Nursing-related time toxicity: An evolutionary concept analysis.

BACKGROUND

Time toxicity has been used in cancer care to describe the time patients lose to treatment and healthcare-related activities. In nursing work, time-related problems have been described across several areas, including documentation burden, electronic health record use, non-nursing tasks, low-value care, time pressure, missed nursing care and recovery loss. However, these phenomena have not been integrated into a coherent nursing concept.

OBJECTIVE

To clarify the concept of nursing-related time toxicity by identifying its surrogate terms, related concepts, defining attributes, antecedents, consequences, empirical referents and contextual features.

DESIGN

An evolutionary concept analysis.

DATA SOURCES: Six databases were searched from May to June 2026: PubMed, CINAHL, Web of Science, Embase, China National Knowledge Infrastructure and Wanfang Data.

REVIEW

METHODS

Rodgers' evolutionary method guided the analysis. Records were screened against predefined eligibility criteria. Articles were included if they focused on nursing work and provided substantive conceptual information on time-related or task-related phenomena. Data were extracted using a structured form and analyzed through iterative qualitative coding and constant comparison within and across studies.

RESULTS

Twenty-three studies published between 2009 and 2026 were included. The term nursing-related time toxicity was not used in the included studies, but the phenomenon was represented through surrogate and related terms such as documentation burden, electronic health record burden, non-nursing tasks, low-value nursing care, time pressure, care left undone, missed nursing care, implicit rationing and missed breaks. Five defining attributes were identified: low-value or non-nursing time occupation, documentation and electronic health record-mediated time consumption, direct care and interaction displacement, time pressure, scarcity and prioritization, and recovery and temporal spillover loss. Antecedents included organizational and workforce conditions, technological conditions, role misalignment and regulatory demands, and clinical care demands. Consequences included unfinished or omitted care, risks to patient safety and care continuity, nurse well-being and occupational consequences, and organizational and workflow consequences.

CONCLUSIONS

Nursing-related time toxicity is an emerging concept that captures harmful patterns of time use in nursing work. It is distinct from general workload, time pressure, documentation burden, missed care and burnout, although it overlaps with each. The proposed definition and conceptual model provide a foundation for future measurement, empirical testing and organizational interventions aimed at protecting professional nursing time.