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How far do nurses walk?

MedSurg Nursing, August, 2006 by John M. Welton, Maureen Decker, Julie Adam, Laurie Zone-Smith

The estimated distances 146 registered nurses walked within a 12-hour shift in four similar adult medical-surgical units at a university hospital are reported. Findings demonstrate that walking is a significant component of inpatient nursing care.

No published studies quantify either the distance walked or the effects of walking on nurses in the hospital setting. The topic is relevant due to the graying of the nursing workforce as well as the looming shortage of nurses (Buerhaus, Staiger, & Auerbach, 2003; Buerhaus, Staiger, & Auerbach, 2000). Continuous walking and other occupational stressors in older nurses can lead potentially to fatigue, joint pain, and other injuries (Sabine, 1999; Yip, 2001). These responses suggest that walking may be a potential hazard for nurses working in acute care hospitals, yet no previously reported studies identify the distances that nurses travel in a typical shift.

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The link between nursing assignment and distance to or between patients also is worthy of scrutiny. Architectural design of the nursing unit was explored by Thompson (2003), but no recent study on the relationship among unit layout, nursing workload, and patient care quality has been published. It may be timely to revisit the design of nursing care units in light of the activity concerns mentioned above, and particularly how to minimize the distance between nurses and patients in an era where patient acuity is rising sharply (Graf, Millar, Feilteau, Coakley, & Erickson, 2003).

The current study is the preliminary result of a pretest-posttest design to evaluate the effectiveness of a wireless phone system and is a replication of a previous study (Spurck, Mohr, Seroka, & Stoner, 1995). Authors hypothesized that the new wireless phones would decrease overall workload of nurses. A main consideration is the amount of time nurses spend going from patient rooms to the central nurses station to receive and initiate phone calls to physicians, or to other areas of the hospital to coordinate care. The results from this study will provide a meaningful estimate of distance walked during a typical shift.

Methods

Design, setting, and sample. The study was conducted prospectively from September 29, 2003, to October 30, 2003 (4 weeks), on four medical-surgical nursing units at a large university hospital in the Southeast. The units, which were similar geographically and architecturally, treated adult patients with a range of medical and surgical diagnoses. All registered nurses working on the study units were invited to participate through email and a letter. An initial meeting was held on each unit for day and night shifts to explain the overall study goals and provide information about the pedometers and documentation. Questions were answered and the investigators reinforced that participation was voluntary. The study was reviewed and approved by the local institutional review board.

Procedure. At the beginning of the shift, the nurse would receive the pedometer from an off-going nurse, reset the device, place the device on his/her right hip, walk 10 steps, then read the number of steps. If the reading was between 9 and 11, the nurse was instructed to proceed with the shift and mark the total steps, hours worked, and room assignment at the end of the shift. If the pedometer was not accurate after repositioning, the nurse was instructed to select another pedometer and repeat the calibration procedure.

The Yamax Digi-Walker (Tokyo) pedometer was selected for the study. These pedometers have been used effectively to measure distance walked in a variety of situations (Hagihara, Tarumi, & Nobutomo, 2001; Manson et al., 1999; Nasr, McCarthy, Walker, & Horrocks, 2002; Silva, Shepherd, Jackson, Dorey, & Schmalzried, 2002; Tudor-Locke, Williams, Reis, & Pluto, 2002). Choice of the instrument was based on demonstrated measurement accuracy and cost (Bassett, Jr. et al., 1996; Crouter, Schneider, Karabulut, & Bassett, Jr., 2003; Schneider, Crouter, Lukajic, & Bassett, Jr., 2003). The device did not use any batteries. Its color was bright yellow for visibility.

Data analysis. Data were entered into a Microsoft Access database from handwritten log sheets by the principal investigator, then analyzed using the Statistical Package for Social Science statistical software version 12.0 (SPSS, Inc., Chicago). No patient or nurse identifying information was included in the analysis data set.

Findings

Tables 1 and 2 describe the overall findings of the 647 observations. Steps per hour worked, miles walked, and miles walked per hour worked were all derived from total steps taken during the shift. Several nurses were sampled for step length (mean distance in feet for each step taken); 2.6 feet was used as a population mean for all participating nurses for the derived value. Although some charge nurses used the pedometers during the study, only those nurses who were assigned patients during the shift were included in the final analysis.

Health Care Industry

How far do nurses walk?

MedSurg Nursing, August, 2006 by John M. Welton, Maureen Decker, Julie Adam, Laurie Zone-Smith

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