, VALID CVIVALUE LABEL VALUE FREQUENCY PERCEKT PERCENT PERCENT

MED 1 1392 42.5 42.5 42.5SURG 2 1884 57.5 57.5 100.0

-------------------------------------------TOTAL 3276 100.0 100.0

VALID CASES 3276 PISSING CASES 0

4.

24-E

" O'

4i

. .,-/ . ; .. ,., - , -_ . v , . .,.. . 2-,:,',.--..........

.3

Table 5

Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

CLINICAL SERVICES

VALID CU,

VALUE LABEL VALUE FREQUENCY PERCEKT PERCENT PERCENT

MED SURG 2.00 3276 100.0 100.0 1000

CTTAL 3276 100C 1000

VALID CASES 3276 MISSING CASES 0

44

i 24-F

"," 4."e',( ."% , . "" , r " " -"" a",,' . ,, . - ,-"-. v . - . . --. ,- . --.---. . •. - .. - . . - .

If. ' ' , - €,, ' ; ", ,; ' .>...'_, -' ,'..,. '/.'...:.':.'.:.

-. "P. i m . w h ; .-

Table 8

% Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

ACTIVITIES OBSERVED

SI VALID CUI

VALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

DIRECT CARE -1 702 21.4 21.4 21.4PERSONAL C 382 11.7 11.7 33.1OFF UNIT ACTV 1 273 8.3 8.3 4*14

. COMMUNICATIVE 2 312 5.5 9.5 50.9MEDS SUPPLIES ECLIP 3 115 4.4 4.4 5594CHARTING CLERICAL 4 293 8.9 8.9 64.3CONFERENCES 5 152 40t 4.6 69.0TRAVEL TRANSPCRT 6 34b 10.E- 10.6 79.5ADMINISTRAIICN 7 301 9.2 9.2 88.7ENVIRONMENTAL 8 70 2.1 2.1 90.8WAIT TIME 9 300 9.2 9.2 100.0

TCTAL 3276 100.0 100.0

VALID CASES 3276 MISSING CASES 0

L

24-G

"1

.5 ." "'' "-,-." -. ,,. ", .- "-., " ", ".." - ' ". "- . """. . . ." " ,."

" 'W , p• " , " . " ' % • " , " • " ' " v % , " t

. " - " ,, ' . . ' - - ", . " . " ' " . w "

Table 10

Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

CARE PROVIDER

VALID CUI

VALUE LABEL VALUE FREQUENCY PERCEKI PERCENT PERCENT

HEAD NURSE 1 192 5.9 5.9 5.9

34 WARDHASTER 2 192 5.9 5.9 11.7

Rh 3 570 17.4 17,4 29.1

91( 4 336 10.3 10.3 39.,

LPN 5 156 o8 4.6 44.1

91B 91r 91G c 1338 40.8 40.8 8.0

AIDE 7 300 9.2 9.2 94.1

HARD CLERK e 192 5.9 5.9 100.0

ICIAL 3276 100.0 100.0

VALID CAS:$ 3276 M4ISSING CASES 0

.4

* 24-H

-o,

'a -- *--.'. .- ,,':.:. ::;-. . :;:;:;: i.- -~. ...".'.,',; ", . -..-. ' .-, .- ". .-..-. ,.. ". ,

• .* . .. .; .. .

.j N' O 0 W O Q N NO 0

% -. 4 MO 0ag ."!. - - - -. ' - - P,, -- . - - 4. - -' - -q - 4. - - - P 4. - -

++ + zm+ 0% coN .. J4

I 4

N C N r P. M ka A 'ow woo 0, A.4 S4 N.S 4

" ldl m M fy 1 .4 .4 m m I, I ili -h i

C 4 1 120 I 0 I

0,0

14 10 m " 14 NO' 1, IPZ f"" .4m~ 0 ft 04 io o

m

-- Ic W 6N P. a1 S N go P- 0 N 0

I--"1 ce.J5 ,c -4-4 I m I~ I I

u I-ju 4j--- 4 --- *e---J--- 4 4. -44 t

OL W5 m " 4w a m + 4 we

P164

-- Pe4 - " N4-4. m4 4 1 4.

