Journal of Nursing Management, 2009, 17, 269–277

Nurses' everyday activities in hospital care

CARINA FURÅKER BSn, PhD, RN

Lecturer, Institute of Health and Care Sciences, Sahlgrenska Akademin, Göteborg University, Göteborg, Sweden

Correspondence F U R Å K E R C .
(2009) Journal of Nursing Management 17, 269–277
Carina Furåker Nurses' everyday activities in hospital care
Institute of Health and Care
Sciences Aim This study aims at examining nursesÕ work in somatic and psychiatric wards
Sahlgrenska Akademin in a hospital in Sweden.
Göteborg University Background It is asked whether the humanistic ideology, emphasizing holistic
Box 300 care and human interaction more than practical skills, which has become
405 30 Göteborg widespread in the Swedish nursing education programmes, fits with the actual
Sweden work that nurses carry out.
E-mail: carina.furaker@fhs.gu.se Method In this study, diaries on work activities were written during 5 days by
30 nurses.
Results It turned out that the nurses generally spend 38% of their working time
with patients (nursing) and the remaining time on other activities.
Discussion There are certain differences between clinics and they can to some
extent be explained by differences in work organization.
Conclusion The results in this piece of research indicate that a relatively
small proportion of nursesÕ working time is used for general and specific nursing.
It should be asked whether or to what extent the humanistic and holistic perspective
taught in nursing education will be utilized in practical nursing.
Keywords: diary, use of working time, work, work content, work organization

Accepted for publication: 24 October 2006

Introduction general nursing care and about 35% of the nursing

Nursing education
Nursing education in Sweden is a 3-year generalized
programme, divided into 120 credits (1 credit
= 1 week) and based on academic principles modified to
European Union Requirements (DS 1992). In the past
10 years, the theoretical part of the education has
expanded at the expense of the practical part, as a result
of a process of academization. The programmes consist
of the main subject nursing and a number of subsidiary
subjects (natural, human and social sciences). Nursing
generally makes up 60 credits, i.e. half of the education,
which leaves 60 credits to the subsidiary subjects and to
practice. The main subject is above all focused on
DOI: 10.1111/j.1365-2934.2007.00832.x
ª 2008 Blackwell Publishing Ltd
curricula is devoted to clinical and practical activities
(Furåker 2001). There has been a tendency to upgrade
the theoretical and academic content relative to the
practical parts.
It can be argued that, during the past decade, there
has been a curriculum revolution in nursing education
programmes in Sweden, a shift of paradigm from
medical science to humanities. Humanistic ideology
refers to a series of ideas and beliefs such as individu-
alism, freedom, sense, and holistic nursing values (Smith
et al. 2004). It is today a common element of nurse
education programmes not only in Sweden but in many
other countries (Purdy 1997, Hamner & Wilder 2001).
The humanistic ideology is more focused on theory than
269
C. Furker
on practice. As it has been given a greater role in
nursing education curricula than the medical, natural
and social sciences, more attention is paid to human
relations, communication, and ethics than to disease,
administration and practical skills.
Another aspect of this development is that the actual
needs of hospital care have become less important in
determining what skills registered nurses should have
(Furåker 2001). In several studies, students have poin-
ted out that the contents of the education have little
connection with reality (Linder 1999, Waldenström
2000), and that the gap between the theoretical and
practical parts has widened (Glen & Clark 1999,
Landers 2000). The basic practical qualifications among
trained nurses tend to decline and there is, according to
Strömberg (1997), a discrepancy between what students
learn in nursing education programmes and what their
professional practice requires. Consequently, nursing
students are not so well prepared for nursing practice,
which creates a credibility problem for the educational
system. The aim of this study is to investigate what
registered nurses really do – i.e. to examine the content
and organization of their work in hospital somatic and
psychiatric care – and to relate the outcome to the
discussion on nursing education.
Some previous studies
In an Australian interview study, the aim was to de-
scribe an ideal nursing model (n = 96 interviews) and to
study current nursing content (n = 144 observations) in
different wards (Fitzgerald et al. 2003). According to
the interviews, the ideal would be to meet patientsÕ and
relativesÕ needs for care, by offering holistic care and by
emphasizing the role of instruction. However, direct
observations in the wards showed that this ideal did not
have much impact on the actual care work, because
little time was devoted to holistic care, patient instruc-
tion, and communication with patients and relatives.
Another Australian interview study had the purpose of
examining what nurses do in everyday work, what
competencies are needed, what challenges nurses face,
and what interaction occurs with other categories of
personnel (Jones & Cheek 2003). It was shown that
there is no such thing as a typical workday; one day
rarely resembles the day before or the next one. Another
conclusion was that the central areas of competence had
to do with being able to make clinical assessments,
communicate and constantly update oneÕs own knowl-
edge (lifelong learning).
A Swedish observational study (Lundgren & Segesten
2001) aimed at investigating the role of the organiza-
tion in dividing up time for different activities on a
270
ward. After an organizational change that led to staffing
solely by nurses, it turned out the time that nurses spent
with patients increased from 33% to 37% of the
workday. Also the time used on administrative activities
increased, from 23% to 25%. Another Swedish study,
using interviews and observations, examined the con-
tents and design of care work as well differences in
power and status at two units, a nursing home and a
medical ward, in a small hospital (Franssén 1997). The
interviews indicated that the nursesÕ thoughts and ideals
coincided with the objectives of health care and nursing
education as regards a holistic perspective in care work,
but that the nursesÕ actions were contrary to their
thinking. In the observational study, it turned out that
the care organization (teamwork) fragmented work into
numerous routines, which made it difficult for nurses to
focus on patients as individuals. The routine/character
of work tasks tended to dominate the activities carried
out at the workplace.
In a study conducted by SwedenÕs National Board of
Health and Welfare (2000), the assignment was to chart
the extent and orientation of the administrative work
done by care personnel. The study was based upon
interviews with doctors (168), nurses (108) and others
(22) in a variety of hospitals – regional, large, small –
and district health centres. It appeared that the time
used for administration by doctors and nurses is at least
25% of normal working time, which of course reduces
the time for direct contacts with patients. The Board
concluded that there is a certain degree of Ôdocumen-
tation hysteriaÕ at some care institutions.
Aim and research questions
The present investigation deals with the content of
nursesÕ work and how it is organized in different
somatic and psychiatric wards in a hospital, by asking
particularly:
• What is the time expenditure in different work
activities?
• What is the distribution of work activities in surgi-
cal, geriatric, medical and psychiatric care?
• How much of the workdayÕs content do the nurses
devote to direct care of patients?
Method and material
The method of collecting data was to use diaries written
by nurses during a week (five workdays). These show
both the content of work and the time allocated to each
activity, as well as how the work is organized. This
study used a diary with flexible time intervals: each
ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 269–277

