Bridging between clinical nursing practice and robotics: Whichnursing tasks can be transferred to robots?
Tomoko KOMAGATA1, Yoshiko SASAKI2, Kitaro YOSHIMITSU3 , Etsuko
KOBAYASHI4 , Kenta KUWANA5 , Kaori KUSUDA6, Ken MASAMUNE3
1

School of Nursing, Tokyo Women's Medical University, Japan

2

Graduate School of Health Sciences, Tokyo Medical and Dental University, Japan

3

Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Japan

4

Graduate School of Engineering, University of Tokyo, Japan

5

School of Engineering, Tokyo Denki University, Japan

6

Faculty of Healthcare, Tokyo Healthcare University, Japan

Corresponding Author:
Tomoko KOMAGATA, Ph.D.
Associate Professor,
School of Nursing, Tokyo Women’s Medical
University
8-1, Kawadacho, Shinjuku-ku, Tokyo, 1628666, Japan+81-3-3353-8112 (ext.31472)
komagata.tomoko@twmu.ac.jp

Introduction
The nursing workforce shortage is a chronic andcritical issue worldwide1. A potential solution tobridge the gap between the increasing nursing
needs and nursing workforce supply in a superaged society is to delegate nursing tasks torobots. However, the introduction of robots into
the medical/nursing field in Japan is still limited.
An investigation was conducted into the current
state of nursing tasks, identifying tasks that canbe delegated and separating them from othertasks.
The role of nursing profession in Japan isdefined in the Public Health Nurses, Midwives,
and Nurses Act as "a person who has acquired anursing license from the Minister of Health,Labour and Welfare to provide medical
treatment or assist in medical care for injured
and ill persons or puerperal (postpartum) women,
as a profession”2. Practically, include tasks suchas support for medical treatment (e.g., clinicalobservation and assessments of patients’condition, administration of medicines, andwound management) in out- and in-patientsettings, cleaning and setting up around patients'
unit,
assistanceformeals,
physicalcleanliness/hygiene, and safe activities and goodrest, coordination with family and local medical
institutions upon discharge, patient/family
education, and so on. Nursing assistants aredefined as "persons who, as a member of thenursing team, provide nursing assistance that
does not require professional nursing skills
under the direction of a nurse in a place where
nursing care is provided"3. In Japan, nurses musthave obtained a nursing license by completing aprescribed nursing education program andpassing the national nursing examination. In
contrast, nursing assistants are not required tohave a specific license or qualification.
Most countries worldwide are facing a shortageof nurses1, as a consequence of several factors,
such as insufficient training capacity to meet thedemand, low salaries not commensurate withqualifications, tasks and responsibilities, andoutflow of nurses to other countries. In highincome countries, including Japan, theimbalance between the needs of society and thenursing workforce supply due to aging
populations has contributed to the growing
shortage of nurses in recent years. Japan is thelargest super-aged society in the world, with theaging rate reaching a record high of 29.1% in
20234. The number of older people is expected
to increase significantly over the next two
decades, with a peak expected in 20404.
Simultaneously, the birth rate is steeply
declining. For example, in 2023, 750,000 births(40,000 less than those in 2022) occurred, andthe total fertility rate fell to 1.685. Japan has thehighest life expectancy in the world, 84.3 years,
but a healthy life expectancy of 74.1 years6.
Consequently, many older adults live forapproximately ten years under medical andnursing care, thus increasing the demand for
medical and nursing needs.
With the rapid increase in nursing services, ashortage of nurses is prone to occur. The
problem lies not only in population decline but
also in nurse turnover, which has generally
remained around 11% for the past decade7.
However, a National and Public Hospital
Workers' Union Japan survey, including
approximately 50% of nurses, reported they
could not provide "adequate nursing care" owing
to shortages and other workloads. Moreover,approximately 75% of nurses “want to quit theirjob” 8. Nursing assistants also continue to be inshort supply, and their retention rate is low;
approximately 30% of both nursing assistants
and nurses resign within a year of employment7.
A report stated that "nurses should perform tasks
appropriate to their nursing license that reflect
their abilities to the maximum extent possible inpractice”9. In addition to nursing tasks that
require knowledge and skills, there are tasks that
do not require skills, and nurses are frequently
demanded to spend a large amount of time onsuch tasks10 11. The inability to provide adequate
nursing care due to being overwhelmed by taskscauses job dissatisfaction, which, in addition tofatigue, increases nurse turnover11. Task shiftingamong healthcare professionals is being
considered; however, this measure ischallenging to implement as the population is
declining, and the number of people in all
professions is decreasing. The challenges inintroducing foreign nursing staff to Japan havealready become apparent12, and the increasingneeds of the rapidly aging populations in Asian
countries also make this measure unlikely13.
One potential solution to the nursing workforce
shortage is delegating the nursing tasks to robots.
In recent years, various Information andCommunication Technology (ICT) applications
have been introduced in healthcare. However,
little progress has been made in introducing ICT
to nursing field. For example, the 'nursing
record', which records information related to thepatients’ condition, has been computerized, but
the tasks of the human nurse have remained thesame, only the tools have changed. Tools to
reduce workloads need people to use them;
however, in future, the number of people will
decrease overwhelmingly, requiring a function
to perform some nursing tasks independently,
rather than as a tool. This study aims to clarify
the detailed tasks of nurses and nursing
assistants and examine which tasks could bedelegated to robots.

