multitasking: how much is too much?

he other day I was sitting atmy desk typing an editorial,checking my e-mail, listeningto a mandatory continuingeducation program on hepati-

tis C, and worrying about the AORNJournal work piling up. I realized I wasn’t concentrating on any of it thor-oughly and was making errors.

Research performed over the lastfew decades has shown that qualityand depth of thought deteriorate whena person tries to attend to more thanone task at a time (ie, multitask).1 Peri-operative nurses are routinely expectedto handle many tasks simultaneously.Computer charting, answering pagers,monitoring technical equipment, pro-tecting the patient, assisting all mem-bers of the surgical team, and prepar-ing medications are only a few of anurse’s routine daily tasks, some ofwhich may need to be performedsimultaneously. How many tasks are so repetitive one doesn’t have to thinkabout the actions involved? How manyare complex and require focus, judg-ment, and decision making? Does mul-titasking contribute to safety issues?

THE MECHANICS OF MULTITASKINGExperts believe that rather than

simultaneously attending to all tasks atonce, what really happens duringmultitasking is a rapid change of focusbetween tasks.1,2 Hal Pashler, PhD, apsychology professor at the Universityof California, San Diego, found that“highly practiced skills” can be easilyperformed while one is thinking aboutsomething else, but the addition of atask that requires decision-makingswitches one’s attention to that task.1

When people perform higher leveltasks, they are using the cognitive func-tion called “executive control.”2 Thisfunction is housed in the prefrontal

MARCH 2007, VOL 85, NO 3 • AORN JOURNAL • 505

Multitasking: How much is too much?

E D I T O R I A L

Nancy J. Girard,RN

T

© AORN, Inc, 2007

cortex, the part of the brain associatedwith perception and thinking. Execu-tive control is the brain’s supervisor formost cognitive functioning. It establish-es priorities, decides what tasks are themost important, and assigns mentalresources to completing the tasks.2

Executive control has two mainactivities: goal shifting (ie, do this nowrather than that) and ruleactivation (ie, turning offthe rule for one task andturning on the rule foranother) that help peopleunconsciously switchfrom one task to another.2

Although these activitiestake only several tenthsof a second, the repeatedneed to switch betweentasks can add to extratime for performing bothtasks.2 Many studies onmultitasking reflect thesame findings: there aremental and time costs formultitasking.1,2

When people try to perform two ormore related tasks either at the sametime or alternating rapidly betweenthem, errors go way up, and it takesfar longer—often double the time ormore—to get the job done than ifthey were done sequentially.1

Young people, who have grown upusing advanced technology, are accus-tomed to multitasking, but researchersare now finding they have a decreasedability to concentrate, think deeply, andstay on task.1 Older people’s cognitiveability to multitask decreases evenmore because of fundamental changesin the brain as one ages, such as slow-ing of thought processing, visual pro-cessing, or motor movements.3

Quality anddepth of thoughtdeteriorate whena person tries toattend to morethan one task

at a time.

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MARCH 2007, VOL 85, NO 3 Editorial

MULTITASKING AND SAFETYA common example of

modern-day multitasking isusing a cell phone while driv-ing. In one study,3 all partici-pants showed a decrease inbraking reflexes and ability tokeep the simulated car on theroad when they took on thesecond task of using a cellphone. To determine whetherage was a factor in multitask-ing ability, young people ages20 to 30 years were tested, aswere older adults ages 60 to70 years. The study examinedlateral stability on the road(ie, how much one weavesfrom side to side in the lane)and brake response (ie, howfast one can stop when a lightsuddenly turns red).

There was no differencebetween the two groupswhen only one task (ie, simu-lated driving) was performed.Then a second task wasassigned in addition to thedriving. The participants hadto dial an 11-digit telephonenumber; initiate the call; and,after receiving voice confir-mation that they had dialedthe right number, hang up.When this second task was

added, participants in bothage groups had a significantdecrease in ability to maintainlateral stability and in brakingresponse time, although theeffect was greater for olderdrivers. The study demon-strated the potential for safetyrisks in this everyday multi-tasking situation.

BE AWAREWe cannot change the need

for multitasking in the OR. If anurse is positioning a patientwhile the surgeon is applyinga tourniquet, the nurse mayquickly have to shift prioritiesto help the surgeon apply castpadding. It is necessary thenthat the nurse return to thefunctions of positioning tomake sure that it is completedand done correctly. In additionto performing work duties, ifa nurse also looks at e-mail,surfs the Internet, or playscomputer games during longsurgeries (which I hope noneof our readers do), there isincreased potential for errorsdue to cognitive overload.

Being aware that multitask-ing could present a safety riskmay decrease chances for error.

One can try to avoid doingtwo complex or unfamiliartasks at the same time, beaware that unusual or new sit-uations may make multitask-ing slower and more difficult,and know that age may play afactor in ability to multitask. ❖

NANCY J. GIRARDPHD, RN, FAAN EDITOR-IN-CHIEF

REFERENCES1. Wallis C. The multitaskinggeneration. Time. March 19, 2006.Available at: http://www.time.com/time/magazine/article/0,9171,1174696,00.html. AccessedJanuary 26, 2007.2. Is Multitasking More Efficient?Shifting Mental Gears CostsTime, Especially When Shiftingto Less Familiar Tasks [newsrelease]. Washington, DC: TheAmerican Psychological Associ-ation; August 5, 2001. Availableat: http://www.apa.org/releases/multitasking.html. AccessedJanuary 26, 2007.3. Salvucci D, Chavez A, Lee FJ.Modeling effects of age in com-plex tasks: a case study in driv-ing. Proceedings of the 26th AnnualConference of the Cognitive Society.Hillsdale, NJ: Lawrence ErlbaumAssociates. In press. Available at:http://viscog.cs.drexel.edu/publications/CSC04.pdf. AccessedJanuary 26, 2007.

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