Relationship Between Number of Assigned Patients and RN Time to Administer Medications During the Peak-Time Medication Pass
Abstract
Inpatient nurse staffing affects patient outcomes. Less is known about the mechanism of this relationship and how lower overall staffing in a unit affects individual RN activities at the bedside. We estimated the relationship between the number of patients assigned to an RN and time spent on medication administration at the peak-time medication pass (PTM), a common nursing task, using multivariable linear regression to adjust for patient severity and staff and unit fixed effects. The sample included all 9,272 RNs administering medications during the PTM on 243 inpatient units in 113 VHA hospitals in 2019. After adjusting for staff and unit fixed effects and average patient severity of illness, the PTM duration for an RN assigned 3 patients is 20.67 minutes longer than when they are assigned 2 patients, and the adjusted difference between 4 and 2 patients is 35.42 minutes. PTM duration per patient declines; relative to 2 patients, RNs assigned 3 patients spend 0.78 fewer minutes per patient delivering medications (3% reduction), and RNs assigned 4 patients spend 2.52 fewer minutes (11% reduction). Individual nurses spend more time overall delivering medications when assigned more patients. Nurses compensate for the increased patient load by only marginally reducing time spent with each patient, even after controlling for patient severity and other factors.
