Ms. Laskowski-Jones,
I applaud your editorial in the March issue of Nursing2023 titled "Why call it nonproductive time." In the 44 years of my tenure as a nurse, I have had a fundamental issue with this self-serving business administration misnomer. The smoke-and-mirrors budgetary process of healthcare entities traditionally carves expenditures into multiple "pockets"-as hospital administrators describe it. In my opinion, this particular division of expenditure related to nursing remuneration has but one purpose: To establish and validate the premise that healthcare employers are paying nurses for not working or not generating revenue. You are correct in stating nonproductive time budgeting has a high degree of disconnection from the overall needs of a patient-care unit function.
During a literature search regarding direct and indirect (productive and nonproductive time) measurement, I discovered a complex variety of methods, theories, and measurement tools designed to quantify this flawed division of clinician time on duty. There is the Work Observation Method by Activity Timing method, the Caring Behaviors Assessment, and numerous individually designed time/task studies that involve following nurses during their shifts to produce a chronology of their actions.1,2 Each method seeks to highlight time spent in direct nurse-patient interaction that qualifies as productive or revenue-generating time. Each is based on a misleading, invalid, and deceptive premise perpetuated by a misunderstanding of the fact that there can be no direct or productive care without the preparatory and supportive groundwork of associated indirect time.
Souza et al.3 masterfully describe the co-existence of indirect and direct patient-care time as care management. They conclude that there can be no direct patient care without indirect activities that support or otherwise make actual care possible, and that rethinking and restating workload by considering all contributing components is necessary to gain a true perspective of nursing care
As a closing thought: I wonder how healthcare facilities can continue to be credentialed by the American Nurses Credentialing Center as Magnet(R)-compliant and have such coordinated accounting and budgetary programs designed to limit the availability of nurse educational offerings and paid nurse time to devote to process improvement.
Respectfully,
Edward K. Sammons, BS, RN, MHA, DNP student
Raleigh, N.C.
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