How Is Registered Nursing Time Used? A Multicentre Observational Study of Nursing Activities, Scope of Practice, and Opportunities for Workforce Redesign in Medical–Surgical Wards in Italy

Abstract

Background/Objectives: Nursing workforce shortages and increasing care complexity have intensified the need to understand how registered nurses allocate their working time and whether nursing expertise is used where it adds the greatest clinical value. This study empirically measured the distribution, frequency, and duration of observed nursing activities and examined differences across participating hospitals and medical–surgical units in Italy. Methods: A multicentre observational study was conducted across 13 medical and surgical units in five Italian teaching hospitals. Registered nurses were observed during complete morning and afternoon shifts over a three-week period. Activities were classified as direct care, indirect care, organisational activities, or non-patient care. Time allocation, activity frequency, and duration were examined across units and hospitals. The Enacted Scope of Practice model, Role Theory, and Job Demands–Resources Theory informed interpretation of the findings but were not used to classify individual activities. Results: Overall, 45% of cumulative recorded activity time was devoted to direct care, 24% to indirect care, 10% to organisational activities, and 21% to non-patient care. Direct care accounted for 51% of recorded activity time in medical units and 41% in surgical units, whereas indirect care represented 17% and 28%, respectively. Considerable hospital-level variability was observed, particularly for indirect, organisational, and non-patient care activities. Direct care was also the most frequent activity category, while organisational activities were less frequent but comparatively time-intensive. Conclusions: Nursing work extends substantially beyond bedside care and includes clinically relevant indirect and organisational activities. Interpreted through the Enacted Scope of Practice framework, the findings identify areas requiring further competency-based evaluations to support work redesigning that protects activities requiring registered nursing expertise, redistributes appropriate tasks, and reduces avoidable organisational inefficiencies.

The authors' abstract, as published at the source. Nursing Reports, 2026 · DOI ↗