Accepted: 18 April 2017

DOI: 10.1111/jonm.12502

ORIGINAL ARTICLE

Time motion analysis of nursing work in ICU, telemetry and

medical-­surgical units

Elizabeth Schenk PHD, MHI, RN-BC, Research Assistant Professor 1 | Ruth Schleyer MSN,
RN-BC, Clinical Director 2 | Cami R. Jones PhD, Research Assistant 1 | Sarah Fincham DNP,
ARNP, NP-C, Clinical Assistant Professor 1 | Kenn B. Daratha PhD, Associate Professor 1 |
Karen A. Monsen PhD, RN, FAAN, Associate Professor and Co-Director 3

1
College of Nursing, Washington State
University, Spokane, Washington, USA
2
Informatics, Academics &
Education, Providence Health & Services,
Renton, Washington, USA
3 Background: The differences in nurses’ acute-­care work across unit types are not well
Center for Nursing Informatics, School
of Nursing, University of Minnesota,
Minneapolis, Minnesota, USA
Correspondence
Elizabeth Schenk, Providence St. Patrick
Hospital, Missoula, MT, USA.
Email: elizabeth.schenk@wsu.edu
Aim: This study examined nurses’ work, comparing nursing interventions and locations
across three units in a United States hospital using Omaha System standardized termi-
nology as the organizing framework.
understood. Prior investigators have used time–motion methodologies; few have
compared differences across units, nor used standardized terminology.
Methods: Nurse-­observers recorded locations and interventions of nurses on three
acute-­care units using hand-­held devices and web-­based TimeCaT™ software. Nursing
interventions were mapped to Omaha System terms. Unit-­differences were analysed.
Results: Nurses changed locations approximately every 2 min, and averaged approxi-
mately one intervention/minute. Unit differences were found in both the interven-
tions performed and the locations. Most interventions were case-­management related,
demonstrating the nurses’ patient management/coordination role.
Conclusions: Unit differences in nursing interventions and location were found among
three unit types. Omaha System terminology, as well as the observational method
used, were found to be feasible and practical.
Implications for Nursing Management: Nursing work varies by unit, yet managers
have not been armed with empirical data with which to make more informed decisions
about nurses’ work priorities, clinical outcomes, patient satisfaction, staff satisfaction
and cost. The results from this study will help them to do so.

KEYWORDS
hospital nursing staff, intensive care unit, medical-surgical, telemetry, time and motion studies,
omaha system

1 | INTRODUCTION
Nursing, the largest professional workforce in health care, is central
to the management and delivery of care for patients and families
(Shalala et al., 2011). A better understanding of acute-­care nursing
work, including the care interventions they perform and where, could
contribute valuable knowledge in helping nurse managers to meet the
suggested goals of health care, including those of the quadruple aim:
enhancing patient experience, improving outcomes, reducing costs
and improving the work life of staff (Bodenheimer & Sinsky, 2014).
Numerous observations of nursing work have been reported,
though the use of varied methods makes it difficult to compare the
results across studies. Lopetegui et al. (2014) examined the breadth
of study approaches in health care measuring work. These varied,

640 | © 2017 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/jonm J Nurs Manag. 2017;25:640–646.

