Clinical interruptions, incessant unfiltered patient alarms and alerts, and extensive documentation – these are all things that inhibit nurses from providing the best patient care and can cause burnout. Unfortunately, these issues are the norm at most hospitals and healthcare systems. Decatur Morgan was no different, but they decided to do something about it. They assessed the situation, solicited feedback from clinical staff, worked on a plan, and took action to enable their nurses to do what they do best: care for their patients.
Bryan Vest, MSN, RN, Service Line Director of Inpatient Nursing at Decatur Morgan, talked to us about the hospital’s journey to enhanced care delivery, higher patient satisfaction, and improved nurse retention.
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TigerConnect: What were the issues Decatur Morgan was experiencing?
Bryan Vest: Our nursing environment became a checklist environment where nurses had to document and submit an enormous amount of detail about each patient encounter to their charge nurses at the end of each shift. It did not take long before our nurses felt they no longer were able to truly care for, and build relationships with, patients and their families.
We asked our nurses to write their ideal job descriptions. When we got them back, there wasn’t a single task listed. Instead, everything was entirely focused on relationships: relationships with patients, with families, with physicians, and with co-workers.
In an optimal workflow, these nurses should be going from patient room to patient room. However, our nurses were going back and forth to the soiled utility room, the clean utility room, the central station, etc., resulting in minimized time at the bedside.
TC: What was the plan for change and how was it executed?
BV: We saw the need to increase the time nurse directors spent on the unit floor to at least 50 percent. This added presence allowed for more daily interactions with staff and created opportunities for observation, modeling, and coaching. To accomplish this, we reduced the load of minor clerical work by shifting it to administrative subordinates.
In order to increase the support of the frontline nurses and directors, the role of the charge nurse needed to be amplified. Traditionally, the charge nurse role at Decatur Morgan was in name only. The charge nurse would be given an assignment and move through the shift as just any other RN on the unit. Our team decided to magnify the authority of the charge nurse by offering true autonomy and empowerment, allowing them to more effectively manage the daily operations of the unit.
It was clear that the RNs needed assistance from support staff to help take on the many duties that didn’t require a nursing license. I refer to this concept as “working at the top of your license.” By having RNs primarily attend to the tasks aligned with their licensing (admit/discharge, performing procedures, rounding, etc.) – while being supported by the nursing assistant on lesser tasks – they would gain valuable time to build the nurse/patient relationship.
Another outcome from our audit showed that RNs were spending 28 minutes per patient per day at the Pyxis med stations. To rectify this, LPN medication nurses were hired to prepare meds for patients and act as a liaison between the RN and the pharmacy to increase RN time with patients.
TC: What did you do to make sure staff complied?
BV: Recognizing that change is not easy and that people are nostalgic about the old way of doing things (even when they know it isn’t working), leadership had to address how to lead in a transformational style. The team adopted the principle that modeling, coaching, and clear communication were absolutely essential to transforming the organization’s approach to patient care. They understood that the key to successful implementation was to ensure that the entire staff (including management) understood and believed in the “why.”
TC: Were there any additional positive outcomes after implementation?
BV: An unexpected – but extremely valuable – result was a significant decrease in RN turnover, saving substantial hospital funds. This was the first time that Decatur’s RN turnover rate was a single-digit percentage. The leadership and support given to the staff have been fundamental to reaching this objective. Decatur’s model has been recognized by the nursing community, which has made it a very sought-after, desirable place to work.
TC: How do you ensure continued improvement?
I told my team over and over that this process will never be complete. We will forever be improving our processes to optimize patient care in our hospital. We meet with the entire service line twice a year in a town hall-type meeting to continue to elicit feedback on what’s working, what’s not, and what we can do to improve their ability to provide excellent care for patients and their families.
And when we decide to implement a new change in procedure or process, we can rely on the flexibility of the Critical Alert [now TigerConnect Alarm Management & Event Notification] system to help us meet that challenge.
TC: Was there a goal in mind when you started seeing patient satisfaction percentages increase?
BV: Some 64 percent is the goal for patient satisfaction surveys. Then there is a ranking – usually between 1 and 20. The percentage was 30-40 percent, and it has continued to increase. At times we’ve been up in the 70s, which moves the ranking up to the 80th percentile – double what we were doing before. This was over a 3-month period.
TC: What changed in the management of your processes?
BV: We were tasked with focusing on patient satisfaction – one of the lacking scores was our consistently long response time – and we couldn’t figure out how to raise our satisfaction. When we discovered that we could see the response times to patient calls in real-time, that changed everything. It allowed us to test out ideas and see what worked.
TC: What was your breakthrough moment?
BV: Because the system is web-based, one of our team members was able to view the reporting from her home. This allowed her to watch what was going on during the weekends, and she was able to see that there were delays in call response. This made all of the difference! Understanding that the satisfaction dipped over the weekend allowed us to pinpoint issues with workflow, shifts, scheduling, and personnel.
With the innovative use of analytics from TigerConnect’s nurse call, RTLS, and mobile applications, Decatur Morgan’s leadership can now visualize clinical workflow, identify inefficiencies, continuously monitor processes, and deploy corrective actions as needed. They were able to increase patient satisfaction scores, reduce patient falls, decrease RN turnover, and, most importantly, significantly increase the amount of time nurses have to care for their patients.
To ensure success in improving nurse workflows, it’s imperative to work with the nursing staff, hearing what they have to say to truly understand how to alleviate what hinders them from caring for their patients. For a successful implementation, it’s also vital that the entire staff, including management, understands and believes in why enhancements are needed and what they can accomplish.