Time standards of nursing in Primary Health Care: an observational study

To determine time standards for interventions and activities conducted by nursing professionals in Family Health Units (FHU) in Brazil to substantiate the calculation of work force.

METHOD

This was an observational study carried out in 27 FHU, in 12 municipalities in 10 states, in 2013. In each unit, nursing professionals were observed every 10 minutes, for eight work hours, on five consecutive days via the work sampling technique.

RESULTS

A total of 32,613 observations were made, involving 47 nurses and 93 nursing technicians/assistants. Appointments were the main intervention carried out by nurses, with a mean time of 25.3 minutes, followed by record-keeping, which corresponded to 9.7%. On average, nursing technicians/assistants spent 6.3% of their time keeping records and 30.6 intervention minutes on immunization/vaccination control.

CONCLUSION

The study resulted in standard times of interventions carried out by the FHU nursing team, which can underpin the determination of nursing staff size and human resource policies. Furthermore, the study showed the panorama of interventions currently employed, allowing for the work process to be reviewed and optimized.

Descriptors:
Primary Health Care; Community Health Nursing; Public Health Nursing; Health Manpower; Workload.

	Strata 1 to 4				Stratum 5				Stratum 6				Brazil
	Nurse		Tec./Assist.		Nurse		Tec./Assist.		Nurse		Tec./Assist.		Nurse		Tec./Assist.
	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
Interventions	1950	60	2559	47	775	53	797	31	2713	61	4243	40	5438	59	7599	41
Direct care	961	49	1588	62	434	56	627	79	1407	52	2397	56	2802	52	4612	61
Indirect care	989	51	971	38	341	44	170	21	1306	48	1846	44	2636	48	2987	39
Unit-related Activities	358	11	654	12	56	4	174	7	232	5	1700	16	646	7	2528	14
Personal Activities	367	11	873	16	130	9	315	12	720	16	1765	17	1217	13	2953	16
Standby time	104	3	617	11	27	2	399	16	146	3	1898	18	277	3	2914	16
Absences	403	12	665	12	392	27	791	31	553	12	731	7	1348	15	2187	12
No observation	82	3	104	2	90	6	92	4	100	2	271	3	272	3	467	3
Effective working time	2412	74	3830	70	858	58	1370	53	3091	69	7841	74	6361	69	13041	70
Total	3264	100	5472	100	1470	100	2568	100	4464	100	10608	100	9198	100	18648	100

Interventions	Strata 1 to 4		Stratum 5		Stratum 6		Brazil
Interventions	Time	Freq. (%)	Time	Freq. (%)	Time	Freq. (%)	Time	Freq. (%)
Educational actions for health professionals	24.0	0.6	174.0	6.3	67.0	2.0	73.0	2.1
Administering medication	12.0	0.1	-	-	13.0	0.0	13.0	0.1
Supporting students	11.0	0.4	13.0	0.9	11.0	2.0	12.0	1.0
Assisting in tests/procedures	14.0	0.3	-	-	20.0	1.0	19.0	0.6
Attending to spontaneous demands	30.8	8.5	32.1	5.5	16.1	7.5	23.3	7.5
Appointment	32.4	7.1	36.7	13.4	19.4	14.2	25.3	11.6
Community Disease Management	11.0	0.0	12.0	0.3	-	-	12.0	0.1
Immunization/vaccination control	24.0	1.3	27.0	0.2	29.0	0.0	25.0	0.7
Infection control	12.0	0.0	11.0	0.3	12.0	0.0	12.0	0.1
Supply control	11.0	0.6	-	-	12.0	1.0	12.0	0.5
Organizing work processes	11.0	2.9	11.0	1.7	12.0	5.0	12.0	3.7
Developing administrative processes/routines	13.0	0.8	-	0.0	13.0	0.0	13.0	0.3
Documentation	11.0	11.6	12.0	5.7	13.0	16.0	12.0	12.4
Interpreting laboratory data	12.0	0.4	11.0	0.1	11.0	0.0	11.0	0.2
Mapping and territorialization	12.0	0.3	-	0.0	15.0	0.0	13.0	0.1
Monitoring vital signs	12.0	0.6	13.0	0.2	13.0	0.0	12.0	0.3
Health System Guidance	12.0	1.1	12.0	0.2	13.0	1.0	12.0	1.0
Outpatient procedures	21.6	0.1	44.0	0.1	14.5	0.2	19.3	0.1
Promoting educational actions	19.4	2.5	44.6	4.8	31.4	1.9	28.0	2.6
Referrals and counter-referrals	11.0	0.5	-	-	13.0	0.0	11.0	0.3
Administration meetings	75.0	6.4	324.0	7.0	37.0	5.0	60.0	5.9
Meeting for evaluation of multidisciplinary care	63.0	1.1	58.0	1.2	29.0	3.0	35.0	1.9
Unit work supervision	12.0	0.3	12.0	0.1	14.0	1.0	13.0	0.4
Sharing information about care provided	12.0	6.4	12.0	3.5	12.0	7.0	12.0	6.2
Health surveillance	12.0	0.6	-	-	13.0	2.0	12.0	1.3
Home visits	25.9	8.1	66.1	5.1	54.1	3.9	35.6	5.6

