Public Health Nurses' Time Allocation in Local Government Nursing Settings: A Self‐Reported Prospective Time Study

This study quantified how public health nurses in Japan allocate their work time, revealing significant differences between prefectural and municipal nurses and highlighting the burden of administrative tasks. The findings suggest a need for workload reallocation to align with each level's mandate.

K. Yoshioka-Maeda; Hiroshige Matsumoto; C. Honda; Kazuya Taira; Noriko Hosoya; Miki Sato; Riho Iwasaki-Motegi; Yuka Sumikawa; H. Fujii; Takahiro Miura; Misa Shiomi· Journal of Advanced Nursing· 2025· DOI 10.1111/jan.70314

The core problem

Public health nurses (PHNs) play a critical role in community health, yet their time allocation across various tasks remains poorly understood. In Japan, PHNs work at both prefectural and municipal levels, each with distinct administrative mandates. Prefectural PHNs typically focus on regional health planning and coordination, while municipal PHNs provide direct services such as health examinations and individual coordination. However, the actual distribution of their daily activities has not been quantitatively examined. This study aimed to clarify how PHNs allocate their time across tasks and compare time-use patterns between prefectural and municipal PHNs, as well as across different job positions. Understanding these patterns is essential for optimizing workforce planning and ensuring that PHNs can focus on high-impact public health services.

Innovation

This study employed a self-reported, prospective time study design. Participants were PHNs from two municipalities and one prefecture in Japan. They recorded their daily practices and time allocations using Kintone, a cloud-based platform. Data were collected over a period, resulting in 9,502 person-days of data from 121 participants. Time allocation differences by administrative level (prefectural vs. municipal) and job position (manager vs. non-manager) were analyzed using linear mixed-effects models to account for repeated measures and clustering. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline. The trial was registered with the UMIN Clinical Trials Registry (UMIN000051509).

Introduction

Public health nurses (PHNs) play a critical role in community health, yet their time allocation across various tasks remains poorly understood. In Japan, PHNs work at both prefectural and municipal levels, each with distinct administrative mandates. Prefectural PHNs typically focus on regional health planning and coordination, while municipal PHNs provide direct services such as health examinations and individual coordination. However, the actual distribution of their daily activities has not been quantitatively examined. This study aimed to clarify how PHNs allocate their time across tasks and compare time-use patterns between prefectural and municipal PHNs, as well as across different job positions. Understanding these patterns is essential for optimizing workforce planning and ensuring that PHNs can focus on high-impact public health services.

Why it matters

The findings reveal structural differences in role expectations between prefectural and municipal PHNs. Municipal PHNs are more involved in direct service delivery and paperwork, while prefectural PHNs focus on management and coordination. The high proportion of time spent on administrative tasks, such as application paperwork, suggests a hidden burden that may detract from clinical and community health activities. Managers also face a shift away from direct care, which may impact their ability to supervise and support frontline staff. These patterns underscore the need to reallocate workloads to better align with each level's mandate. Strategies such as task prioritization, integration of information and communication technology (ICT) tools, and enhanced administrative support could reduce non-clinical workload and enable PHNs to focus on high-impact, value-added services that promote health equity. This study provides the first quantitative evidence of PHNs' time allocation across administrative levels and positions, offering critical insights for workforce planning and sustainable public health service delivery.

Who should read this

Praktisi kesehatan, peneliti klinis, dan pembaca Research Digest.

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