counted as one from one action to the next, andrequired time for the action was measured inminutes using a standard wristwatch. Where
several actions were observed simultaneously,
the time expended was divided by the number ofactions. These direct observed data werecategorized by the actions according to theircontent; clarify the nature of the task, the timeneeded for each action, and the frequency of
their occurrence. During or after the direct
observation, semi-structured interviews wereconducted with the participants regarding theburdensome tasks and the tasks that they wanted
to or not to shift to robots. The interviews wererecorded with the consent of the participants andwere qualitatively and descriptively analyzed
after being converted into text. The participants
were verbally informed of the research details in
advance, and their written consent was obtained.
The study was conducted with the approval of
the Ethics Review Committee of the Faculty of
Medicine, Tokyo Medical and Dental University(C2022-032). This work was supported by JSPS
KAKENHI Grant Numbers JP19K11215 and
JP22K11138.

Methods
We conducted a survey in 2023 that covered all
five wards (surgical, internal medicine,community-based care, women-only, andpalliative care) of a private general hospital with200 beds in central Tokyo. With the cooperationof the nursing department of the hospital, we
selected nurses and nursing assistants who had
worked in the ward for at least one year andcould independently perform standard tasks. The
selected candidates who gave their informed
consent. They were recruited for the survey as
study participants.
A time allocation study was conducted by direct
observation (shadowing) to identify not only theregular tasks described in the nursing operations
manual, but also the detailed and miscellaneoustasks in between the lines14. The researcher who
has a nursing license and clinical experiences
accompanied the participant from the beginningto the end of the day shift work at approximately
one meter, observing and recording all theactions of the participant. The actions were

Results
In the target hospital, 25–30 nurses wereassigned to each ward of approximately 30
inpatients. Working hours were in two shifts:
day shift 8:30–16:30 and night shift 16:30–8:30.
All nurses, except those working short shifts,
worked both day and night shifts, with eightdays off in four weeks and no more than fournight shifts per month. In the wards, five to six
nurses, a head nurse, and one or two nursing
assistants worked the day shift, while three
nurses worked the night shift. No family
accompaniment existed except in exceptional
cases such as highly critical or terminal periods,
and the nurses and nursing assistants were
responsible for patients’ daily lives. Each ward
had five to six private and four-bedded rooms,
two communal toilet, one bathroom, one
storeroom, one linen room, and one waste room,
as well as an elevator and one lift each for large
and small luggage.
1) Nursing tasks

Direct observation of nurses was conducted onten participants, two in each ward (Table 1). All
participants were female, had a medianexperience of 16.5 years, and were in their 30s
and 40s. The observation period wasapproximately seven hours, but eight of the tenparticipants arrived at work 15–30 minutes
earlier than the stipulated time and started work.
The lunch break was 45 minutes, but the median
actual break was 40 minutes. The median
number of observed actions was 316, which wasless for nurses with more years of experience.
The observed actions were categorized into 40
domains according to their contents, and thetime spent on each action and the number ofoccurrences were calculated (Figure 1). The“nursing record entries” consumed the most time,
followed by “reporting and exchanging
information between nurses”. “Moving within
the ward” was the third most time-consuming
and most frequent activity. On average, 83 trips
per one dayshift were made to and from wards
and staff stations to exchange information,
retrieve items from wards to the equipment andlinen rooms, and separate waste after patientcare and dispose of each item in its designatedplace, requiring 46 minutes. While tasks, such as“explanation to patients”, “medical treatment”,
and “clinical observation” require specialist
knowledge and skills, tasks such as “disposing
rubbish”, “tidying”, “cleaning”, and “othersmall tasks requested by patients” (e.g. changing
batteries in TV remotes, picking up items thathave fallen under the bed, and taking drinks
from the fridge) do not require specialist
knowledge and skills. These non-skilled tasks
accounted for approximately 75% of all tasks.
Six of the ten participants were interviewed
regarding the tasks they would/would not like todelegate to the robot. All study participants
wanted to transfer the nursing record entry. They
also asked for more efficient informationgathering tasks such as patient conditions, theday’s schedules, and their reminders. Some alsosuggested that robots would be better for tasks
that repeat the same content, such as showing
patients around the ward on admission or
explaining preparations before the generalexamination. Tasks requiring muscular strength,

