I read an article a few weeks ago that truly blew me away. It first caught my attention in Becker’s Hospital Review, but I have since seen it appear in other publications, such as the Wall Street Journal. It was about bringing nurses back to the bedside. You may be thinking “Isn’t that where they are already?” But here’s the big surprise. The article was about Novant Health in North Carolina and their initiative to free-up nurses so they can spend more time doing what they do best: taking care of patients.
It all began when hospital leaders wanted to know how much time nurses actually spent in patient rooms during a 12 hour shift. What they found was shocking to me, at first. It was only 2 ½-3 hours! They weren’t alone; other healthcare organizations had similar findings. Still, that really floored me! But then I recalled when I was a bedside nurse and I have to admit, considering the nurse/patient ratios and all the activities involved in caring for the average med-surg patient, 2 ½-3 hours sounds about right. I often commented that although it may have taken me five minutes to complete a task, it took more than twice as long to gather the supplies … sometimes having to call or even go to another department … then round up a co-worker to provide an extra set of hands, and afterwards, of course, document it all. With shorter patient stays, quicker patient turnover, and older, sicker patients, med-surg nurses are really squeezed.
Novant decided to do something about it and set an ambitious goal—70% of nurses’ time (or 8.5 hours of a 12 hour shift) spent in patient rooms. To develop a plan to accomplish this, they gathered a group of 40 nurses from across their healthcare system. Wisely, they engaged their own experienced nurses to brainstorm solutions instead of hiring an outside consulting group to swoop in, do a big study, and then dictate a plan of action. The nurses studied process flow and discovered the top activities that pulled them away from the bedside: hunting for supplies, tracking down medications, filling out paperwork, and looking for test results.
The battle plan they developed involved implementing a care team approach that called for LPNs, CNAs, pharmacy techs, and other support staff, to rally around the RN to ensure all of a patient’s needs would be addressed. This included some adjustments in each person’s role so that each team member functions to the full extent of their training and licensing.
In addition, they relocated supplies either in or closer to patient rooms; brought medications to the point-of-care; and implemented an EMR with physician order entry, along with a computer workstation in each patient room. This was all aimed at reducing the required steps in caring for the patient along with documenting that care. Bringing everything the patient needs to the point of care—what a revolutionary idea!
Integral to this strategy was automating the capture of medical device data, which freed-up the clinician from the manual process of entering data into the patient record; not to mention increasing the accuracy of the data, as well. It’s an essential tool that allows nurses more time to focus on the most important part of their job—the patient.
Research proves the more time nurses spend at the bedside, the fewer patient falls, the fewer medication errors, the higher the patient satisfaction rates, and the lower the infection rates. Furthermore, nursing satisfaction also increases, leading to lower nurse turnover. Med-surg units are the backbone of any hospital. Easing the workload of this vital group can only lead to good things.
Oh, and by the way, Novant reached their goal. Nurses are now spending 72% of their time in patients’ rooms allowing them to not only care for their patients, but also keep patients and their families better informed regarding post-hospital care, ways to improve their health, and the prevention of subsequent hospitalizations. Very impressive Novant! Bravo!
How much time do you think nurses at your hospital are engaged in direct patient care?
What measures have been instituted in your organization to increase nurses’ time at the bedside?
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