L%, J Ut

"s mm m Nm+ mmmP - m

.0 >- %A ISa I P0 'a S01 0 . . 0 .0 1 :c 0 NI

4A-4 I A~e wep- 1. AOSAIS:I ;; inW

eSM O I I I I

z IL I4 .- 4 - 45 - 4.- * -I. * I I Is

z- N,-) €i W 0' e1 -44 P., 4- 10 fI;. 0 Mq, ,-*oo4"m0 5 cy 1 0 0 1Su Is S0

lixzSwe

1-00 m a S N AM00 QSr W% 0 N S N I aS N0 %1N

t2 -4 s4•44 . W% ,, • N . 0 4. ,*

n I ' m I

,SI1 O

ZA I N4) 6 S) wINO 4 O S S NO1 ,* ' .4I ' 5T 5'1, ~l

ujj M % 4prP.- UA I

! c , II

0- 0

W4 1 0 01 N -N f" 4 4E . IO S * -N

I I6 a 0

I. I ., 9 I I 52

W0 5 5 59

4A-

M W1

44 W S do S S IS

,,I M4 SmMO."- .- " * . _.,_. S-*,.' 09 . . ... .1-' ' - - '" .

~ S OMS CMI 241 OS OMS W S PMS M I

U 5 5 5 .4 6 -45 4.4 .AS

I~~ -.b-.

74'

~j. ~0sA @0% E 0

en34 s CP ao f-*4 0*

u9- 40 f 14 ~ N

4r ..0 N I~

r-10 -I omP f4

Wi 06:

CJJ ON W &.4 M" b-4 "do N

CLco I I U~ % I044

W) a a+~ + +

Mot I Cr-4Se@ N I low

co PaI*s -N

"d " " S "

c C CD- 0 - I oh.SoSIOS 4m

6-4 4. f. - in4 *P 04 -. v I 4p

S e reO I ee;- 0: - S7 9

1 a NO .06 P4

Z& V- N. 4 1

oe a

~~3 00

0I xI %A II

I-~~~- Lai - E,zCk u atII

C.p UA a 5

P44 d4.Ps4.-

U)2 co Ili

L I

ao r40 ey .

1a ,o 01

'4K 29 8

1 )

P" Io 0 1 0 00N

mm I e

4.J o 0 -g c

cx 0

cm b4J

.WO IL0 .

