If you think you're the only Nursing Management journal aficionado who learns from our articles, you're mistaken. I've had my own a-ha moments as a result of our authors. One of those moments was in May when we published part 1 of the American Association of Critical-Care Nurses' Clinical Scene Investigator (CSI) Academy series. Redefining "nonproductive" time was ardently discussed, and I whole-heartedly agree. The concept of considering time spent in forums to innovate and improve practice is clearly "productive." It's time we call this out.
In the same issue as the CSI article was another related feature-the importance of developing emerging bedside leaders. This is our future and how we engage our staff and maximize improvements. Isn't time spent cultivating bedside leaders productive?
Simply put, our finance colleagues traditionally define nonproductive time for RNs as any time not spent in direct patient care. Of course, vacation, holidays, and sick time are included; there's no argument. However, anyone who has spent time near the bedside or read any of the nursing productivity studies from the past few years knows that "direct patient care" is a bit of a misnomer. The noblest activities of direct care are found in face-to-face time with patients and families, which is, unfortunately, not a majority of the RNs' time. More time is spent chasing supplies and medications, tracking down members of the team, and documenting. So, we already have a chink in the armor of direct care hours.
This brings us to the almighty nursing care hours per patient day, which is being computed, compared, tracked, and trended religiously by many of you to quantify and measure direct patient care hours. Should direct care be synonymous with productive time, especially as we're defining it here? If the time spent "on the clock" is contributing to improved outcomes and/or professional and leadership development-whether it's meeting time, research time, or educational time-then it's valuable, beneficial, and productive, but not direct care in the truest sense.
We all know that squeezing in a 1-hour monthly meeting during work time when staff members have a busy patient assignment doesn't lend itself to clear thinking, brainstorming, analysis, or innovation. There are ways to budget this time without incurring the dreaded overtime hours, such as building up the float or per diem teams, planning meetings midweek when staffing tends to be better and may not require backfill, adding a smidgeon into the factor you use to calculate how many full-time equivalents are needed in the budget, saving elsewhere and using the monies to pay for it, getting a grant to cover the program, or tailoring meeting and educational time to what works best for the team. Leaders with a mission find a way.
I can't argue the case better than the CSI authors did in May. More important, we must change our paradigm, start believing, and fiercely advocate for budgeted time for our staff to participate in these activities. It isn't a significant amount of time or money when compared with the whole, and it's productive time, no question. Our mission is to serve patients and staff. Supporting staff time for engagement, improvements, and development is hugely beneficial to both-a win-win.
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