How nurses spend their time-shift and the strategies adopted to maximize it: a scoping review

Introduction. Investigating how nurses spend their time during the shifts has become important mainly recently, due to the nursing shortage. Aim. The aims of the study were to map and summarise, (a) how nurses use their time shift in different care settings, and ( b) the time-shift management strategies implemented. Method. A scoping review according to the Arksey and O'Malley framework, integrated by Levac and colleagues and the Preferred Reporting Items for Systematic review and Meta- analysis extension- Scoping reviews guideline was conducted in 2021. Results. Thirty- one studies were included (30 primary studies, one secondary), published from 1987 to 2021, mainly conducted in USA, UK and Sweden. Most of them were based on quantitative designs (23/30). In critical and psychiatric settings, the nursing time is dedicated almost equally in direct and indirect care; in the medical, surgical, and oncological units, the direct care activities occupy around the 30% of the nursing time- shift, whereas the indirect care activities increase. In long-term settings the indirect care reaches the 60% of nursing time while in home care around one third of time is spent in direct care. Nurses enact different time- management strategies during the shift. Conclusion. Nurses spend limited time at the bedside, as perceived also in the Italian nursing practice; making more visible to patients and their caregivers the value of the indirect care performed by nurses is necessary.