V ) --

0.acee m

*L .q~1

cm I u0

+ +6

0l -K4 N V

~~~~ 0 060 ."

I I 0 k

7. -j

zo a. Q.

2 6 46

e j IA S6-. ~e~ ecm~ w ~ N

-4 A

24-

ON O 1 O 0

oo - :lb

- I I -

0u I k4

LUW SU

P- -

.4 I of 2 A

r. I CI L

Zg IA 10 LAA 140

C) *.'0I Iz

LLJz ir.

LDA.1O 0A 1 IN0OSLC) wc j II~ O~,

=Z@A 1 OS Ato " I I a4

(1) in 4A IMO.4 SMO=~ Ia...")

0I , - z 1.0

*j aLJ LM - .

0- a I rvLA. t

A~~~# to"oS.4..4

Z NnSN6L2 1.4 *j 0

z z

U.4 Io %

4 I

TABLE 16Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

MAJOR NURSING ACTIVITY CATEGORIES BY SERVICE

4',.-.

SERVICECOUNT I

ROW PCT IMED SURC ROWCOL PCT I TOTAL

1 21PERTO1 ---... • . e4

1' 1 I 655 1 655

UNAVAILABLE 1 100,0 1 20.01 20.01

2 I 1919 I 1919INDIRECT CARE 1 10.C 1 58.6

1 58.6 1

3 1 702 1 7C2DIRECT CARE 1 100.0 1 21.4

COLUMN 3276 3276-27 O7AL 100.0 100.0

NUMBER OF MISSING OBSERVATICNS 0 0

"24-M

.

, '.

, I - ' .. . - . . ". " _- ., , , .......".. - . • . . . , . . ,, . . .

Table 17

Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

DAY SHIFT - MAJOR NURSING ACTIVITY CATEGORIES BY SERVICE

SERVICECOUNT I

ROW PCT IMED SURC RONCOL PCT I TOTAL

I 21PERTOT -. . - - - -

1 1 503 1 503UNAVAILABLE I 100.0 I 21.3

I 21.3 I4" .. . ',- - 4

2 1 1346 1 1346INDIRECT CARE 1 100.0 I 57.1

1 57.1 1

3 I 509 1 509DIRECT CARE 1 100.0 1 21o6

1 21.6 1

COLUMN 2358 2358TOTAL IOC,0 100.0

NUMBER OF MISSING OBSERVATIONS 0

24-N

...

- . 'v." '

. , . -i... , , . _ - --., ". .- . * . q '. - .' . 4.. . : . 4. 4 .-. ,. .-. .- ..--. ,' ~ * . .... ,' - . . . ..- ,4 .

Table 18

4-; Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

EVENING SHIFT - MAJOR NURSING ACTIVITY CATEGORIES BY SERVICE

SERVI CE

ROW PCT IMED SURG ROkCOL PCT I TOTAL

1 21• ~ ~ ~ ~~PE R T O T. . . . .. . .•

1 1 109 1 IC9

UNAVAILABLE 1 100.0 I 18.21 18.2 1

2 1 324 I 324INDIRECT CARE 1 106.O I 54.0

I54.0 1

3 I 167 1 167DIRECT CARE I 100.0 I 27.8

I 27.8 I

COLUMN 600 6COTOTAL 100.0 100.0

* 4NUMBER OF MISSING OBSERVATIONS = 0

24-0

,.e

4%*. " " " " ' " " " " - " " " . - "- . ' " " " 4 " " " '' ''

*.&7

Table 19

Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

NIGHT SHIFT - MAJOR NURSING ACTIVITY CATEGORIES BY SERVICE

SERVI CECOUNT I

ROW PCT IMED SURG ROWCOL PCT I TOTAL

1 21,-'2 P ER TOT ........ a -. - .. a

1 I 43 1 43UNAVAILABLE 1 100.0 I 13.5

1 13.5 1

2 1 249 1 249INDIRECT CARE I 100.0 1 7803

I 78.3 I

3 I 26 1 26

DIRECT CARE I 100.0 1 8.2I 8.2 1

", 4-- - " .'4

COLUMN 318 318TOTAL 100.0 1000

NUMBER OF NISSING OBSERVATICNS - 0

~.1

'.Mo. r%

24-P

9,' iI "*"2 %" "*%"" :C ",, '- C- .. ' -"'' " "

Table 20Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

PERCENTAGES OF TIME SPENT IN INDIRECT NURSING

VALUE L.4B-L VALUL FREQUENCY PERCEI T

COHMUNICAlIVE 312 16.3

, NEDS SUPPLIES EGUIP 3 145 7.6

CHARTING CLERICAL 4 2)3 15.3

CUJNFERE NCkS 15? 7.9

TRAVEL TRANSPURT 6 34.5 18.C

ADMNINSTRATION 7 301 15.7