activityÕs start and end times are given by the person
writing the diary. The diarist designated and noted the
activities that occurred at a certain time, and the
activityÕs duration. These data concern not only time
and content, but also which individuals and places are
important (social and geographic context). It is impor-
tant to make diaries long enough to cover weekly
rhythms (Ellegård et al. 1999).
The directors of the 10 wards at a hospital in western
Sweden were asked about the possibility of studying
how nurses use their working time during 5-day and/or
evening shifts, not at night. Then the directors informed
the nurses at the respective wards. Many nurses were
interested and approximately 4–5 nurses per ward
agreed to participate. This must be regarded as an
explorative study, no representative selection having
been made. The interested full-time nurses were in-
formed clinic wise (surgical, geriatric, medical and
psychiatric clinics) of the purpose, and the diariesÕ
design was discussed as well as the choice of week. In
total, 30 diaries were written in May 2004 – 11 of them
at the surgical, six at the geriatric, eight at the medical
and five at the psychiatric clinic.
Four general ethical requirements have been met:
those of information (that the researcher is to give
information about the study), consent (that the infor-
mants in the study have the right to decide by them-
selves whether to collaborate), confidentiality (that the
informants should be ensured discretion), and utiliza-
tion (that the data collected are to be used solely for
purposes of research) (HSFR 1999). For reasons of
research ethics, no specific ward and no individualÕs
diary content will be presented. In order to improve the
credibility of interpretations, the diary-writing nurses
were invited to a seminar in each clinic to discuss the
preliminary results. This led to certain minor correc-
tions.
Analysis
Content analysis was used to examine the content, time
expenditure and structure of the diaries (Silverman
1993). First, the 30 diaries were read so as to get an
overall picture of the nursesÕ activities. The material was
coded manually. Each activity in the diaries was noted
as well as the sequential order and duration of activities.
The work content was categorized and the duration of
each category was recorded to provide comparability
across diaries and specialties. A main distinction was
that between nursing – with two subcategories: general
and specific nursing – and other activities – with five
subcategories: reporting, ward rounds, administration
ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 269–277
NursesÕ everyday activities in hospital care
and documentation, pedagogical activities, breaks and
personal activities. It should be emphasized that these
other activities are partly important elements in the
caring process.
Results
Overall activities in clinics
The nurses begin work some time between 06.30 and
08.00 hours and finish between 03.30 and 04.00 hours.
Individual schedules are common and the flexible hours
mean that they can sometimes leave earlier in the
afternoon. The afternoon shift begins between 01.30
and 02.00 hours and usually ends at 10.00 hours.
Overtime is rare as nurses have flexible hours. Full-time
work means 38.25 hours/week, or 7.65 hours/day, but
there are in addition 30 minutes of rest according to the
nursesÕ contract. Breaks are supposed to be taken when
time is available.
At the medical clinic, the nurses work in a care
organization with alternation between nursing (ÔouterÕ,
team-nursing model) and other activities (ÔinnerÕ, func-
tional model). At the geriatric and surgical clinics, care
is usually organized in a so-called round system (func-
tional model), but sometimes one nurse serves the oth-
ers in an Ôerrand-nurse modelÕ. At the psychiatric clinic,
the work is organized according to the Ôpatient-
responsible nursing modelÕ (PAS) which means that the
nurse is responsible for six to eight patients.
At the surgical and geriatric clinic, the diaries indicate
a clearer weekly rhythm than at the other clinics, with
the same recurrent activities and numerous routines. As
the nurses at the medical clinics alternate between
ÔouterÕ (team-nursing model) and ÔinnerÕ (functional
model) the weekly rhythm varies. At the psychiatric
clinic, the weekly rhythm is vaguer, as the patients
require a different kind of nursing. These psychiatric
wards are locked and in comparison to the other clinics
the activity demands leeway for more and longer con-
versations, and handling of and providing medicines
when needed. Furthermore, much time is devoted to
opening and closing doors for patients and relatives.
The diaries also show that the nurses have difficulties