SCHENK et al.
including time and motion, self-­report from interviews, self-­report using
logged time and others. The authors noted confusion in the literature
regarding time–motion study, and suggested that ‘continuous obser-
vation time–motion studies’ is the preferred approach in health care.
They noted the challenge of comparing studies when different meth-
ods for data collection and analysis are used. This was found specifi-
cally in nursing studies as well. Some researchers measured work using
lists of nursing activities generated by investigators and staff (Ampt &
Westbrook, 2007; Cornell et al., 2010; Keohane et al., 2008). Others
used general categories such as direct-­care, indirect-­care or admin-
istrative activities (Douglas et al., 2013). Some used observers who
followed working nurses and recorded activities (Ampt & Westbrook,
2007; Douglas et al., 2013). Others used ­
self-­
reporting methods
(Hendrich, Chow, Skierczynski, & Lu, 2008) or surveyed nurses about
their work (Conrad, Hanson, Hasenau, & Stocker-­Schneider, 2012). A
review did not find any studies in nursing that fitted Lopetegui’s stan-
dard for ‘continuous observation time-­motion studies’.
Variation in the methodologies used for measuring nursing work
make it difficult to compare the results coherently. A wide range of
results is reported, but it is not clear whether the differences have
more to do with what was observed, or with how the data were col-
lected. For example, the nurses observed on four units in a teaching
hospital were found to spend the largest percentage of their time
(22.5%) on professional communication (Ampt & Westbrook, 2007).
The ICU nurses’ time has been observed at greater than 75% on
patient care (50% on direct care) averaging 125 activities/hr (Douglas
et al., 2013). In another study, ICU nurses spent 40.5% of their time
performing direct-­
care activities (32.4% in indirect-­
care) (Abbey,
Chaboyer, & Mitchell, 2012). Administrative tasks comprised 31% of
their time (Ravat et al., 2014), and elsewhere 17.2% on medication
administration and 35.3% on documentation (Hendrich et al., 2008).
Several studies were conducted on multiple unit types (Douglas et al.,
2013; Hendrich et al., 2008; Westbrook, Li, Georgiou, Paoloni, &
Cullen, 2013), but did not examine unit specific differences in nursing
work or nurse–patient staffing ratios.
There is support for using standardized nursing terminology to cat-
egorize, describe and measure nursing work (Schwirian, 2013; Tastan
et al., 2014). Although most studies analysing nursing work have not
used standardized nursing terminology, several time–motion studies
have emerged, allowing for the systematic measurement of nurses’
work (Zhang et al., 2011). Investigators have piloted an approach
capturing nursing cost based on standardized terminology (Dykes,
Wantland, Whittenburg, Lipsitz, & Saba, 2013). Others have adapted
(Zhang et al., 2011) and refined (Fratzke, Melton, & Monsen, 2013) a
data collection tool using the Omaha System (Martin, 2005) for record-
ing observations of acute-­care nurses. Zhang et al. (2011) asserted
the critical importance of using the Omaha System for nursing time–
motion study because of its professional value in describing nursing
work simply, comprehensively and holistically. The Omaha System is
a multidisciplinary standardized interface terminology that exists in
the public domain. Developed by researchers at the Visiting Nurses
Association in Omaha, Nebraska, it is used widely in community care
and other settings for Electronic Health Record (EHR) documentation
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| 641
(Martin, 2005; Omaha System Guidelines, 2016). Organized around
a structured problem list, it describes evidence-­based interventions,
generating useful data for evaluating patient acuity and nurse staffing
patterns (Bowles, 2000; Brooten et al., 2007; Garcia, McNaughton,
Radosevich, Brandt, & Monsen, 2013; Jurkovich, Ophaug, Salberg,
& Monsen, 2014; Monsen et al., 2011; Omaha System Guidelines,
2016; Pruinelli, Fu, Monsen, & Westra, 2014; Thompson, Monsen,
Wanamaker, Augustyniak, & Thompson, 2012).
The Omaha System was used as a framework to organize nurs-
ing interventions, and develop an observational approach using web-­
based time-­motion capture software developed by Lopetegui (2011)
(TimeCaT™). This handheld tablet-­based method yields valuable infor-
mation, and reveals significant differences in nurses’ work across units.
2 | AIMS
The study aims were to determine (1) the time that nurses spent in
different interventions and locations across three units; and (2) the
distribution of interventions in Omaha System problems, categories
and targets, allowing standardized description, analysis and compari-
son of nursing interventions.
3 | METHODS
The 446-­bed urban, non-­profit, regional hospital was selected from a
small convenience sample of hospitals in a large health care system in
the western United States prior to implementation of a comprehen-
sive EHR. Three study-­units, Medical-­Surgical (Med-­Surg), Telemetry
(Tele) and Intensive Care Unit (ICU) were identified as representative
of unit types across the health care system. Medical-­Surgical units
treat patients of mixed acuity and condition. Telemetry units treat
higher-­acuity patients needing cardiac and/or respiratory monitor-
ing. ICUs treat patients needing the highest level of care, including
mechanical ventilation, complex monitoring and extensive medical
therapy. The study site adheres to state law mandated staffing ratios.
The 32-­bed Med-­Surg unit used staffing of one nurse to five patients;
the 34-­bed Tele unit used one to four; the 38-­bed ICU used staffing of
one nurse to one or two patients. The Institutional Review Board used
by this hospital approved this study.
The authors developed the Omaha System data collection approach
in a previous phase of this study (Monsen, et al., 2015). Hospital nurs-
ing leadership identified nurses from the three study-­unit types who
were interviewed in focus groups and queried by survey, using a com-
prehensive appendix of defined Omaha System terms, to determine
the essential aspects of their daily work. The nurse-­selected terms
were combined with Omaha System intervention terms included in
earlier reported study instruments (Bowles, 2000; Zhang et al., 2011)
and refined through subsequent discussions among participants until
consensus was achieved. The complete and validated list of interven-
tions was entered in the TimeCaT™ software. The resulting validated
list of common, important nursing interventions linked to Omaha