ENVIRONMENTAL 73 3.6

WA1I TI"E 9 300 15.6

TUTAL 1919 100.0

VALID CASLS 1919 I41SING CASES 0

24-Q

I

-* * *- ._ . . .. ,: ,. . ., .,,,

Table 22

Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY CARE PROVIDER

PROvCUUNT I

aOM PCT MAD0 NUk kAMIASI 44 91( LPN 918 91F AlOI E uARO CLi R3iCOL PCT ISE EI 916 4 TOlrTAL

1 11 - 2 31 41 si 61 - 1 1*" " ALI ------ ---------.l-- -*,I--- ----- 4--- - -------------.. 1---... ----- l----- o+

2 1 4 3 16 1 84 1 24 1 13 1 B4 1 30 1 191 312C.IGoUIA I WE 1 13.5 1 5.1 I 26.9 1 7.7 1 4.2 1 2S.9 1 9.6 1 6.1 1 16.3

1 29.8 1 11.9 1 21.3 1 11.5 1 12.5 1 13.0 1 20.1 1 13.5 I

3 1 6 1 7 , 40 1 27 1 6 t 8 1 9 1 1 itsISLOS SUPPLIIS IQ 1 4.1 1 4.b 1 27.6 1 18.6 1 S.5 1 33.1 1 6.2 1 1 7.6

1 4.3 1 5.2 1 10.2 1 13.0 1 7.7 1 1.4 1 6.0 1 1

4 1 30 1 I fl I 2S 1 17 1 79 1 191 311 203CHAMRIM CLEIIiCA 1 10.2 1 1 31.4 1 8.5 1 5.8 I 27.0 1 6.5 1 10.6 1 15.3

1 21.3 1 1 23.4 1 12.0 1 16.3 1 12.2 1 12.8 1 22.0 1.5. ----- 4--- -- ------ *-- ------ I-----S- -- -

5 1 36 1 7 1 38 1 10 1 10 1 53 1 161 1 152CUH1KkffEAS 1 11.8 1 4.6 1 25.0 1 6.6 1 6.6 I 3t.9 1 10.5 1 1 7.9

1 12.8 1 5.2 1 9.6 1 4.8 1 9.6 I 8.2 1 10.7 1 1

0 1 11 1 17 1 32 1 59 1 71 179 1 221 191 366IVaL TANSPORT 1 3.2 1 4.9 1 9.2 1 17.1 1 2.0 I 51.7 1 b.4 I 5.5 1 16.0

I 7.6 1 12.6 1 8.1 1 28.4 I 6.7 1 .'7.7 14o8 1 13.5 1

7 1 26 1 651 8 01 37 1 6 1 13 1 83 641 301ALNIlISIRAI1Oi 1 9.3 1 21.6 1 19.9 1 12.3 1 2.0 1 7.6 1 6.0 1 21.3 1 15.7

1 19.9 1 408.1 I 15.2 1 17.8 1 5.8 I 3.6 1 12.1 1 45.4 1----------------------- .... * 3 ------------ ------ - - ..................

8 1 2 3 2 "1 41 3 1 4 1 45 1 71 1 70ENVIRONMENTAL 1 2.9 1 2.9 1 5.7 1 4.3 I S.7 1 68.6 1 10.0 1 1 3.6

1 1.4 1 1.5 1 1.0 1 1.4 I 3.0 I 1.4 1 4.7 1 3

9 1 4 1 21 1 64 1 23 1 39 1 133 1 28 81 300WAIT TI E i 1.3 1 7.0 1 14. 1 7.7 1 13.0 I 44.3 1 9.3 1 2.7 I IS.

1 2.8 1 15.6 1 11.2 1 11.3 I 37.S 1 20.6 I 18.8 1 5.? I* ----- -- ------ - --- ---- ------- - -4--- ------

COLUMN 141 1is 394 zo8 104 b? 149 141 1919TOAL. 1.3 7.0 20.5 10.8 5.4 33.7 7.8 7.3 100.0

NUMILA OF NISSING OSERVAIICS * 0

4.

ri

%4

5%

24-R

5-.4

.1.o

. ." , -. ,{ + , ,+ , + ,+ , ..

a7

Table 23

Ft Devens

TIME SPENT IN INDIRECT NURSING CARE STUDY

0INDIRECT CARE BY SERVICE

COUNT SERVICE

ROW PCT IMED SLRC RC%

COL PCT I TOTALI 2

ACT ---------2 1 312 1. 312CCMMUNICATIVE 1 100. I 16.3

1 16.3 14.---. 0---

3 1 145 I 145NEDS SUPPLIES E4 I 100.0 1 ?7.61 7.6 1....................................•

, 1 293 1 293CHARTING CLERICA 1 100.0 1 15.3

I 15.3 1

5 1 152 1 152CONFERENCES 1 100.0 1 7.9

1 7.9 I

6 1 346 1 3*6TRAVEL TRANSPCRT I 100.0 1 10.01 18.0 1

7 I 301 •1 3C1AOMINISTRATION 1 100O 1 15.7

1 15.7 1

S81 70 1 70ENVIRONMENTAL 1 100.0 1 3.6

1 3.6 1

9 1 300 1 3C0WAIT TIME I 100.0 1 15.6

1 15.6 1

COLUMN 1919 1919ICTAL 100.0 100.0

NUMeER C;F MISSING OBSERVATICNS * 1357

24-S

.p

.4"-

KENNER ARMY COMMUNITY HOSPITAL