in planning and organizing the work, because they are
constantly – or let themselves be – interrupted by tele-
phone calls, new patients, opening and closing doors,
giving medicine when needed, and talking with relatives
and personnel. These are hindrances to creating conti-
nuity in the work.
The nurses spend 95% of the workday at the ward.
They leave it for breaks, taking patients to and from
271
C. Furker
operations or X-rays, and fetching or delivering speci-
mens and referrals.
Nursing
Nursing refers to the nursesÕ activities in direct contact
with patients and can be divided into a General and a
Specific subcategory.
General nursing
In this study, General Nursing comprises activities
related to the patientÕs personal hygiene, making beds,
continuous conversations, arrival interviews, food dis-
tribution, wound treatment and greeting patients.
The time spent on General Nursing varies from
40 minutes to 3 hours 25 minutes/day (averaging
1 hour 55 minutes). On average, 19% of the workday
is taken up by General Nursing. The nurses who alter-
nate between ÔinnerÕ and ÔouterÕ activities use 30% of
the workday for General Nursing – usually for making
beds, the patientÕs personal hygiene and food distribu-
tion.
Morning work. Made 5 beds. Helped patients to
the shower, changed 1 bed, talked with several
patients in the morning (18).
In the surgical wards, nurses use on average 14% of
the workday for General Nursing. It is common that the
psychiatric nurses accompany and talk with the patients
to a greater extent and for their part General Nursing
on average makes up 18% of the workday. Also in the
surgical, geriatric and medical nursing, we found a great
deal of conversations with patients and relatives. At
these clinics, the conversations vary in length, but they
are usually shorter than those in psychiatric nursing.
The content of the conversations is seldom recorded,
but they are likely to deal with problems, planning, and
needs related to Nursing.
General Nursing is conducted mostly during the
morning and evening shifts by helping patients with
toilet visits and arrival interviews. The arrival inter-
views are common at all clinics and, together with
documentation, on average 20–25 minutes are spent on
each new entrant.
Specific nursing
Specific Nursing comprises distribution of medicines,
injections, infusions, transfusions, taking specimens,
and preparation for treatments, operations. The time
expenditure varies between 1 hour and 2 hours
40 minutes/day (averaging 1 hour 36 minutes), and
takes up 19% of the workday.
272
The activity that takes most time is giving medicines
to the patients, which occurs in the morning, the
afternoon and the evening. This activity involves both
dividing up (with a medicine cart) and distributing
medicines, talking with patients and relatives, measur-
ing pulse and blood pressure, and instructing. In the
psychiatric clinic, much time is devoted to dividing
(with a medicine cabinet) and distributing medicine.
Medicine division. Talking with patients about
whether there are any worries and how the night
has been (15).
Nursing thus consists of both General and Specific
nursing, with the activity and real time that the nurse
uses together with the patient. The total time has a
spread between the clinics from 1 hour 40 minutes to
4 hours 35 minutes/day (averaging 3 hours 11 minutes/
day) and comprises on average 38% of the workday
(Tables 1, 2).
The nurses in the medical clinic use most of the time
for Nursing. The ward round is an activity involving
both the patient and the nurse, but it is not counted in
Nursing.
Other activities
The category ÔOther activitiesÕ refers to the time when
nurses are not in direct contact with the patients.
Reports
Reports on planning and distribution of Nursing, and
on the patientsÕ condition, are given between work
shifts – night and day, morning and afternoon, day and
night – as well as during the work shifts between per-
sonnel of different categories. Several diaries note the
Ômorning gatheringÕ as a social context with coffee for
planning, delegation and distribution of work tasks.
The reports from night to day staff and from night to
day staff occurring between 06.30 and 07.00 hours and
at approximately 09.30 hours, respectively, are usually
made orally. The reports between morning and after-
Table 1
Work content and time expenditure as an average part of the
workday for all clinics
Nursing Time (%) Other activities Time (%)
General nursing 19 Administration, documentation 25
Specific nursing 19 Breaks, personal activities 13
Ward rounds 6
Pedagogical activities 3
Reports 15
ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 269–277
 NursesÕ everyday activities in hospital care

