Nurses Aiming To Spend More Time With Patients


By Laura Landro

Hospitals Hope Extra Face Time and Personal Attention Will Help Make Recovery Easier

Hospitals are freeing up nurses to do the one thing they often don't have enough time for: taking care of patients.

Swamped with tasks such as hunting for supplies, tracking down medications, filling out paperwork at the nursing station and looking for missing test results, nurses may spend less than two hours of a 12-hour shift in direct patient care, studies show. But research has also found that the more time nurses spend at the bedside, the less likely patients are to suffer falls, infections and medication errors, and the more likely they will be satisfied with their care.

Chris Hoang, a nurse at Novant HealthPresbyterian Medical Center in Charlotte, N.C., spent his shift last Saturday juggling direct care duties such as administering medications, assessing patients and talking to their families. But he had to take time hunting down a battery for some equipment and picking up and warming food for a patient.

Now hospitals are changing traditional work practices, shifting more routine tasks to certified nurse assistants and other less highly skilled staffers. They are eliminating inefficient processes that make nurses walk as many as 5 miles around the hospital in a single shift. Some hospitals are aiming to triple the amount of time nurses spend with patients.

That means locating supplies inside patient rooms and having pharmacists deliver medications to patient floors. As more hospitals adopt electronic medical records and place computers in patient rooms, they are enabling nurses to access information quickly and fill out medical charts while keeping close to patients.

The aim is to let nurses spend more time both caring for patients and educating them and their families on follow-up care once they leave the hospital. An aging population means sicker patients with more complex needs, yet hospital stays are much shorter than in the past. Patients get discharged sooner with more complicated follow-up care, and hospitals face financial penalties for readmitting patients soon after discharge. Meanwhile, many hospitals face nursing shortages, with heavy turnover among burned-out nurses who find they are not doing the job they entered the profession for.

"We shouldn't be using expensive professional nursing time doing unnecessary and inefficient things when that time could be reinvested in direct patient care," says Patricia Rutherford, a nurse and vice president at the Institute for Healthcare Improvement.

The nonprofit, in partnership with the Robert Wood Johnson Foundation, developed Transforming Care at the Bedside, a program to help hospitals increase to 70% the amount of time nurses spend in direct patient care while improving the work environment for nurses. Nursing groups and state hospital associations are using its tools in workshops for front-line nurses and other care-team members. Many hospitals are adapting its lessons to their units.

Presbyterian Medical Center is one of 14 hospitals operated by Winston-Salem, N.C.-based Novant Health, which found in a 2010 internal audit that nurses were involved in direct patient care at the bedside for only 2.5 hours every 12-hour shift. "Not only was that eye-opening, it was also completely unacceptable," says chief clinical officer Sallye Liner, a nurse by training. "We realized we needed to change the way we delivered care and get our nurses back to the bedside."

Novant hit 6.5 hours per shift at the end of 2013 with a goal to hit 8.5 hours by the end of 2015.

Novant has expanded the duties of staffers, like licensed practical nurses, or LPNs, and certified nurse assistants, or CNAs, at all its hospitals, including 50 medical-surgical units. CNAs are licensed to provide care such as changing wound dressings and inserting bladder catheters, but they often weren't doing so. The shift to the team-based model helped Novant save $20 million last year, adding more certified nurse assistants without any overall reduction in nursing staff.

Novant's efforts got a boost from new electronic medical records which it installed in four hospitals starting last year. Three more go live next month. Computers were placed in patient rooms so nurses could fill in medical data at the bedside and share test results. At Presbyterian Medical Center, the electronic records have reduced by 42 minutes the amount of time spent paging doctors, copying and faxing, and tracking down tests, Novant's analysis shows.

Mr. Hoang, 27, graduated from nursing school last year after working as a certified nurse assistant. He says having computers in the room not only enables him to spend more time with patients, but also allows him to show them images and charts to help explain their condition. "If a patient has a chest X-ray, I can pull it up to show them what their lungs look like, and why they may hear a gurgling sound and feel the way they do, instead of having the doctor just come in and say, 'Well, you've got pneumonia.' "

Last week, Mr. Hoang was caring for patient Rafe Pride Sr. , 91, who was hospitalized for diverticulitis, an intestinal infection. His daughter, Cleauary Pride Jackson says she noticed that nurses were "more hands-on" than in past hospitalizations, when she says her concerns weren't always completely addressed. Mr. Hoang "really went to bat to make sure things happened and tests were being run when they were supposed to be run," Ms. Jackson says. "He was a total patient advocate."

Nurses make rounds hourly to check on the half-dozen or more patients under their care. Nurse assistants stop in every hour on the half-hour. During shift changes, incoming and outgoing nurses now hand off care in patient rooms instead of the hallway. Rather than the past practice of simply asking how patients are doing, they now have a list of specific questions, including whether they need help getting to the bathroom from the bed. The change helped sharply reduce the number of call bells and cut the number of patient falls 70% across all medical-surgical units, Ms. Liner says.

Kathleen Venant, clinical unit leader on Presbyterian's medical-surgical unit for kidney and gastrointestinal patients says nurses had to take courses on delegating such responsibilities. "We were so used to taking care of everything. We now are more comfortable telling the CNAs, 'I need a catheter inserted,' instead of doing it ourselves."

Deborah Cashwell, 57, who has been hospitalized several times for recurrent GI issues, says nurse assistant Katherine Rivers is always checking in on her, bathing her and helping her in and out of bed. "I haven't had to push a call button once today," she said while in the hospital two weeks ago.

Nurse Corinne White says spending more time with patients enables her to bond with them. As a result, she says they feel comfortable communicating their needs and concerns, especially when about to undergo an invasive procedure like a catheter insertion. "If I am rushing around taking care of this and gathering that, they don't have time to get to know you a bit in order to open up and express themselves," she says.


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