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Reclaiming the day for patient care

Danielle Miller, RNC, PhD (c)
Elizabeth Meyers
Elizabeth Meyers, RN, PhD(c), CPHIMSS

Every day, millions of nurses report to hospitals across the globe. They assume responsibility for the care of patients across their healthcare continuum. The responsibilities of the nurse is multifaceted. They care for the patients and often times their families all while continually updating the physician on the patient’s progress. This is in addition to continually documenting both.

In a study of 767 medical-surgical nurses, it was discovered that less than 20 percent of their time is spent on direct patient care activities. And surprisingly, more than 22 percent of nurses’ time is devoted to non-clinical tasks. Paying nurses to perform non-nurse activities drives substantial cost and burden in the healthcare inpatient setting. Efficiency on the front lines makes a difference to patients and the bottom line.

How can we as nurse reclaim our workday to focus more on patient care?

Keep nurses in patient rooms.

Nurses’ patient-focus skyrockets to more than 90 percent when they are in patient rooms, but plummets to less than 18 percent when off the unit. A simple way to increase efficiency is to begin by keeping nurses in patient rooms as much as possible. Nurses travel between 1 and 5 miles each shift, moving between patients, gathering supplies, and hunting for equipment.

Keeping nurses focused on patients might be as easy re-assessing supply locations, aligning assignments to co-locate patients, or implementing an equipment tracking system.

We can also leverage the available technology by matching the skills and credentials of the nurse with the unique needs of the patient. When nurse leaders look beyond simple patient classification levels, we allow for the increased efficiency of patient care.

Streamline documentation.

Documentation takes up about 35 percent of a nurse’s day. This is an area ripe for improvement. When electronic health records were implemented, many hospitals did not have the time to streamline processes. The resulting documentation screens are duplicative, hard to navigate, and not user friendly.

Nursing informatics leaders are now promoting changes to streamline and automate documentation. In the mid-west, one organization formed an internal task force of nursing, legal, integration, and process-improvement leads. This group was able to implement changes that save hours of nursing documentation time each day, freeing up nurses to focus on patients.

Another way to save on documentation is to automate it. The new API standard from HL7, FHIR (Fast Healthcare Interoperability Resource) allows for improved data transmission. For nurses, this means document once, and leverage technology to move the data where it can be viewed to provide information. No more duplicative charting.

Delegate work appropriately.

Nearly 10 percent of a nurse’s time is spent performing patient assessments. These assessments are an important part of nursing duties, but there are a few places to check for improvement. One is around delegation: routine vital signs can be delegated to a nursing assistant. Often short staffing leads to fewer helpers on the floor and more tedious work for nurses. Leadership must carefully evaluate the right staffing mix for each particular unit.

Nurse leaders need to ensure that nurses are practicing at the top of licensure. Performing a skill mix analysis of the organizations workforce, allows for the most appropriate utilization of both nurses and nursing support. Nurses can then delegate appropriate task within scope that will allow for nurses to spend more time with their patients.

Sometimes assessments take longer because of a lack of equipment. Radio-frequency identification tags can be integrated with a bio-medical asset management system and pin-point the exact location of equipment on a unit floor-plan. This saves nurses time by eliminating the hide-and-seek game for equipment each time assessments are needed.

Medication administration.

A primary nursing function is the safe administration of medications. Nurses provide the last safety check to ensure the right medication is given at the right time and the right dose, the right way, to the right patient. Many quality checks go into making this process safe. But, leaders should investigate if it’s really necessary for nurses to spend more than 17 percent of their time delivering medications. Is there enough access to the medication storage area? Are enough scanners available, so nurses don’t need to wait in line? Are medications readily available from pharmacy? These items can drastically increase the time it takes to find.

Care coordination.

With the increased pressure to minimize inpatient days, came an increased focus on discharge planning. Nurses spend an enormous amount of time coordinating care for their patients with physicians, social services, discharge planners and the entire multi-disciplinary team. Nurse leaders can utilize technology to stay connected with the patients post -acute medical providers. The ability to have the data from previous medical visits outside of the typical brick and mortar acute hospital would save both time and money by avoiding duplicate test and procedures. A fully integrated electronic record that allows for sharing of data can assist in planning along the continuum of care for patients.

Usually discharge planning begins when the patient is admitted to the hospital. It continues daily through planning meetings that take the time of not only the primary nurse, but a discharge planner, social worker, and the entire care team.

Hospital leaders can streamline this process by carefully managing relationships with post-acute providers at system level. Integration of electronic health records outside the 4-walls of the hospitals can improve communications and planning for patient discharge. Solid relationships with post-acute care facilities creates known care paths for each patient type, and information sharing can help each entity appropriately plan and even predict patient flow.

Utilizing this approach creates a clear picture for staff-to-management communication and also provides organizations with data rich analytics. The integration of an electronic health records, both prospectively and retrospectively, allows the EHR to serve as a data source for resource allocation and clinical documentation, strategically optimizing operations using resources and allowing nurses to have more time with their patients at the bedside.

In summary, nurses chose a career of caring for patients. It’s in the best interest for all to help them achieve their career objective, keeping them at the bedside, providing care directly to patients, practicing the full scope of their licensure without being pulled off-task by non-value-added tasks.

As nurses, our primary goal as care givers is to provide high quality, safe care.

New technologies and process improvements can help achieve this goal, which is good for nurse satisfaction, good for patient care, and good for the bottom line.

Hendrich, A., Chow, M., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: How do medical-surgical nurses spend their time? RCHE Publications, 50.