642 | SCHENK et al.
System terms is presented in an easy-­to-­use hand-­held web-­based
™ ™
application, TimeCaT . The TimeCaT interface consists of three data
entry fields for task, communication and location with timers that run
simultaneously, enabling observation of co-­occurrences across these
three fields. The final interface included 38 common nursing interven-
™
tions listed in Table S1, and an image of the TimeCaT interface can be
seen in Figure S1.
The Omaha System is a standardized nursing terminology and
ontology designed for use across the continuum of care by nurses and
all disciplines (Martin, 2005). It consists of three instruments: Problem
Classification Scheme, Intervention Scheme and Problem Rating Scale
for Outcomes. The problem classification scheme consists of problem
concepts in four domains (environmental, psychosocial, physiological
and health-­related behaviours). The intervention scheme consists of
four levels, problem, category, target and care description. The first
level (problem) consists of the concepts in the problem classifica-
tion scheme. The second level (category) consists of four categories:
(1) teaching, guidance and counselling (TGC; shorthand icon, %); (2)
treatments and procedures (TP; shorthand icon, *), (3) case manage-
ment (CM; shorthand icon,::) and (4) surveillance (S; shorthand icon,
✓). The third level (target) consists of 75 targets, which provide addi-
tional information about the focus of the intervention. The fourth level
(care description) is not taxonomic, enabling granular description of
the intervention. The problem rating scale for outcomes is an ordinal
measure of three problem-­specific dimensions: knowledge, behaviour
and status from 1 (lowest) to 5 (highest) (Martin, 2005). The Omaha
System terms and outcome measures may be used on paper or embed-
ded within software as described by Martin (2005), with emphasis on
adhering to the defined terms and taxonomic structure to ensure
rigour and interoperability.
In the Omaha System, interventions are related to a single problem
concept such as the skin problem. At the first level, a category term
specifies the action of the intervention; for example, a nurse might
perform ‘treatments and procedures’ for a wound. At the second level,
a target further specifies the nature of the intervention; for example,
‘dressing change/wound care’. At the third level, a suggested care
description term is fully customizable; therefore, the facility protocol
or other evidence-­based wound care guideline may be referenced as
needed. Thus, the intervention in this example consists of four data
points (problem-­
category-­
target-­
care description): skin, treatments
and procedures, dressing change/wound care, guideline name. The
linguistic syntax of these four data points may be expressed in sen-
tence form as follows: ‘I (the nurse) addressed the Skin Problem by
performing Treatments and procedures-­dressing change/wound care,
and I used the facility guideline’ (Monsen et al., 2011). In the TimeCaT™
interface, these four data points were abbreviated for single-­click doc-
umentation of the four linked data points as ‘*wound’ with the defini-
tion ‘nurse provides wound care’.
Observers: Nurse-­observers recorded locations and interventions
of the nurses on three different acute-­care units using hand-­held
devices and web-­based TimeCaT™ software. Seven registered nurse
(RN) observers were a convenience sample of expert nurses familiar