FORT LEE, VIRGINIA

.'

'i

.,

4'4.~

7477-77-- -. 7

Table 1

Ft Lee

TIME SPENT IN INDIRECT NJRSING CARE STUDY

MONTHS OF DATA COLLECTION

VALID CUIVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENI

APRIL 4 6108 100.0 100.0 100.0

TOTAL 6108 100.0 100.0

VALID CASES 6108 MISSING CASES 0

,.2-*l

i 25-B

.,.

-1 ,- . - a .. ,. . . ., - --- - . t t -. -- t , ' * , w ' ' '-, o

- . ' ". . . - - -- -. ";' J - -

Table 2

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

WEEKDAYS OF DATA COLLECTION.

VALID CU4VALUE LABEL VALUE FREQUENCY PERCENbT PERCENT PERCENT

SUNDAY 1 336 5.5 5.5 5.5MONDAY 2 36 .6 .6 6.1TUESDAY 3 1*4b. 23.7 23w7 29.8WEDNESDAY 4 960 15.7 15.7 45.5THURSDAY 5 1086 i7.e 178 63.3FRIDAY 6 1*76 24*2 24o2 87o4SATURDAY " 768 12.6 1206 100.0

TCTAL 6108 0o.0 100.0

VALID CASES 6108 MI!SING CA5ES 0

25-

aA&a..

. . . .. u • o.- -. -L. . _ - .... • ..

Table 3

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

SHIFTS OF DATA COLLECTION

VALID CUlfVALUE LABEL VALUE FREQUENCY PERCENT PERCENt PERCENT

DAY 1 4518 74,C 74,0 74.0EVENING 2 1014 16o6 16.6 90.6NIGHT 3 576 9.4 9.4 100.0

TCTAL 6108 100.0 100.0

VALID CASES 6108 MISSING CASES 0

42,5-

*.6'

"S,"

b 25,D

Table 4

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

ORIGINAL CLINICAL SETTING

Q.'

I VALID CU"

VALUE LABEL VALUE FREQUENCY PERCE1T PERCENT PERCENT

SURI, 2 1902 31.1 31.1 31.1

MED SURG COMBO 3 1014 16o6 16.6 47.7ICU STEP DOWN M S 1e 3192 52.3 52.3 100.0

ICIAL 6108 100.0 100.0

VALID CASES elO8 MISSING CASES 0

.

3p

!.4.

mb25- E

I 776 137 7 - .--. .

S

Table 5

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

CLINICAL SERVICES

i "VALID Clii

VALUE LABEL VALUE FREQUENCY PERCENT1 PERCENT PERCENT

MED SURG 2000 6108 100.0 100.0 100.3

TIJIAL 6108 100.0 100.0

VALID CASES 6108 MISSING CASES 0

14

25-

.

•.5

.*

pi *. . ..... o°_ .....

Table 8

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

11.410 ACTIVITIES OBSERVED

VALID CUqVALUE LABEL VALUE FREQUENCY PERCENT PERCENT PERCENT

D1RECT CARE -1 1070 17.5 17.5 17.5PERSONAL 0 779 12.8 12.8 30.3OFF UNIT ACTV 1 315 5.2 5.2 35.4COMMUNICATIVE 2 47 4 7.8 7.8 43.2HEDS SUPPLIES EQUIP 3 366 6.C 6.0 49.2CHARTING CLERICAL 4 815 13.3 13.3 62.5CONFERENCES 5 310 501 5.1 67.6TRAVEL TRANSPORT 6 746 12.2 12.2 79.8ADMINISTRATIOJN 7 #05 6.6 6.6 86.iENVIRUN14ENTAL 8 202 3.3 3.3 P9.8WAIT TIME 9 626 10.2 10.2 100.0

TETAL 6108 100.0 100.0VALID CASES 6108 PISSING CASES 0

4

'a

aj' 25-G4

.4 , . .. . -*

Table 10

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

CARE PROVIDER

'; VALID CU4* VALUE LABEL VALUE FREQUENCY PERCEkT PERCENT PERCENT

HEAD NURSL 1 288 4.7 4.7 4.7WAROMAS7Ek 2 384 6.3 6.3 11.0RN 3 1680 27.5 27.5 38.591C 4 558 9.1 9.1 47.6LPN 5 816 13.4 13.4 61.0918 91F 91G 6 1533 25.0 25S.0 86.1AIOE 7 4 74 7.8 7.8 93.9WARD CLERK 8 378 6.2 6.2 100.0

5%,. TCTAL 6108 100.0 100.0

VALID CASES 6108 MISSING CASES 0