such as moving a patient from a bed to awheelchair, were also mentioned. Looking after
patients with dementia, especially at night, wasalso mentioned by several participants. However,no requests for transferring the third most timeconsuming task—moving around the wards—
was mentioned, nor was there any sense of
burden. The tasks that they did not want to bedelegated to robots included direct patient careand listening to patients, with the participants
stating that “we would like to have time to justtalk to patients and listen to them calmly”, “Wewould like to bathe all the patients who needassistance with bathing every day, just as they doat home."2) Tasks of nursing assistants
The survey of nursing assistants was conducted
on seven participants, two in each of the fourwards where assistants were assigned at the timeof the survey and one in one ward (Table 2). All
participants were female, with a medianexperience of ten years. The nursing assistants
worked 8:30-16:30 without overtime and had theprescribed 45-minute lunch break. The median
number of observed actions was 407, and,contrary to the nurses, the participants with more
years of experience had more actions.
The observed actions were categorized into 24
domains, and the time spent on each and thenumber of occurrences was calculated. Figure 2
shows the average time and number ofoccurrences spent by the seven nursing
assistants on their daily tasks. Nursing assistants
spent most time moving around the ward,
followed by exchanging information between
assistants. In addition to assisting with bathing,changing bed sheets, cleaning and setting up thepatient’s units, and so on, non-skilled but
essential life support tasks for the patients were
performed, such as helping patients with smallpurchases and using their smartphones (thesmall requests which patients hesitate to ask to
the nurses). Ordering and restocking medical
and hygiene materials used in the wards was also
their task, and they would order and pick up any
items needed the next day. When the patientswere moved from one room to another before orafter surgery, the nursing assistants were also
responsible for moving beds, shelves, and thebelongings of the patients. All nursing assistanttasks are non-skilled, but the skilled tasks fornurses would be impossible without them. The
nursing assistants were constantly aware of thisand performed miscellaneous and detailed tasks
with anticipation and care based on theirexperience to ensure that medical and nursing
care was performed smoothly.
Regarding the nursing assistants, wheninterviewed about the tasks they would liketransferred to robots, they mentioned tasks suchas ordering and restocking supplies, carrying
heavy items such as beds and selves, andaccompanying patients with minor illnesses
when go out from the ward activities such as
shopping and medical examination.

Discussion
The study results show a crucial juncture in theevolution of clinical nursing practice,highlighting the essential role of human nurses
and the growing potential of robotics to support
this profession. Our findings reveal a substantial
part of the nursing workload comprised of nonskilled tasks, such as moving around the ward,
disposing of rubbish, and managing various
administrative tasks. These are areas where
robotic assistance could not only alleviate thephysical burden on nurses, but also reclaim
valuable time for patient care and other highvalue, skilled tasks that require human judgment,
empathy, and interaction.
Interestingly, while our participants did not
perceive tasks like moving around the ward as
burdensome, the quantifiable data suggest thatthe time dedicated to such activities could be
strategically reallocated to enhance patient care
if robots were to assume these responsibilities.
This aligns with the notion that nursing
professionals, deeply committed to patient
welfare, might underreport their own strain or
the inefficiency of their work patterns. By
introducing robots to handle tasks such as waste
disposal, carrying supplies, and even managing
straightforward,
but time-consuming

administrative duties, we can envision a shift
towards a more sustainable model of nursingthat prioritizes human interaction and theapplication of clinical ability.
However, the seamless integration of robots into
the nursing ecosystem requires carefulconsideration. It is essential to acknowledge thenuanced dynamics of patient care that robots
cannot replicate, such as the empathetic
communication and understanding that form thecornerstone of nursing. The goal of integrating
robotics is not to replace nurses, but rather tocomplement their work, allowing them todedicate more time to patient care and tasks that
use their irreplaceable human skills.
Furthermore, our study participants expressed aclear preference for retaining direct patient care
activities within the human domain,emphasizing the value of personal interaction innursing. This insight is pivotal, guiding us
towards implementing robotic solutions in amanner that respects and preserves the humanessence of nursing. As we navigate thechallenges of a global nursing shortage, the goal
should not merely be to offload tasks to robots,
but to enhance the quality and reach of nursing
care through thoughtful collaboration between
humans and technology.

