A physician’s lament is nursing’s, too.
By Maureen Shawn Kennedy, AJN editor-in-chief
Last week, the New York Times Well blog published “The Importance of Sitting With Patients” by Dhruv Khullar, a Harvard medical resident. Khullar expressed regret over not spending more time with a patient who was near death, and then discussed how little time residents actually spend with patients—eight minutes, according to a Journal of General Internal Medicine study (2013) that analyzed the time of 29 interns over a month. (The study found that only 12% of the residents’ time was spent on direct patient care; 40% of their time was spent on computers.)
Khullar detailed the various activities that take him away from direct patient contact and noted as well that the shorter working hours mandated for residents had the unintended consequence of reducing time with patients. He wondered:
By squeezing the same clinical and administrative work into fewer hours, do we inadvertently encourage completion of activities essential in the operational sense at the expense of activities essential in the human sense?
The second part of the question seemed especially pertinent for nurses. Hospital nurses have long lamented that paperwork, insufficient staffing, and nonnursing tasks keep them from the bedside. The promise of computers to reduce documentation time has yet to be realized, as first-generation documentation systems are not necessarily designed from a nursing perspective and often lack the specificity and flexibility to truly capture nursing activities.
The same might be said for some medication delivery systems. And we know from Beatrice Kalisch’s research on missed nursing care that it’s not just a matter of missed opportunities for empathy—the lack of adequate time for direct care also has negative consequences for patient outcomes.
Khullar talks about the trade-off of empathy for efficiency:
We hide behind buzzwords like ‘patient-centeredness’ and ‘shared decision-making’ without being able to offer the time that gives these terms true weight. Ultimately, reconciling this tension may mean reconceptualizing ‘efficiency’ to include the tremendous value that exists in having more time to spend with our patients.
This, too, is the challenge for nursing. As hospitals tout patient-focused care, are they investing in resources to make it more than a marketing slogan? What is your hospital doing to make it easier for you to provide nursing care?