25-H9:

.j to P ei M 06% .0- co 00 do0 GoN 0-9 IUD j4 00 a '' If% S'n .. # 0s E* I'0- NE go4 ~ %' M In~ 6A I~ -o

--e-- ..- - - ---.-- - - -- .-------

MO 1 S F. NS00 41 0 a. Q I 4 VM OM I Q 0 a~ 4

f" 0 1 .40 0 1 S a w~ 0 00 005 N4%a f% L

11 a a "* ay z

wa. ~ ~ ~ ~ ~ ~ ~ ~ , ;N S I. gs'S'** O0'S

4z S I I 4 e .. a -M+ +

-j IL P. Z I:

ca of IeV) ''so 4e~ .a . .~

eJ aL am a. 0CZ a at ainaaW V. I

*- - - -u --

S a a0 a4 p 00 O %06 0 00 .5 1 a I gy% 'yA P %I as

P-4 500 a4 It- aN Ma. uo l a

V ~ ~ ~ ~ ~ ~ 6 I W% .4 t- .0 -. :- -. m a- tog 7 .* aLA La I I a"10 1 .Ij0 *0

In a %% A 4 od y.4 a y %t o a e a GLAJ~~ P.* -'- C- - W% * ! : -!1 :P

L a. a.. ac W a a% d p

U aa + P" +

M ala 0 w 0 W s: a 1 9 4

LL W N

U4

e 0 1 1 .J 1 4

I5-Me .4 I Q %M %f 0d

A,. q; P: P4 ! r-

. . - - -. . - . -- P O Y o - .-

Table 13

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

MAJOR NURSING ACTIVITY CATEGORIES BY CARE PROVIDER

PROW

COUNT IROW PCI iHEAD NUR WAROIPASI RK 91C LPN 91J 91F AIDE WARD CLE R34COL PCI ISE ER 916 RK IOIAL

I a] 21 31 41 51 61 71 81PFRlOI -------- -------- . .----------------.-------------- ---.-.--------- - .-----

I 56 1 151 I 158 i 135 1 131 1 321 1 ?3 I 69 2 1094UNAVAlLRALE 1 5.1 1 13.8 1 14.4 1 12.3 1 12.0 1 29.3 1 6.7 1 6.3 I 17.9

I 19.4 1 39.3 1 9.4 I 24.2 I 16.1 1 210 1 15.4 1 18.3 1-.......---------.. .. oe-eeeeee .,eee .,,.,,,, ,F,.., -- o,,1- - - - - - --.-,,,*eeeeeeeeee 4 . - -- o

2 I 214 1 219 1 1119 1 302 1 526 1 914 1 202 I 306 1 39%4INDIRECT CARE I 5.4 1 5.6 29.9 1 T. 1 13.3 1 23.2 I 7.2 1 7.8 I 64.6

I 14.3 1 510 1 10.2 1 54.1 I 6405 I 59.7 i 595 1 81.5 1

31 11 141 343 1 121 1 1591 2951 119 3 1 1 070DIRECI CARE I 1. 1 1.3 1 32.1 1 11.3 1 1499 1 27.6 1 11.1 1 *1 i 17.5

1 6.3 i 3.6 1 20.4 1 23.7 1 19.5 1 19.3 1 25.1 1 o3 1• .... o~~~*-----4------0 ---- 4 o ......... 4 Ooofl... .. ,.4 .o... . .e ........- 4eeeeeee

CULUWN 286 384 1650 558 016 1530 49 376 6108IOTAL 401 6o3 27.5 901 1394 25.0 7.s 6.2 100.0

NUMBER [IF HISSING OSSERVAlIONS * 0

.5

25-J

.,i

Table 14

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

SERVICE BY CARE PROVIDER

PRUVCOUNt I

pUW PCI I"EAD MUM MARIJHASI RN 91C LPN 916 91F AIDE MARI) CLEC(It PCI I SF FR 91G1 K 6I II 21 31 I1 51 61 71 81

S V ICE ------- - ----------- ......... -- .......- - ... ...-- - . -------------- .....----------

2 1 288 I 384 1 1690 1 556 1 816 1 1530 I S 7 1 378 1"ID SUNG 1 4.7 I 6.3 1 27.5 1 9.1 1 13o4 1 25o0 1 7.8 I 6.2 1

1 100.0 I 100.0 1 300.0 1 10000 1 100.0 I 100.0 1 10000 1 100.0 1S- - ---- 4-- 4 - - ----- - -e -

4-

4- - - aaa -a4

.. COLUMN 288 381 1690 558 816 1530 414 370TOTAL S.1 6.3 27.5 901 13.4 250 708 602

NU"PER or HISSING OBSERVAII NS * 0

25-K

F. -I -

-A coo (00

at ae p

NAO N mea 4

14 0 0 0 g

: Si

a. ao I in a * z

- i-a

* za SC *@SCim a. atLL 04 ofme

= ui U. 9% 9= z A 40ix Sl '"

-. ~ l tCD) W S

L&J ~ m *O"0o-of Sm " .5o e

