Abstract
Introduction. International experience shows that school nurses spend 36% of their working time working directly with children and 64% on other duties. Administrative tasks account for 22.1%, while preventive activities involving children and parents represent only 2.8%. As only 72% of these professionals are employed on a permanent basis, approaches to workload standardization need to be reconsidered. The workload structure of nurses in rural schools in Kazakhstan remains insufficiently studied, highlighting the need for a comprehensive analysis of working time allocation. Objective: to evaluate the work time structure and the ratio of core activities among school nurses in rural schools. Materials and methods. A secondary statistical analysis of time-motion observation data on the work activities of 14 nurses from 9 rural schools was conducted. For each nurse, 10 observation days were analyzed, yielding a total of 140 nurse-day observations and 14,112 consecutive records with a total duration of 76,389 minutes. The proportions of working time allocated to different activities were calculated using interval duration as a weight. Cluster bootstrap, permutation tests, Spearman’s correlation coefficient, and mixed-effects models accounting for repeated observations were used to assess differences and uncertainty. Statistical analysis was performed using R version 4.5.2. Results. The median duration of the observed working day was 540 [540-595] minutes. The largest proportion of time was spent on paper-based administrative work (32.3 %), followed by personal breaks (19.5 %), clinical work (11.6 %), and work in information systems (10.2 %). The administrative proportion varied between schools from 32.2 % to 62.3 %, while the clinical and preventive proportion ranged from 9.5 % to 32.9 %. Parallel work was recorded in 27.7 % of intervals, and the median frequency of switching between activities was 2.93 per hour. Conclusions. Administrative workload, broadly defined, accounted for 47.75% of school nurses’ working time. The median proportion of time spent in direct contact with children was 14.9% [5.9–26.7], while clinical and preventive activities accounted for approximately one fifth of the total observed time. No statistically significant differences were found between schools with one and two nurses. Workforce planning should consider not only the number of students but also the task structure and administrative workload.