Reflections on the cost of hospital nursing: a comparison of factors affecting time distribution in ward, theatre and outpatient departments.

An understanding of the influences upon nurses' time distribution is important for the evaluation of care and the justification of the cost of the nursing service. Time devoted to the care of breast cancer patients at different stages of their illness was studied by direct observation in ward, theatre and outpatient departments. Factors affecting the time spent with patients were found to differ in each location. In the ward and theatre, nurses' work was primarily patient-orientated in that the most significant determinants of the amount of nurse-patient contact appeared to be characteristics of the patients themselves. Particularly in the ward, nurses seemed free to make their own decisions concerning the patients who most needed their attention. In outpatient departments, organizational factors and the characteristics of the doctors conducting the clinics seemed most significant in determining nurses' time distribution. However, there were signs that nurses recognize differences between patients to which their current pattern of work organization does not allow adequate response.