Interventions	Strata 1 to 4		Stratum 5		Stratum 6		Brazil
Interventions	Time	Freq. (%)	Time	Freq. (%)	Time	Freq. (%)	Time	Freq. (%)
Educational actions for health professionals	26	0.70	135	2.30	87	2.00	66	1.40
Administering medication	12.8	1.10	13,9	2.30	13,5	1.50	13.4	1.50
Supporting students	12	0.30	-	0.00	14	0.20	13	0.30
Supporting physicians	12	0.10	19	0.10	19	0.10	18	0.10
Assisting in tests/procedures	48.2	0.60	48.1	1.00	14.6	1.50	23	1.20
Attending to spontaneous demands	15.8	0.10	39	1.60	30.2	0.90	32.2	0.80
Electrolyte control	12	0.00	13	0.50	12	0.10	12	0.10
Immunization/vaccination control	39.3	6.50	39	10.20	21.1	5.20	30.6	6.20
Infection control	13	1.40	15	0.40	14	2.00	13	1.40
Supply control	13	2.30	15	1.60	13	5.00	13	3.60
Organizing work processes	12	1.30	-	-	13	1.00	13	1.00
Urgency/emergency care	38	0.10	-	-	11	0.00	20	0.10
Developing community health	12	0.10	-	-	14	0.00	13	0.10
Developing administrative processes/routines	13	0.20	-	-	13	0.00	13	0.10
Documentation	13	9.50	14	3.20	13	11.00	13	9.30
Risk identification	-	0.00	14	0.20	13	1.00	13	0.40
Monitoring vital signs	13.1	5.60	12.8	3.90	13	4.00	13	4.50
Health System Guidance	13	1.50	14	1.80	13	2.00	13	1.50
Outpatient procedures	44.1	1.60	40.9	1.30	20.2	2.30	27.8	1.90
Promoting educational actions	25.1	1.00	24.6	0.30	28.6	1.70	27.6	1.30
Venous puncture: venous blood sampling	-	-	-	-	12.5	1.60	12.5	0.90
Referrals and counter-referrals	13	0.80	-	-	13	0.00	13	0.30
Administration meetings	60	1.70	-	-	88	2.00	74	1.40
Meeting for evaluation of multidisciplinary care	62	0.20	-	-	44	2.00	45	1.00
Safety supervision	13	0.10	-	-	13	0.20	13	0.20
Institutional transportation	14	1.00	-	-	13	0.00	14	0.40
Sharing information on care provided	13	3.30	15	1.60	13	3.00	13	3.00
Health surveillance	12	0.20	15	0.30	12	1.00	13	0.40
Home visits	48.5	10.20	71.6	2.00	39.7	2.30	47.7	4.60

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Daiana Bonfim. Escola de Enfermagem da USP. Av. Dr. Enéas de Carvalho Aguiar, 419 - Cerqueira César. CEP 05403-000 - São Paulo, SP, Brazil. daiana.bonfim@gmail.com