Table 2
Distribution of time in direct nursing on average between the clinics

Nursing Surgical ward Geriatric ward Medical ward Psychiatric ward

General nursing 70 minutes 111 minutes 150 minutes 100 minutes

Specific nursing 95 minutes 85 minutes 100 minutes 105 minutes
2 hours 45 minutes 3 hours 16 minutes 4 hours 17 minutes 3 hours 15 minutes

Table 3 6% of the nursesÕ workday. The morning round is the

Distribution of time/day for indirect care on average between the
longest; sometimes two doctors with different special-
clinics (except pedagogical activities)
ties separately or jointly conduct a round that may
Other activities Surgical Geriatric Medical Psychiatric occupy the whole morning.
(minutes) ward ward ward ward
At the psychiatric clinic there are large rounds, ward
Administration 125 135 115 150 rounds (averaging 22 minutes/day) and conversations
Documentation 80 65 82 53
with doctors. The latter – occurring once per week and
Reports 80 90 80 90
Breaks/personal 62 45 54 53 patient – means that the patient-responsible nurse
activities describes Ôher/his patientÕ in a conversation with the
Ward rounds 35 46 30 22 doctor. The nurseÕs degree of activity in the round work
is clarified in the diaries, and it is higher at the psychi-
atric clinic than at the other clinics (Table 3).
Table 4
Time in percentage for direct nursing and indirect care Breaks and personal activities
Clinics Nursing Other activities The nurses distinguish between breaks and Ôcoffee
pausesÕ. Breaks occur between 12.00 and 12.30 hours,
Surgical 32 68
Geriatric 33 67 when many of the nurses leave the workplace. Coffee
Medical 52 48 pauses are taken during both the morning and after-
Psychiatric 41 59 noon shifts. On average, 57 minutes/day are used for
breaks and pauses, comprising 13% of the workday.
There are also working lunches. During coffee breaks,
noon shifts, beginning at 01.00 or 01.30 hours, may be the nurses are frequently interrupted by telephone calls
oral and/or may mean that the nurses have to read the and personnel.
nursing journal at the computer screen (report reading).
Staff pause. Interrupted several times for questions
Both of these alternatives are often used at the medical
about a patient, questions from a physiotherapist
and geriatric clinics, while oral reports are most
(1).
common at the surgical clinic and report reading is
commonest at the psychiatric clinic. Seven diaries record the possibility of engaging in
The time expenditure for giving reports is variable activities of oneÕs own when the work allows it, such as
from 45 minutes to 2 hours/day (averaging 1 hour seeking information on web pages, studying a dictio-
20 minutes) and comprises on average 15% of the nary, or socializing. These comprise about 1% of the
workday. Among the three nurses who use <1 hour/day work content.
for reporting, one works as an Ôouter nurseÕ – with no Occasionally there is room for informal activities.
responsibility for rounds and administrative work – and Four nurses participate in gymnastics (10 minutes), one
two in psychiatric care. The time expenditure does not performs gymnastics together with the patients, one
differ much between the clinics. receives massage, and another nurse takes a Ôhealth
promenadeÕ. In some wards, the Ômorning gatheringÕ is
Ward rounds noted as both a social (coffee) and a work-related
The round is an activity where the nurse collaborates activity (Tables 3, 4).
with doctors as well as other personnel. Two or some-
times three rounds occur per day – one or two in the Administration
morning and one in the afternoon. The time expendi- In this study, administration consists of documentation,
ture varies little between the clinics and is between 20 handling of referrals and supplies, work before and
and 50 minutes/day (averaging 45 minutes), comprising after ward rounds, meetings, faxing, telephone contacts,

ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 269–277 273
C. Furker
talks with personnel, care planning or conferences, and
fetching or delivering specimens. The time expenditure
for the administrative work varies from 1 hour
20 minutes to 3 hours 30 minutes/day (averaging
2 hours 10 minutes), and comprises 25% of the work-
day.
Documentation, as part of the administrative work,
has a spread in time expenditure from 20 minutes to
1 hour 55 minutes/day (averaging 1 hour). Half of the
administrative work consists on average of documen-
tation, i.e. 13% of the workday.
Of the nurses, half (15) have taken part in diverse
meetings during work, on average for 30–60 minutes –
such as nurse meetings, work-place meetings and
infection-control meetings. The administrative work
includes delegating and distributing work tasks, usually
to auxiliary nurses and mental attendants, as shown by
half of the diaries. It is sometimes difficult to distinguish
in the texts between delegation and distribution.
Asked the auxiliary nurse to give the patient
medicine since time is running out (15).
A part of the preparations for discharging patients is
faxing, usually to doctors in their home municipalities.
Nurses in the medical clinic and, primarily, the geriatric
clinic send faxes several times a day. The faxing also
includes preparations for faxing.
Many conversations with colleagues, doctors, and
assistance assessors are of administrative character as
they contain planning for discharge, transfer to other
care units, or reception of patients. Also noted are
activities outside the ordinary Nursing work, such as
the writing of meeting protocols or deviation reports.
The nurses in the study take and make between 5 and
20 telephone calls each per day. The surgical clinic has
the largest number of calls. If each call lasts for
2 minutes, the nurses at the four clinics use on average
22 minutes/day for telephoning.
A further task for the nurses is the fetching and
delivery of specimens of various kinds, referrals, test
and X-ray results, and blood. They also take and leave
patients for operations, X-rays, and intensive care,
during an average of 10 minutes/day.
Pedagogical activities
On average, 3% of the workday at the four clinics is
devoted to supervision and teaching/instruction. In this
study, 13 nurses supervise nursing students in their
fourth and sixth terms of education, and two diaries
recorded supervision of recently graduated nurses. Four
nurses at the surgical, three at the geriatric, and four at
the medical clinic are supervisors. No nurse is a super-
274
visor of students at the psychiatric clinic. The diary
usually begins or ends with, for example:
A new graduate nurse alongside and a nursing
student in term 4 (20).
Students who are with me all day and need a lot of
supervision. Fuss around my student (22).
To Ôhave a studentÕ means continuous guidance dur-
ing the work shift. How much time is actually used for
supervising students and new colleagues is unclear from
the diaries. On average, 20–25 minutes/day are noted.
More than half of the nurses (17) state that they
instruct, inform and discuss with patients, relatives and
personnel. Teaching patients and relatives is concerned
with stomia care, giving injections, treating sores,
aphasia training and medicines.
Going ward rounds and talking with patients and
asking how they feel. Talking with one who is to
have a bronchoscopy at SU about how it is done
(19).
Some telephone calls give advice to patients and rel-
atives. Teaching patients and relatives has been regis-
tered at the surgical, geriatric and medical clinics.
Teaching the personnel may involve, for instance, doc-
umentation, as has happened at all the clinics. On
average, about 15 minutes/day are devoted to teaching.
Teaching takes the form of lectures, usually by doctors
but also by other staff. Several nurses attended lectures
during the week of the study.
Conversations are often noted. Their content is not
specified but can be assumed to involve instruction and
advice. Discussions among the personnel are also noted.
Discussion
This study deals with nursesÕ daily work at 10 wards.
The research question is how they use their working
time, where they carry out their work tasks and with
whom they interact. A time-related geographic method
(diaries) has been applied to capture the complexity of
nursesÕ work situation (Ellegård et al. 1999). What
respondents have written in the diaries convey a picture
of their everyday work tasks and the time distribution
of different activities.
Using diaries for collecting data is an appropriate
method but there are of course certain limitations. The
30 nurses sometimes failed to describe certain activities,
for example educational activities, supervision, com-
munication with patients, colleagues and personnel, and
the number and contents of phone calls. We can think
ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 269–277