Conclusion
In conclusion, bridging the gap between clinicalnursing practice and robotics presents anopportunity to address workforce shortages,
while maintaining, if not enhancing, the qualityof care. By targeting specific non-skilled tasks
for robotic assistance, we can relieve theworkload on nurses, allowing them to focus on
the core of their profession: providing
compassionate, skilled care that supports thehealth and wellbeing of their patients. Thisvision for the future necessitates a collaborative
effort between healthcare professionals,
technologists, and policymakers to ensure thatrobotic integration respects the values of nursing
and meets the evolving needs of our societies.

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the Work of Nurses, Licensed Practical
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Table 1 Characteristics of the study participants (Nurses)
Contents
Clinical experiences (years)
Observed time (hours/minutes)

Participants
A

B

C

D

E

F

G

H

I

J

25

13

20

20

13

30

9

13

20

9

8 h 46 m 7 h 16 m 5 h 31 m 6 h 22 m 7 h 49 m 7 h 04 m 7 h 35 m 8 h 15 m 7 h 02 m 6 h 57 m

Observed actions

349

317

171

292

412

320

289

320

310

314

Lunch break (minutes)

40

45

44

40

35

40

40

43

45

38

Preparation foe the day’s work (minutes)

30

15

0

0

30

13

25

40

26

30

0

Figure 1 Observed nursing tasks: length of time and frequency (average of 10 nurses)
Response for the visitor

Preparation or the examination

On the Job Training

Time (min)Diaper changing

Attendance for Informed consent etc.

Response for admission and discharge

Preparation for post-operative care

Preparing for work

Wash hands, disinfect, change gloves

Meal assistance

Delivery and setting the meals

Postmortem care

Assistance with transfers

Preparing for nursing care

Conversations with patient families

Storage/management of medical narcotics

Make handwritten notes on whiteboards, etc.

Cleaning and setting up around patients' bed

Paper works

Accompanying the patient on a light walk

Answer phone calls

Participation to the meeting

Hot/cold pack changing

Assistance with toiletting

Responding to phone and nurse calls

Disposing patients' trash and cleaning up

Visual confirmation before medication

Verifying patients' data, schedule and…

Hygiene and personal care

Clinical observation/monitoring

Responding to patients' minor requests

Preparation for the day's work (unpaid)

Preparation for medical treatment

Team meeting in the ward

Medical treatment

Conversation with patientsMoving around in the ward

Reporting/information exchange

Nursing record entries by PC

90

80

Frequency (times)

70

60

50

40

30

20

10

Table 2 Characteristics of the Study participants (Nursing assistants)
Contents
Age
Work experiences
Qualification
Observed time (hours)
Observed actions

A
48
15
None
7h0m
245

Participants
B
C
D
E
45
47
47
47
10
10
10
10
Certificate Certificate Certificate Certificate
5 h 30 m 4 h 42 m 4 h 57 m 5 h 39 m
391
403
419
408

F
60
5
None
5 h 21 m
407

G
27
1
None
6 h 09 m
305

0Figure 2 Observed nursing assistants’ tasks: length of time and frequency (average of 7 nursing assistants)
Paper works

Checking and filling out schedules

Time (min)Wash hands, disinfect, change gloves

Moving beds, shelves, and other items

Washing and drying used instruments

120

Responding to patient's minor requests

Prepare and replace medical waste box

Answering phone calls

Watching over patients

Talking to patients

Serves and removes food from the table

Meal preparation (setting table and cups)

Replenishing supplies

Putting things in place and organizing

Putting away used bedsheets/towels/patient's wear

Hygiene and personal care

Assistance with transfers

Cleaning, garbage collection and disposal

Carrying things

StandbyCleaning and organizing patient units

Diaper check and change

Assistance with bathing

Assistance with toiletting

Other minor tasks

Informaion exchange

Bed sheet exchange

Moving around the ward

140
Frequency (times)

100

80

60

40

20