ex COW I meo o.n

U, 4c #A -4 1e 10m93 LU 1

*i I

OgNOI 1 0Pf

U..w

ag a

P- at a 4 o

0- w 4j fi

a j 0et mw S2 Ce

ag ve I

mu In

atz4A

25-L

Table 16

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

MAJOR NURSING ACTIVITY CATEGORIES BY SERVICE

SERVICECCUNT I

ROW PCT IMED SURG RC6COL PCI 1 TOTAL

1 21PERTOT .. "--•---.- +

1 I 1094 I 1094UNAVAILABLE 1 100.0 1 17.9

1 17.9 14--0--- 4

2 1 394' 1 3944INDIRECT CARE 1 100.0 1 614ob

1 64.6 1

3 1 10?0 1 1070DIRECT CARE 1 100.0 1 17.5

1 17.5 1-1---.. - , .I.

COLUMN 6108 biCeTOTAL 100.0 oCoO

NUMBER CF MISSING OBSERVATIENS " 0

25-M

a~~~~~~ -. 7 76 - . . .

Table 17

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

DAY SHIFT - MAJOR NURSING ACTIVITY CATEGORIES BY SERVICE

SERVICECO3UNT I

ROW PCl IMED SURG ROWCOL PCT I TOTAL

I 21P ER TOT . . . .- ....... •

1 1 1003 1 1003UNAVAILABLE I 100.0 1 22.2

1 22.2 1

2 1 2853 1 2853INDIRECT CARE I 100.0 1 63.1

I 63.1 1

3 1 662 1 662DIRECT CARE 1 100.0 1 14.7

1 14.7 1

COLUMN 4518 45182'. TOTAL 100.0 100.0

NUMBER OF MISSING OBSERVATICNS " 0

25-N

.~~~ N~,

V..

Table 18

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

EVENING SHIFT - MAJOR NURSING ACTIVITY CATEGORIES BY SERVICE

SERVICECOUNT I

ROW PCT IMED SURG ROWCOL PCT I 7OTAL

I 21PERTOT . • . . •

1 1 69 1 69UNAVAILABLE 1 100.0 1 6.8

I 68 1

2 1 637 1 637INDIRECT CARE I 100.0 1 62,8

1 62.8 1

3 1 308 1 308DIRECT CARE 1 100.0 1 30.4

1 30.4 i4 -, ---- -----

COLUMN 1014 1014TOTAL 100.0 100.0

NUMBER OF MISSING OBSERVATIONS a 0

25-0

- ~ ~ & 9 ~ >~~ . i ~ :- . . .- W - . • .,.. . ,. *-,

-.a ° t ° . . , , . . .. . . . ._ •

Table 19

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

NIGHT SHIFT - MAJOR NURSING ACTIVITY CATEGORIES BY SERVICE

SERVICECOUNT I

ROW PCT IMED SURG RONCOL PCT I TOTAL

1 21P ER TOT ........... .

1 1 22 1 22UNAVAILABLE 1 1000 I 3.8

1 3.8 1

2 1 454 I 454INDIRECT CARE 1 100.0 1 7b.8

1 78.8 1

3 1 100 1 100DIRECT CARE 1 100.0 1 17.4

I 17.4 I4-0oo-,---,

COLUMN 576 576TOTAL 100.0 100.0

NUMBER OF MISSING OBSERVATIONS - 0

25-P

* . . . . . . . , .*-*. .

Table 20Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

PERCENTAGES OF TIME SPENT IN INDIRECT NURSING

VALk* LABEL VALUE FREJUENc.Y PERCENT

COMMUNICATIVE 2 I7% 12.CMEDS SUPPLIES E UIP 3 366 9.3ChARTING CLERICAL 4 815 2C,7ILONFERENCtS 5 31.) 7.9TRAVEL ]RAhNPURI b 7If 18.5AbLDINISIRAT ION 7 405 10.3ENVIRUNMENIAL 8 22 5.1WAlI Tlrik 9 626 15.5

ICTAL 3944 100.0VALIC CASES 39§4 MISSING CASES 0

25-Q

~. . . . ...

Table 22

Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY CARE PROVIDER

PROWCOUNdI 1

mW PCI INEAO mIR ARORAST aN 91C LPN 918 91F AIDE JARD C"I RoiCOL PCI U1 IA 916 K TOIL

1 11 21 31 41 b1 61 71 6ACT ------ -------------.- - 4------------- -------- -------- --------. *.-------------*

21 45 1 261 13 1 29 1 75 1 51 1 2• 1 011 1CIICATIVf 9.5 1 5.5 I 36.6 1 6.1 1 IS.8 1 13.8 1 5.1 1 6.6 1 12.0