with the units in which the observations were conducted. They were
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identified by hospital nursing leadership and were trained as observers.
Training included watching a set of short practice videos, recording all
observed nursing locations and interventions using TimeCaT™. Cohen’s
kappa was calculated for all paired combinations of observers who
watched the videos (Hallgren, 2012). An average of Cohen’s kappa was
calculated from each observer pair, resulting in a single measurement
per video of inter-­observer agreement. The highest kappa calculated
was 0.68, indicating substantial agreement among observers. Slight to
substantial agreement among observers was found for the remaining
training videos scored (cut-­off values from 0.0 to 0.8).
Observers followed randomly selected RNs during varied hours
depending on observer availability. The average age of observed
nurses was 51.7 years (54.5 in ICU; 50.6 in Med-­Surg and Tele). The
average years of experience were 24.3 (30.5 in ICU; 21.8 in Med-­Surg
and Tele). The total observed time was 89.8 hr with at least 29 hr per
unit (Med-­Surg 29.0; Tele 29.6; ICU 30.9). Twenty RNs were observed
in ICU; 15 on Med-­Surg; and 19 on Telemetry. All observations were
captured using the TimeCaT™ application between 5 a.m. and 5 p.m.
on the three study units over a 3-­week period in 2014. We aimed to
observe at least 30 hr per unit based on precedent set by previous
studies (Fratzke et al., 2013; Zhang et al., 2011).
Unit differences for the percentage of time/location and time per
Omaha System category were analysed by testing for proportional dif-
ferences between two units for all possible combinations. Proportion
testing results are presented by χ2 and associated p values. Significance
was considered at α ≤ .05. All data were analysed using R version 3.2.2
(R Core Team, 2015).
4 | RESULTS
Differences between nursing units were observed for the locations
of nurses (Figure 1). Most nurses’ time (91.8%) was spent in four
locations: hallway, patient room, team area and medication room.
Approximately 34% of nurses’ time was spent in patients’ rooms
across all units. ICU nurses spent significantly more time proportion-
ally in patients’ rooms than either Telemetry (χ2 = 58.57, p < .001) or
Med-­Surg (χ2 = 69.29, p < .001). Nurses spent an average of 47% of
their time in team areas, with Telemetry nurses spending more time
in the team area than ICU nurses (χ2 = 11.25, p < .001). Nurses in
Med-­Surg spent significantly more time transitioning through the hall-
way than both Telemetry (χ2 = 20.01, p < .001) and ICU (χ2 = 23.64,
p < .001). While nurses were observed in the medication room 6.1%
of the time, ICU nurses spent significantly less time in the medication
room compared with both Telemetry (χ2 = 70.10, p < .001) and Med-­
Surg (χ2 = 50.00, p < .001).
Like location differences by unit, we found unit differences in the
percentage of time nurses spent performing interventions (Figure 2).
Across all units, nurses spent an average of 60% of their time on inter-
ventions related to case management. However, ICU nurses spent sig-
nificantly less time proportionally on case management interventions
compared with Telemetry nurses (χ2 = 11.86, p = .001) and Med-­Surg
nurses (χ2 = 15.59, p < .001). One of the most commonly occurring
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SCHENK et al. | 643

