Implications for Virtual Nursing Role Development in Acute Nursing Care: 24-Hour Time-and-Motion Study

Background: Understanding current nursing workflows is essential to informing future workforce redesign strategies, including virtual nursing roles. However, granular insights into current nursing workflows over a 24-hour period and across different staff grades are lacking. Objective: This study aimed to (1) quantify how registered and enrolled nurses in the general acute medicine wards distribute their time across direct and indirect care tasks over a 24-hour period, (2) identify multitasking burdens and temporal distributions, and (3) identify opportunities for the development of a virtual nursing role. Methods: Using time-and-motion methodology, we observed registered and enrolled nurses in 3 general medicine wards over a 24-hour period between April 2024 and June 2024. We observed 3 task categories (administrative, communication, and bedside tasks), with multiple individual tasks monitored under each category. Multitasking (ie, the occurrence of 2 or more tasks concurrently) was also tracked. The checklist was piloted and refined before data collection. Results: We observed a total of 48 nursing shifts. During the daytime, registered nurses spent 70% (587/834 min) of their time on indirect care tasks compared with 54% (412/764 min) of the time for enrolled nurses. At night, the proportion of time spent on indirect care tasks decreased to 58% (410/705 min) for registered nurses and 39% (274/711 min) for enrolled nurses. During a 24-hour period, registered nurses spent 209 (SD 51.8) minutes multitasking in the day and 117 (SD 41.0) minutes at night, whereas enrolled nurses spent 152 (SD 54.7) minutes multitasking in the day and 110 (SD 75.9) minutes at night. Conclusions: These findings highlight opportunities for virtual nursing roles, which, if thoughtfully designed, may help redistribute indirect care tasks, reduce multitasking burden, and enhance overall efficiency without compromising care quality.