1 21.0 1 11.9 1 15.S 1 9.6 1 14.3 1 5.6 1 $.S 1 13.3 1

31 is1 7 1 130 1 34 1 5) •4 1 26 1 21 366PkOS SUPPLIES E0 I 6.1 1 1.9 1 51.9 1 9.3 i 1i.o 1 12.0 1 6.6 1 .5 1 9.3

1 7.0 1 3.2 1 16.1 1 11.3 1 9.5 1 6.6 1 6.5 1 .6 1

61 29 1 1 236 1 %9 1 941 97 1 56 1 204 1 1CHARTING CLRtICA 1 3.6 1 .2 1 34.8 1 6.0 1 11.5 1 11.9 1 6.9 1 25.0 1 20.7

1 13.6 1 .9 1 26.1 1 16.2 1 11.9 1 13.6 1 19.9 1 66.2 1

5 1 27 311 13 21 30 1 311 61 24 1 11 3101WE~hE 8.1 1 10.0 1 32.9 1 9.7 1 10.0 1 20.6 1 7.7 1 .3 1 7.91 12.6 1 16.2 i 6.7 1 9.9 1 5.9 7.0 1 6.s1 .3 1

61 21 1 20 1 136 1 77 1 12)

1 276 1 63 1 281 7Oi1AWVEL IIANSPOST 1 2.0 1 2.7 1 18.2 1 1U.3 1 16.6 1 31.0 1 8.6 1 3.8 1 16.9

1 9.8 1 9.1 1 !1.51 2.S 1 ., 330.2 1 22.3 9.11---------------- ---------- -------- -- -------- -----

7 1 64 1 113 1 106 1 22 1 iJ 1 01 16 1 24 135AMI1NISTRATION 1 1.6 1 27.9 1 26.2 1 S.4 1 .05 1 12.3 1 4.0 1 S.9 1 13.3

1 29.9 1 51.6 £ 9.0 1 7.3 1 1. I 5 1 5.7 1 78 1- -------- 4-- --- ------ ----- ------------- 4

1 1 I 16 1 11 1 365 93 1 2 1 22EMNVlRONINTAL 1 1 1.0 I 8.9 1 5.6 1 17.0 1 63.0 1 20.8 I 1 S.1

1 .09 1 1.5 1 3. i 6.8 10.2 1 14.9 1 1#----4 - ------------- ------------- - * ------- 4------------------

9 1 132 1 i 1601 0 1 1051 239 1 331 1 6266Il 111*I 1 2.1 I 2.9 1 25.6 1 b.s I lo. 1 36.2 1 1.3 i 1.3 I 1.9

1 6.1 1 6.2 1 13.6 1 16.6 I 20.0 1 2.1 1 11.7 1 2.6 1,4---...--- --4.o@.- 4----.4 ...---. '----*4--- ,.4-o...(,---oO

CULUN 216 219 1179 3C2 526 316 262 308 39%6TOTL* S.4 5.6 29.9 7.7 13.3 23.2 7.2 7.8 too.*

NUNE OP NISSIN5 OSSIRAtv&IIUNS 0

25-R

-..... . .. .. ... . .. .. . ,, _ .. , ...-..-. '., -. .,., 0. ,. .. . .. -. ,, .-.*. .,"

, -i., , . r . . . - . .-.. '- . . .... . . . . . . . . .

Table 23

d Ft Lee

TIME SPENT IN INDIRECT NURSING CARE STUDY

INDIRECT CARE BY SERVICE

Cutf0oI IWON PC7 ME#C upf. 1101LOL PCT I Ul IAL

AcT ------- *---------------------------------------2 I 414 I *4

C C1iW% I I I VE 100.0 i 1.01 12.0 1

3 1 J 1 i 366MiLUS SUWLIES EQi 1 100.0 I 9.3

1 9.3 14*--- 4

, i 815 i 415L14A1KUM44 CLENICA 1 100.0 I 20O

1 20.7 1

5 1 310 I 310CLuiMfkmhdIS I 100.C 1 7.9I 7.91I

6 1 1.9 1 q

TR(AVEL iAlNSIPCI 1 100.0 1 16.9i 10.9 1

7 1 405 1 405AdNINISTRAION 1 100.0 1 10.3

1 10.3 1

8 1 202 i 202NVI ft OMMNAL i 100.0 1 5.1

S 5.1 I

WAIlT TIM 1 100.0 1 15.91 15.9 1

CLUi4M 394; 3944TOTAL 100.0 100.0

UMNbER bF MISSIIOG UBSkVAIILgNS *

25-S

10. DISTRIBUTION.

National Technical Information Center (2)

HQDA (DASG-HCD-S) (1)

Dir, Joint Medical Library, Offices of The Surgeons General, USA/USAF,The Pentagon, RM 1B-473, Washington, DC 20310 (1)

AHS, Stimson Library (1)

HQDA (DASG-CN) (2)

C, Dept of Nursing of all US Army MEDDAC/MEDCENs (I ea)

HQ HSC (HSPA-N) (1)

HSHA-INU (1)

HSIG (Nursing) (2)

HSOP-FS (2)

Commander, HQ 7TH MEDCOM, APO NY 09403 (1)

Commander, HQ 8TH MEDCOM, APO SF 96301 (1)

45

V * .>. *vr.**,1~* *