F I G U R E 1 Percent of total time nurses

spent in four most common locations.
Horizontal bars represent the average
percentage of time spent in that location
across all units (Team Area, 47.5%; Patient
Room, 34.9%; Hallway, 11.6%; Med Room,
6.1%). Bars with different letters above are
significantly different from each other

F I G U R E 2 Percent of total time nurses

spent on Omaha System categories by
unit. The majority of nursing time is spend
on case management (CM), regardless of
unit. Horizontal bars represent the average
percent time for all units (CM, 59.8%; TCG,
14.0%; S, 13.7%; TP, 12.5%). Bars with
different letters above are significantly
different from each other. TGC, teaching,
guidance & counselling; S, surveillance; TP,
treatments & procedures

interventions for ICU nurses was teaching others (Table S1). ICU nurses
spent more time proportionally on interventions associated with
Teaching, Guidance, and Counselling interventions compared with
2 2
nurses in both Telemetry (χ = 7.49, p = .006), and Med-­Surg (χ = 4.59,
p = .03). While nurses were observed performing treatment and pro-
cedure interventions 12.5% of the time, ICU nurses spent significantly
more time performing such interventions compared with nurses in both
2 2
Telemetry (χ = 5.85, p = .02) and Med-­Surg (χ = 11.72, p < .001).
Unit differences were observed for both the number of loca-
tion changes and the number of interventions performed per hour
(Figure 3). The greatest number of location changes per hour were
described in the ICU (36.45/hr compared with 29.62 and 24.75 in the
Med-­Surg and Telemetry units, respectively). Additionally, unit differ-
ences were observed for the number of interventions performed per
hour. The average number of interventions across all three nursing
units was 64.75 interventions/hr, with the greatest number observed
in the ICU (83.16 interventions/hr compared with 57.26 and 53.83 in
the Med-­Surg and Telemetry units, respectively).
Three subsets of nursing interventions were compared (Table 1).
The greatest proportion of nursing time was spent on interventions
related to documentation among nurses on the Med-­Surg unit (41.1%)
compared with both nurses on the Telemetry (29.7%) and ICU units
(20.7). Documentation-­
related interventions included notes, chart
review, laboratory results, medication administration record (MAR)
and guideline review. In the telemetry unit, the greatest proportion of
nursing time was spent on interventions related to medication admin-
istration (14.2%) compared with nurses on both the Med-­Surg (11.1%)
and ICU (6.7%) units. Medication administration-­related interventions
included preparing medications, and administering medications and
i.v.s. On the Med-­Surg unit, the greatest proportion of time was spent
on interventions related to patient–family teaching and counselling
(13.0%) compared with both nurses on the Telemetry (10.3%) and
ICU (6.9%) units. Patient–family teaching and counselling interven-
tions included teaching about conditions, laboratories, medications,
plan of care, procedures and nurses giving support to patients and
families. All between-­unit comparisons for each of the three subsets
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644 | SCHENK et al.

F I G U R E 3 Average total number of

nursing locations and interventions per
hour. Horizontal lines with numbers below
(italics) represent the average across all
units for locations and interventions

TABLE 1 Percent of total time and between unit comparisons in three specific nursing intervention focus areas

Percent time Between unit comparisons

Intervention focus Avg. across

areas Tele Med-­Surg ICU units Tele:Med-­Surg Tele:ICU Med-­Surg:ICU

Documentation 29.7 41.1 20.7 30.5 χ2 = 2579.1 χ2 = 1910.9 χ2 = 8714.9

p < .001 p < .001 p < .001
Medication 14.2 11.1 6.7 10.7 χ2 = 380.0 χ2 = 2718.8 χ2 = 1075.3
administration p < .001 p < .001 p < .001
Patient-­family teaching 10.3 13.0 6.9 10.0 χ2 = 318.9 χ2 = 631.7 χ2 = 1808.9
& counselling p < .001 p < .001 p < .001

