Today’s Webinar will begin at 11:30AM 3/28/12. Please do not put your phone on hold; use the mute function or *6 Please type questions or comments

3/28/12

Please do not put your phone on hold; use the mute function or *6

Please type questions or comments into text box

If time permits, we will open up the phone lines at the conclusion of the presentation

Projected Nursing Shortage into 2012 and beyond Changes in supply and demand Recruitment to rural healthcare environment Fewer people entering and staying in nursing Projected need for more health services as population aged Overall RN vacancy in 2001

Patricia Davis, RN Connie A Jastremski, RNNetwork CNO

Increase number enrolled nursing students and retain them through graduation

Retain new graduates, all nurses, including older nurses

Attract nurses who seek different roles or want to return to the bedside

Bassett Healthcare Network-Bassett Medical Center

In early 2000, began to receive attention

Alert to knowledge and wisdom Identify new roles


Age and performance Human Resource benefits entice older worker

Career fulfillment Work design


Turnover costs are staggering◦ Equal to or greater than two times salary◦ 2000 nurse turnover 21.3%

National average salary for med/surg RN of $47,000

$94K for specialty area nurse 2002 NYS Education Department

◦ Brain drain decreases innovation, increases errors, reduces efficiency, undermines growth strategies


Hard to quantify

Efficiency knowledge – how to get job done faster and better

Negative patient outcomes


Admission Nurse implemented 2001 Specialized, limited RN role with core

requirements Admission Nurse completes entire

admission process, followed by handover to accountable RN

Appealing to retired, inactive, under employed, office workers eager for “hands on”

Per diem category, self-schedule, 4 hour shifts, weekly


Eight RNs have served in the role, with five current RNs employed in the role

Program does not serve the units of Psychiatry, Peds, Birthing Center, or ICU


1. Context• 180 bed rural, teaching hospital located in Upstate

New York

2. Admissions/Discharges/Transfers • 10, 982 admissions annually (32/day)• 10, 973 discharges annually (32/day)• 7, 194 transfers in or out

Timing• ADT workload builds at 11 am, decreases at 11 pm• Peak hours 12 noon through 8 pm


1. Realities of retention and recruitment challenges in rural area

2. Idea emerged from staff nurse; not immediately implemented

3. Context of throughput gridlock4. Evidence of improved satisfaction with smooth

admission5. Earlier proposal revisited and piloted6. Purpose to admit patients in thorough,

consistent, timely fashion from all areas – ED, clinics, peri-op, outside agencies and initiate medical and nursing regimens

7. Expose new group to Bassett nursing culture and possibility of other roles in the organization


1. Small test of change

2. Satisfied – and retained – Admission Nurse

3. Satisfied – and retained-staff nurses

4. Good productivity

5. Thorough documentation

6. Satisfied patients


Recruitment – targeted RNs with experience who had left the work place or retired

Key recruitment question to potential applicants’ “What would it take for you to come to work in the hospital?”


• Hired as per diem RNs, salary based on experience• Standard 2 day New Employee Orientation• Specialized – focused to job scope-screening,

physical assessment, BLS certified• Preceptors were nurse educators (one on one)• 4 hours x 4 sessions, competency checklist• Continued follow-up and support (attention to

special needs)• Self-scheduling• Annual lunch with CNO• Electronic documentation rollout- required

specialized support• Invited to all Bassett nursing CE programs and RN

Refresher course


1. How satisfied are you with the role of the Admission Nurse?

• “very satisfied”, a great asset”, “extremely satisfied”

2. How has the Admission Nurse Program changed your job?

• “taken a load off – allows a nurse to stop and take a deep breath vs feeling bombarded with discharges, then admissions”

• “decreased stress, increased time for patient care, timely admitting of patients”


3. Has the Admission Nurse Program had an effect on your job satisfaction?

• “Yes, it increased”• “Yes, because she is able to go over things with the patient.

I sometimes feel I am rushing with those important things – because of so many other things going on.”

4. What is the best thing about the Admission Nurse Program?

◦ “They all do a great job – so helpful to nurses”◦ “When the Admission Nurse is admitting patients, it gives

us the chance to focus on other more acute patient.”


5. What is the one thing you would like to improve about the Admission Nurse Program?

• “on duty for longer hours”• more of them on at the same time• evening coverage


1. How satisfied are you with the role of Admission Nurse?

• “I am enjoy this role immensely”• “very satisfied”

2. What prompted you to engage with the Admission Nurse Program?

• “Desire to continue to work in nursing”• “Desire to return to nursing”• “Needed part work time but needed my weekends free”


3. What is the best thing about being an Admission Nurse?

• “being able to do hands on nursing, in a one on

one setting”

• “the short 4 hour shift and flexibility in

scheduling”

• “I have time for each patient and their family. If a

patient needs a hand held, I have the time.”


4. How difficult was it for you to become skilled in the role?

• “did not seem difficult, orientation was quite thorough…we were mentored until we felt ready.”

• “much of the role seemed like an extension of my previous experience as a Public Health Nurse.”

• “The training was excellent and found the full new employee orientation very helpful.”


• Due to patients awaiting admission to the hospital, beds needed to be available more quickly.

• A Discharge Unit was established in a vacant space once housing a portion of the old ICU. The six bed space would accommodate six patients to await their rides home once the discharge order was written.

• An experienced Med/Surg RN was seeking a position that would utilize her expert knowledge base but be less physically demanding.

• The Discharge RN ran the unit with the support of a Patient Care Associate.


• In 2011it was decided the Discharge Nurse could be better utilized by floating between the Inpatient Medical, Surgical, and Special Care Units to facilitate patient discharges.

• In 2011, the Discharge Nurse completed 1300 discharges, 300 Rehabs, and 300 CHHAs.

• Due to an increase in patient admission demand through Bassett’s ED, on March 19, 2012 a six bed Discharge Unit was re-established in another current open space.


• In early April 2012, the six-bed Discharge Unit will become an Admission Unit.

• The full time Discharge Nurse will resume her coverage and patient discharge support to the Inpatient Units of Medicine, Surgery and Special Care.

• On April 16, 2012, a full time Admission/Discharge RN will support the additional patient demands of the Admission and Discharge Nurse Programs.

• There is ongoing recruitment for an additional full time Discharge Nurse to support the current full FTE discharge position.


www.cynosurehealth.org

Documents

Today’s Webinar will begin at 11:30AM 3/28/12. Please do not put your phone on hold; use the mute function or *6 Please type questions or comments