of several reasons for this: that nurses were too busy,
that they had difficulties in expressing themselves or
that certain activities were deemed routine. Another
problem is the issue of self selection. As always when a
study is based on voluntary participation, it could be
asked whether participants differ from non-partici-
pants. This question is difficult to answer, but we can
note that many nurses expressed an interest in the
purpose of the study and that 30 of them, surprisingly,
agreed to write diaries. A further limitation is that
weekends are not included in the study, although what
nurses do during weekends can be as important as what
they do during other days. Some of the data collection
problems involved in the study have, however, been
dealt with. A valuable feedback was obtained by giving
each diary-writing nurse a report of the preliminary
results and an invitation to a seminar to discuss and
confirm the findings. As a result of these discussions, a
number of smaller corrections were made.
An Australian interview study has shown that nursesÕ
ideal is a holistic view of nursing work with an
emphasis on pedagogical activities and that this ideal,
according to observations, deviates from how everyday
work actually appears (Fitzgerald et al. 2003). The
holistic and humanistic ideal is today very much
emphasized in nursing education in Sweden too. Con-
cepts related to this ideal (such as relationship,
response, communication) are given higher status than
organizational and administrational skills (Furåker
2001). Hence, this study indicates a discrepancy
between the ideology underlying the goals and contents
of nursing programmes and the content of nursesÕ work
in practice.
The present study shows that nurses on average
spend 38% of their working time on nursing, i.e.
together with patients, but that the variation between
clinics is rather large. Nurses at the medical clinic
spend more time with patients than other nurses do
and the differences between clinics can be related to
their different care organizations. Traditions can also
influence the attitudes towards the work organization
and the distribution of work between categories of
personnel. As long as the concepts of nursing and
caring are unclear in the educational programmes,
work contents and the competencies required for
nursing will also remain ambiguous. It can be asked
what is most important in nursing – quality or quan-
tity? The quality of nursing cannot be assessed on the
basis of the data collected here, but it is of course a
crucial issue. In this study, nurses communicated with
patients and their next of kin during less than half of
the time spent working.
ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 269–277
NursesÕ everyday activities in hospital care
At the medical clinic, work days look rather different
compared with other clinics, as a result of whether
nurses work in close connection with auxiliary nurses in
a team-nursing model (ÔouterÕ) or with nursing col-
leagues in a functional organizational model (ÔinnerÕ).
At the psychiatric clinic, the nurses work partly in the
PAS (patient-responsible nursing model), and partly
within a team in close collaboration with mental
attendants. Nurses are a minority in psychiatric care.
The present study indicates that nurses commonly del-
egate work tasks to auxiliary nurses and mental atten-
dants. At the geriatric and surgical clinics, they usually
work together with colleagues in a functional model.
The functional model is characterized by a hierarchical
order with rules and routines for action.
The study by Jones and Cheek (2003) demonstrates
that many nurses receive little appreciation for what
they do. Their work and its contents are undervalued by
the other personnel, presumably because of the diversity
of work tasks and unclear boundaries with other pro-
fessions. Another reason is that nurses cannot establish
priorities among their tasks. It appeared that the care
organization (teamwork) fragmented the work into
numerous routines, hindering individual attention to
the patients; the routine work tasks had priority while
the patient-related tasks became secondary (Franssén
1997). In this study, the care organization influences the
amount of time nurses spend with the patients.
Other activities, i.e. the time the nurse is not with the
patient, comprises on average 62% of the time spent
working in this study. Should these activities be
regarded as nursing, and constitute part of the nursesÕ