of interventions presented in Table 1 were found to be significantly
different. All nursing interventions were ranked by category and by
percentage of time, demonstrating that documentation was the most
time intensive intervention across the units (Table S1).
5 | DISCUSSION
Building on previous work defining nursing interventions using rec-
ognized nursing terminology (Fratzke et al., 2013; Zhang et al., 2011),
this is the first study to compare acute-­care unit differences using the
Omaha System. Unit differences in both location and Omaha System
defined interventions were observed. Location and nurse interven-
tions should not be viewed as homogenous in acute-­care settings.
Examining unit differences, the ICU nurses spent less time teach-
ing patients/families than nurses on the other units. Telemetry nurses
spent more time in medication-­administration than either Med-­Surg
or ICU nurses. Medical-­Surgical nurses spent more time in documen-
tation and in patient/family teaching. These findings suggest the need
for further research and opportunities to adjust care processes based
on specific unit demands.
Consistent with previous studies (Fratzke et al., 2013; Zhang et al.,
2011), our findings illuminated the alarming busyness, and cognitively
and physically demanding complexity of nursing work. The ICU nurses
performed 83.2 interventions/hr, compared to 125 found earlier using
a different metric (Douglas et al., 2013). Documentation took 30.5%
of the total time, compared with an earlier finding of 35.3%, and med-
ication administration-­related interventions comprised 10.7% of the
total time, compared with 17.2% (Hendrich et al., 2008). Although
differences in the tools and definitions used makes it difficult to inter-
pret these variations, we have confidence in comparing our findings
with similar studies based on the Omaha System (Fratzke et al., 2013;
Zhang et al., 2011). For example, Fratzke et al. (2013) reported that
51.8% of nurses’ time was spent in case management in a Med-­Surg
unit compared with 62.4% in Med-­Surg in our study. In addition,
Fratzke et al. (2013) found interventions in a Med-­Surg unit averaged
1.1 min/intervention, aligning with 1.0 min/intervention in our Med-­
Surg unit. The consistency between these findings increases the con-
fidence in the validity of our observations.
This study was performed in a state with mandatory staffing ratios,
enabling a calculation of the number of interventions/patient/unit. In
ICU, staffing was one or two patients/nurse (averaging 1.5), equating
to each patient receiving an average of 55.5 interventions/hr; while
Tele patients (ratio of four patients/nurse) received an average of
13.5 interventions/hr and Med-­Surg patients (ratio of five patients/
nurse) an average of 11.5 interventions/hr.

