title: How registered nurses, licensed practical nurses and resident aides spend time in nursing homes: An observational study.
abstract: BACKGROUND
  Calls for improved conditions in nursing homes have pointed to the importance of optimizing the levels and skills of care providers. Understanding the work of care providers will help to determine if staff are being used to their full potential and if opportunities exist for improved efficiencies.
  
  
  OBJECTIVE
  To explore the activities of care providers in different nursing homes and to identify if variations exist within and across homes and shifts.
  
  
  METHODS
  A multi-centre cross-sectional observational work flow study was conducted in seven different nursing homes sites in one Canadian province. Data were collected by a research assistant who conducted 368 h of observation. The research assistant collected data by following an identical route in each site and recording observations on staff activities.
  
  
  RESULTS
  Findings indicate staff activities vary across roles, sites and shifts. Licensed practical nurses (nursing assistants) have the greatest variation in their role while registered nurses have the least amount of variability. In some sites both registered nurses and licensed practical nurses perform activities that may be safely delegated to others. Care providers spend as much as 53.7% of their time engaged in non-value added activities.
  
  
  CONCLUSIONS
  There may be opportunities for registered nurses and licensed practical nurses to delegate some of their activities to non-regulated workers. The time care providers spend in non-value activities suggest there may be opportunities to improve efficiencies within the nursing home setting.
authors.affiliation: Department of Nursing & Health Sciences, University of New Brunswick, Saint John, Canada. Electronic address: rmcclosk@unbsj.ca.
authors.forename: Rose
authors.initials: R
authors.lastname: McCloskey
authors.affiliation: Loch Lomond Villa Inc., Saint John, NB, Canada.
authors.forename: Cindy
authors.initials: C
authors.lastname: Donovan
authors.affiliation: Department of Computer Science & Applied Statistics, University of New Brunswick, Saint John, Canada.
authors.forename: Connie
authors.initials: C
authors.lastname: Stewart
authors.affiliation: Faculty of Science, University of New Brunswick, Fredericton, NB, Canada.
authors.forename: Alicia
authors.initials: A
authors.lastname: Donovan
mesh_terms: D009509:New Brunswick; D009728:Nursing Assistants; D009735:Nursing Homes; D009740:Nursing Staff; D000078329:Workforce
keywords: Long term care; Nursing home; Resident care; Skill mix; Staffing