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Aim: To describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward., Design: A single-centre observational descriptive study., Method: Using a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre-registered list of 42 activities classified into 13 dimensions., Results: A total of 507.5 work hours were observed. Less than one third of registered nurses' work time was spent with patients. They allocated the most time to the dimensions of 'communication and care coordination' and 'care planning', whereas 'optimizing the quality and safety of care', 'integrating and supervising staff' and 'client education' were allocated the least time., Conclusion: This study provided a reliable description of nurses' time use at work. It highlighted suboptimal use of the full scope of nursing practice., Impact: Both work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses' skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses' knowledge., (© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)