SCHENK et al.
The number of interventions per hour was significantly higher
in ICU. We intuitively expect ICU patients to receive more care due
to patient acuity and the higher (1:2) nurse–patient staffing ratios
­compared with Med-­Surg and Tele Units. However, we also expect
differences in unit staffing ratios would help to equalize the nurs-
ing workload. Instead, we found ICU nurses performed more inter-
ventions per hour, even while caring for fewer patients. Related to
this, patients may experience the nursing presence quite differently.
Patients on Tele and Med-­Surg units received about one-­fifth to one-­
quarter of the nursing interventions than ICU patients. This phenom-
enon is further amplified when intervention categories are examined.
Most nurses’ time is spent performing case management interven-
tions, including essential nursing work of coordination, planning and
communication. Yet many of these interventions occur outside the
patient room, not experienced as direct-­care interventions from the
patient perspective, and thus may be invisible to patients. Given the
importance of patient experience in the quadruple aim, attention must
be given to maximizing patient perceptions of nursing care, including
those not experienced directly.
The study suggests several implications. Empirical data such as
these can contribute to the analysis of acuity systems, cost calcula-
tions, decisions about resource allocation and impacts on satisfaction,
all of which address quadruple aim concerns (Bodenheimer & Sinsky,
2014; Shalala et al., 2011). Further, the time–motion observational
method employed in this study may be useful in analysing patient-­
safety risks related to nurse busyness and multitasking; measuring the
alignment of patient need with nursing care delivered; understand-
ing the challenges of nursing workload on an ageing workforce; and
determining the impacts that these factors have on cost and quality
outcomes.
Unexpectedly, the average age of observed nurses was nearly
52 years (older nurses were not specifically recruited). This raises
questions about the long-­term sustainability of the work force, given
the constant motion and rapid pace of interventions. Further research
is needed to examine the effects of this activity level on patient and
nurse safety, particularly among older nurses.
Classifying nursing interventions according to the Omaha System
contributes a standardized metric for analysing nursing work with
an opportunity to collect and compare data across sites and studies.
Although the Omaha System has been used in other settings for over
40 years, this is the first application of its use comparing nursing inter-
ventions across different acute-­care units. The consistency of these
findings with previous Omaha System time-­motion studies (Fratzke
et al., 2013; Zhang et al., 2011) further demonstrates the applicability
of the Omaha System in acute care.
6 | LIMITATIONS AND FURTHER STUDY
Several limitations were identified. The observers were utilized based
on their availability, rather than through a more structured recruit-
ment process, which may achieve a more representative sample. The
­observational study itself is limited; 90 hrs of observation (30 per unit)
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| 645
seems substantial, but is still small for making comparisons between
units and different observers. Observation for an entire shift may con-
tribute to a greater understanding of the distribution of nursing inter-
ventions and locations throughout the nursing shift. Observer training
data were analysed to document inter-­rater reliability. However, with
such a complex endeavour, the possibility of observer bias exists.
The study results suggest opportunities for further research.
Observations were across daytime hours; additional research is
needed for observations of other work times. This study addresses
limitations of other time–motion approaches by advancing the quality
of time–motion tools available for acute care, and anchoring interven-
tions in a standardized terminology for nursing. However, the team
approach to care should also be evaluated. The Omaha System as a
multidisciplinary terminology may be suitable for team-­based care
studies. Further research is needed to examine the use of the Omaha
System and TimeCaT™ for other disciplines.
7 | CONCLUSIONS
This is the first time–motion study to use the Omaha System to com-
pare nursing interventions and locations across three unit types in an
acute-­care facility. There were differences in specific interventions,
and where nurses spent their time. The ICU nurses performed more
interventions with more location changes compared with Med-­Surg or
Tele nurses; although registered nurses spent most of their time per-
forming case management interventions in all three unit types. This
demonstrates an appropriate use of the professional nurses’ skills, in
the coordination, management and communication of care. The busy-
ness of the nurses was alarming, with an average of 65 interventions/
hr being performed per nurse.
The data-­collection method was practical, feasible and effective,
allowing the capture of complex data in a busy workplace, with minimal
training of the nurse observers. The results showed that the Omaha
System translates well to acute care. The TimeCaT™ tool was effective
for observing complex nurse behaviour. The findings advance the field
of time–motion study in nursing.
8 | IMPLICATIONS FOR
NURSING MANAGEMENT
The results of this study will be of particular utility to nurse managers
as they staff, plan and assign care. With a better understanding of
the differences in nurses’ work across unit types, managers can better
accomplish these goals. Nurse managers around the world are con-
cerned with balancing nurses’ workload, efficiency and safety. This
study demonstrates that nursing work in acute care settings is not
homogenous; individual unit measures are needed.
Armed with these data, nurse managers may be better able to plan
care in their units, and with future studies, to consider impacts on
nurses’ job satisfaction, appropriate staffing ratios, cost and impacts
of workload on patient outcomes, including satisfaction, quality and

646 | SCHENK et al.
safety. By using a standardized nursing terminology, this study pro-
vides data that can be easily compared with other investigators using
similar methods. By building the body of knowledge of nursing work
in comparable studies, nurse managers will benefit as they add to the
arsenal of knowledge with which they can accomplish complex man-
agement goals.
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S U P P O RT I NG I NFO R M AT I O N
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How to cite this article: Schenk E, Schleyer R, Jones CR,
Fincham S, Daratha KB, Monsen KA. Time motion analysis of
nursing work in ICU, telemetry and medical-­surgical units. J Nurs
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