specific work content? Is everything nurses do in hos-
pital wards nursing? There is a discussion on whether
other professions, for example economists and manag-
ers, should do part of nursesÕ work tasks. It is difficult to
draw a clear line between nursing and other activities
that are related to patients. An example is the ward
rounds. Nurses at the psychiatric clinic use most of their
time for administrative tasks, and least time for docu-
mentation, which may be as a result of the fact that they
have a long tradition of documentation or that mental
attendants document as well.
Studies by the National Board of Health and Welfare
in Sweden (2000), and by Lundgren and Segesten
(2001), show that the time used for administration is
about 25% of the normal working time, which is con-
sistent with the results in this study. The forms of
reporting in care work have been discussed for decades,
and the goal is to give relevant and succinct reports
(Asplund 1968). Reporting in the present study does not
seem to be very succinct. It takes up much of the
275
C. Furker
workday (on average 1 hour 20 minutes), which can be
attributed to the use of both oral and computer-written
reports. Half of the administrative time goes to docu-
mentation, which is in agreement with other studies
(Fitzgerald et al. 2003). The National Board of Health
and Welfare (2000) has used the label Ôdocumentation
hysteriaÕ for some care institutions. The large spread in
time expenditure for documentation may have several
explanations, organizational as well as traditional and
personal. Some nurses require more time, are uncertain
and have a greater need for control. The average pro-
portion of the workday spent on documentation is
equal to the time used for breaks and personal activities
– about an hour per day. In Australian and Swedish
studies (Lundgren & Segesten 2001, Fitzgerald et al.
2003), the nurses use 13% of the workday as their own
or personal time, which can be attributed both to breaks
and to improving oneself in the profession. Being con-
stantly able to update knowledge is central in nursing
work, according to Jones and Cheek (2003) and
National Board of Health and Welfare (2005). The
present study indicates that little time per week is
devoted to improvement; only lectures on various
diseases are offered.
A small part of the workday, 3%, is used for the
nursesÕ pedagogical activities of instruction and super-
vision. According to Friberg (2001) there is uncertainty
regarding what the nurses are to instruct about and
how. They teach in different ways, by explaining or
challenging as well as through questions and answers
with patients. The patients can undoubtedly be influ-
enced by the nursesÕ unclear pedagogical function. Only
about half of the nurses in this study have noted that
they teach patients, relatives and personnel, possibly
because they are uncertain about what teaching is or
feel that the concept is unfamiliar. According to Fitz-
gerald et al. (2003), pedagogical activities are a part of
nursesÕ ideal picture of care work. In this study, nearly
half of the nurses supervise students. Being a supervisor
or instructor entails continuous activity throughout the
workday, so it is plausible that more time than the
amount reported has been spent on supervising students
and teaching patients.
The lack of continuity in nursing work has also
become evident in this study, as nurses are constantly
interrupted while working. They are most disturbed by
other personnel for exchange of information, but in
addition by telephone calls and the task of opening and
closing doors. This is in line with another study, in
which it was demonstrated that nurses are constantly
interrupted in decision-making (Hedberg & Larsson
2004). To be, or let oneself be, repeatedly interrupted in
276
nursing work implies not being allowed to do oneÕs own
planning and setting of priorities in work content and
time expenditure, and this surely affects the quality of
decisions as well as the effectiveness of the nursing work
programmes.
The results in this piece of research indicate that a
relatively small proportion of nursesÕ working time is
used for general and specific nursing. It should then be
asked whether or to what extent the humanistic and
holistic perspective taught in nursing education will be
used in practical nursing.
Acknowledgement
This research has been financed by grants from Regional
Coordination Group, Västra Götaland, Sweden.
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